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Nurses with and without hands-free devices

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Nurses with and without hands-free devices

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Chart Comparison

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Will These Nurse Robots Take Your Job. Don't Freak Out Just Yet.

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Will These Nurse Robots Take Your Job. Don't Freak Out Just Yet.

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For those of you who have watched Disney's film Big Hero 6, you might have been humored and touched by the personality of "Baymax," the lead character's personal robotic healthcare companion.

This pudgy, lovable, medical machine was programmed to care for those in need by scanning a human body for illnesses or injury, assessing the environment, triaging the conditions, providing treatment, and tending to the emotional needs of the patient. This fictional robot was built with impressive strength and programmed to store a massive amount of data, including 10,000 different medical procedures. His multifunctional hands had palms that could be used as defibrillators and fingertips that dispensed antibacterial spray.

Baymax may seem like a complete fantasy creation by imaginative children's storytellers, but robotics engineers across the globe make healthcare AI seem like a more practical and undeniable possibility with each breakthrough invention.
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Meet Japan's Nurse Robots

Right now in Japan, human-like robots are already being utilized as supplemental healthcare workers in elderly homes across the country. Larger robotic machines can be used to carry-out laborious physical tasks like moving patients, and smaller interactive robots are being used to combat loneliness and inactivity in the elderly population.

Meet the robot nurse bear - Japanese robotics engineers at Riken and Sumitomo Riko Labs have created a robotic bear capable of helping care for elderly patients. This bear can lift a patient from standing position or from the floor, transfer a patient to a wheelchair, carry a patient from point A to B, and turn patients in bed.

An increasing elderly population paired with an insufficient amount of healthcare workers able to care for it makes revolutionary inventions like nurse robots incredibly helpful.

Now, meet friendly robots Paro, Pepper, and Dinsow. Each robot serves a vital role in the Japanese healthcare system. Japan has the highest percentage of 75+ individuals out of any OCED country, so looking to their systems of managing elderly is like looking into our futures.

Without sufficient staffing for elderly care, more Japanese citizens are forced to leave their jobs to take care of aging family members. And those who do work in nursing and healthcare, suffer from high stress and fatigue. So Japan is looking towards robotics for help.
Robot Dinsow Robot Paro
Robot Paro is able to engage in simple conversations, direct group entertainment programs, and comfort shy patients with affection.
Robot Pepper
Robot Pepper can function in a more clinical way, helping to triage needs, schedule appointments, provide patient education, and interpret patterns in vitals/labs in proper medical context. Robot Dinsow is helping lonely and inactive elderly patients with mood, ambulation, ROM exercises, reminders to take medicine, and involvement in self-care.

Even technologies like the bed from Panasonic can provide revolutionary solutions for nurses. Their high-tech bed is capable of splitting into two parts, one which turns into a wheelchair, reducing the physical burden of nurses to transfer patients. Different robotic machines are also distributing food trays, medicines, and laboratory specimens throughout hospitals with accuracy and safe-handling.

Robots Relieve Some Burden From Nurses

It is highly likely that artificial intelligence (AI) will be implemented in clinical settings rapidly and on global scale. Prototypes resembling "robot nurses" could have both negative and positive impact. A potential con of robotic nursing is the ability for intelligent online hackers to infiltrate the healthcare databases and gain access to sensitive private information.

Another possible drawback of robotic nursing aid is the lack of "human touch." And of course, more robots as nurses might mean less demand for nurses, although probably unlikely. It is more likely that the aid of robotic nursing will just allow nurses to fulfill more meaningful duties and work stressors would decrease.

Moreover, the potential benefits of robotic nursing far outweigh the drawbacks.

Robotic nurses will have the ability to triage patients in clinics, emergency departments, and via telehealth services in order to streamline care and provide standardized approaches to symptom management with far fewer resources.

With AI as a tool to help treat and prevent illness, the number of hospital admissions and complications that result from lack of education or access to health services could decrease. AI will be linked to personal smartphones to help patients at home adhere to medication regimes, comply with disease management, check vitals and blood glucose when indicated, etc.

Improved Patient Care?

Robotic nursing will be used as a platform for patient education as well. In hospitals, outpatient settings, and at home, patients will be able to access hundreds of videos outlining medication uses, side effects, disease management, support group, emotional support hotlines, and all at the blink of an eye in any language.

The robotics that helps with patient transfers, ambulation, and lifting will significantly reduce physical stress on nurses and allow nurses to more efficiently use their hours at work. Robots are programmed with algorithms that reduce calculation errors to virtually zero, so it will eventually be safer to double check medications with a robot - even chemotherapy and blood products.

With less burden on nurses and improved quality of care for patients, collaboration with nurse robots will improve current trends of nursing shortages and unsafe patient ratios.

Robots will be able to help with discharge planning and procedures. They will be integrated into all hospital technologies and monitors so that we can earlier and more accurately detect signs of patient decompensation. Thus, patients will see improved health outcomes.

Big data clouds of information stored by AI will allow healthcare providers to have continuity of care and rely less on the medical history given by patients. Robots are already helping elderly combat loneliness, and with increased use, they can help stabilize mood and give support to a variety of patients with mental illnesses.

Robot nurses will help us to schedule tasks during our nursing shift and prioritize our care with the click of a button. Charting will become less of a burden and less time-consuming for nurses because most will be automatically delegated to AI.

With all there is to be excited about, there are aspects of nursing that can't be replaced by robots (or so we may think). Our ability as nurses to understand context, interpret hidden emotions, recognize implications, reflect empathy, and act on intuition, are all very innate and humanly skills that drive our success as nurses. It is to be seen whether robotics can parallel these characteristics, but until the time comes, there is still remarkable value in those personal attributes.

Nurse Robots In The U.S.

In the US, robots are already being implemented in hospitals to improve current practices. For example, Tugs, made by Pittsburgh-based Aethon, is used in hospitals nationwide for transportation of medications, linens, and lab specimens.

Aethon claims these machines replace the need of "runners" who would previously execute such deliveries, the equivalent of 2.8 full-time employees. Another similar prototype, called the North American RoboCourier, comes out of Denver.

West Coast hospitals are using a product called VGo, which acts as a personal avatar for purposes of communication between people. Washington D.C.'s V.A. Medical Center and Alzheimer's Association are early users of the aforementioned Paro robotic baby harp seal.

Robotic IV Automation, or RIVA, comes out of Winnipeg and is used in the US to help pharmacies prepare IV syringes and bags. And a revolutionary robotic product called LUCAS CPR may forever change emergency response methods. LUCAS is a chest compression system which is automated, safe, and efficient to use. It is easy to carry and can be applied to the patient within 20 seconds. It's also been shown to deliver automated compressions that sustain higher blood flow to the brain and heart compared to manual compressions.

You might want to ask yourself: Can I embrace the coming changes? How will this affect my career? Hopefully, you are excited about the possibilities for nurses and robots to work side by side!
Next Up: Amazon and Telenursing - a Match Made in Healthcare Heaven?

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Will These Nurse Robots Take Your Job? Don't Freak Out Just Yet.

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For those of you who have watched Disney's film Big Hero 6, you might have been humored and touched by the personality of "Baymax," the lead character's personal robotic healthcare companion.

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Robo Nurse illustration by Eric Tomakin, RN, BSN, Johns Hopkins Department of Surgery

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Robo Nurse illustration by Eric Tomakin, RN, BSN, Johns Hopkins Department of Surgery

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Clinical decision support technology is becoming more popular among healthcare provider organizations to blend large volumes of information and ensure that the key details do not escape the attention of the care team. The fast rise of artificial intelligence and machine learning in clinical decision support tools has generated excitement over the potential for providers to revolutionize diagnostics, including in the areas of pathology, radiology and imaging.

Clinical decision support technology experts offer a variety of opinions on where the tools are headed and how healthcare provider organizations should prepare for tomorrow's tools -and the next generation of technologies will be tasked with providing greater guidance and sound advice in new ways.

Artificial intelligence

Hospital clinical and IT leaders should expect a steady adoption of artificial intelligence-driven analytic tools, first in teaching hospitals and academic medical centers, said Douglas Brown, president and managing partner at Black Book Research, a healthcare technology and services research firm.

These tools will transform the skill levels of human clinicians, diagnostic decision-making, prescription drug support, integrate clinical decision support into EHR workflows, clinical goals and priorities, and trust in the accuracy and reliability of the underlying data, Brown added.

"Clinical decision support must be sustained with as much reliable information as possible."
Douglas Brown, Black Book Research

"Lackluster clinical decision support systems of the past 20 years will be replaced by service-oriented architecture and interfaces, reduced risk, better analytics, reduced alert fatigue, and the development of open standards to ensure compatibility with as many systems as possible," Brown said. "Clinical decision support must be sustained with as much reliable information as possible."

That will no doubt include health data gathered from the electronic health record, customers, health plans, medical equipment and wearable devices.

Black Book's research found that 77 percent of hospitals fear that weak early clinical decision support system implementations have challenged the clinical judgment of medical professionals. What's more, 86 percent of respondents who use new systems said the tech is highly scalable, which enables hospitals to determine if existing data sets are sufficient to support new algorithms designed to extract actionable insights from financial, clinical, operational and customer-driven sources.

Beyond alert fatigue: making better use of health data

Some experts think about the evolution of clinical decision support technology in terms of what needs to be done in the short-term, mid-term and long-term. Some things can be done right now, while others will take a bit longer to implement.

"Clinical decision support to date has often been a by-product of the requirements of meaningful use, and has met with varying degrees of success," said Richard Loomis, MD, CIO, clinical solutions, at Elsevier, a health IT vendor that specializes in clinical decision support technology. "There is alert fatigue, and a limitation around how much alert content can be made available. There also is a high cost and effort - often borne by health systems and hospitals - to build out and deliver this content, and more importantly to keep it current. In many instances, this content is built out but then not enough thought is given to how to keep it up to date."

As healthcare moves into the next phase of clinical decision support, it's time to integrate content, Loomis said. In the near-term, healthcare needs to consolidate clinical decision support to help all members of the care team - physicians, nurses, respiratory therapists, allied health professionals, care managers, everyone who's taking care of the patient, he added.

"We must move beyond alerts to provide comprehensive content in the clinical workflow to drive each intended clinical action," he said. "This would cover inpatient, ambulatory, post-acute care, and even home care - and ultimately result in better decision making and a reduction in the unintended variability of care. We can still do a better job of ensuring the five 'rights' of clinical decision support: the right information, to the right person, in the right intervention format, through the right channel, at the right time in the workflow."

Next, healthcare has to harmonize content, Loomis said. Healthcare must begin thinking about patients, and start to deliver directly to them the same content it gives to providers, but in a patient-oriented way, he suggested.

"By aligning care team clinical decision support with patient-facing clinical decision support, we will drive patient engagement with their care in a way that aligns to the overall plan of care," he said. "In many cases, feedback captured from a patient, such as blood glucose measurements by a diabetic patient, would drive not only the patient pathway but also inform the provider pathway."

Looking at clinical decision support in the long term, healthcare must begin to take the data generated by providers, learn from that data, then use it in a virtual feedback loop to better inform pathway content, Loomis said.

"Our thinking about the long-term evolution of clinical decision support is in sync with the Institute of Medicine's 'The Learning Healthcare System' report," Loomis explained. "We need to create a cycle where we provide decision support, generate evidence, understand what does and doesn't work for the providers and patients, and respond accordingly to continuously and iteratively drive better care delivery."

AI across the continuum

Healthcare is approaching an inflection point toward advanced clinical decision support tools, and in the future physicians will have more visually dynamic and interactive pathways that move beyond decision support to true evidence-based decision making more deeply embedded in the clinical workflow, said Diana Nole, CEO of Wolters Kluwer Health, a health IT vendor that markets clinical decision support technology.

"Further, patient care is not one-size-fits-all and physicians will be able to access decision-making resources with personalized and patient-specific care recommendations," Nole said. "To optimize clinical effectiveness, healthcare organizations can leverage more advanced tools that focus on helping patients with the highest risk/highest benefit conditions."

"To optimize clinical effectiveness, healthcare organizations can leverage more advanced tools that focus on helping patients with the highest risk/highest benefit conditions."
Diana Nole, Wolters Kluwer Health

And artificial intelligence will play an exciting role in the future of clinical decision support technology, she added. Physicians, pharmacists, nurses and other care providers across the continuum of care will be able to tap AI as a resource with the potential to analyze patient data in the EHR to inform and support clinical decision making, she said.

From the provider perspective, Sabiha Raoof, MD, chief medical officer and patient safety officer at Jamaica Hospital Medical Center and Flushing Hospital Medical Center, knows what she wants tech vendors to deliver in the future.

"I would like to see clinical decision support tools assist radiologists in improving appropriateness of follow-up recommendations for incidental findings," Raoof said. "Clinical decision support for radiologists will help improve adherence to guidelines for follow-up of these incidental findings. It will help reduce the variability in follow-up recommendations and reduce unnecessary imaging studies. Having these guidelines available at the point of care is critical."
Twitter: @SiwickiHealthIT
Email the writer:bill.siwicki@himssmedia.com

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Next-gen clinical decision support tools: Analytics and health data in the EHR workflow

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Clinical decision support technology is becoming more popular among healthcare provider organizations to blend large volumes of information and ensure that the key details do not escape the attention of the care team. The fast rise of artificial intelligence and machine learning in clinical decision support tools has generated excitement over the potential for providers to revolutionize diagnostics, including in the areas of pathology, radiology and imaging.

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Technology hitting the market will help doctors examine heart conditions or check for colon cancer without breaking the skin

smithsonian.com

Holograms aren't just for Princess Leia anymore. Interactive technology hitting the market now can help doctors examine vital organs using 3D displays that hover over a desktop screen.

This week, a company called EchoPixel announced that the U.S. Food and Drug Administration has cleared its True3D Viewer for use in diagnostics and surgical planning. The software platform converts existing 2D medical imaging data such as MRI and CT scans into fully interactive virtual reality images. With the system, doctors can view, manipulate and dissect body parts that are re-created in mid-air above an ordinary desktop.

The use of 2D digital scans revolutionized medicine, because they allowed doctors to see an individual patient's anatomy without cutting into the body. "But when a doctor evaluates them, they are looking at a series of 2D slices and trying to create that 3D anatomy in their mind," says Sergio Aguirre, founder and CTO of EchoPixel. "Doctors are focusing energy on solving this 3D problem instead of the clinical problem at hand, and we think this software will help them get a clearer view of the problem more quickly."

Other systems, like GE's Vivid E9 with XDclear, already compile such images to produce 3D visuals that appear much like the real thing, and they even have 3D properties that allow them to be rotated or taken apart. But they are still limited to display on a flat screen. EchoPixel appears to take 3D imaging a step further by generating interactive holograms.

Experts have become very good at reading 2D images and manipulating 3D representations on a flat screen, so holograms may not add a huge advantage in some applications, says Sandy Napel, co-director of Stanford University's Radiology 3D and Quantitative Imaging Laboratory. But there are specific procedures that EchoPixel may be primed to improve. For instance, the technology is already being tested at the University of California, San Francisco, for virtual colonoscopies-an alternative to the unpopular procedure in which a colonoscope is inserted and manipulated within the human body.

"You want to simulate what a doctor would see while examining the interior surfaces of the colon with a colonoscope, and you want to see 100 percent of the interior surface of this long, curving tube that is the large intestine," Napel explains. "Using CT scan images, this technology can really reproduce this tube-like colon, re-create it floating in space, and nothing has to actually enter the body. You can rotate the image at different angles, cut it in half and search the interior surface for polyps. It's a way of visualizing the colon that has great potential to improve how quickly you could look at 100 percent of the interior."

The True3D Viewer lets doctors examine holographic scans to diagnose conditions and prep for surgery. The software can also be used as a teaching tool for patients. (EchoPixel)

True 3D medical imaging may also benefit doctors who need to visualize abnormal or complex 3D structures, like the mess of broken and displaced bones that can result from trauma due to a motor vehicle accident. "A surgeon that's going to plan to remove fragments and fix that kind of injury might benefit by viewing a true 3D representation of what they will actually see when they have the patient in the operating room," Napel says. "I think having, say, a 3D pelvis floating above a desktop, where you could see all the actual fractures and displacements, could have great potential for surgical planning."

Heart conditions in very young patients are another area where medical holograms could shine. "The heart is a complicated structure, but every medical student can draw a picture of a normal heart," Napel says. "However, when you have narrowings, aneurisms, congenital abnormalities-being able to visualize these in 3D could be really helpful. Think about kids born with genetic defects that cause the heart to develop abnormally. A surgeon is going to go in there and operate on a very young human being and hopefully make a correction. They'll get a careful report from a radiologist, saying that some blood vessels are connected here and they should be there, and the surgeons can see it also on CT scans, but not the same way they are going to see it in the operating room." Having a 3D preview of what they'll see when they start surgery could help the doctor understand the situation much more quickly.

And while years of education and experience enable doctors to work effectively with 2D medical images, the rest of us often have a very hard time deciphering them. That highlights another intriguing application for virtual reality-patient education. It's a promising niche in an era when the public is demanding more information from their medical providers.

"Patients want to know exactly what a doctor is going to do to them. I think it could be pretty neat and pretty powerful for patients going in for complex surgeries to see exactly what it is the surgeon is going to see and what they are going to do during the operation."

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Medical Holograms Are Now Part of the Surgeon's Toolkit

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smithsonian.com Holograms aren't just for Princess Leia anymore. Interactive technology hitting the market now can help doctors examine vital organs using 3D displays that hover over a desktop screen. This week, a company called EchoPixel announced that the U.S. Food and Drug Administration has cleared its True3D Viewer for use in diagnostics and surgical planning.

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Technology shakes up the health care sector

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Hackensack University Medical Center is using technology to create a new landscape for its workforce.

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Medical devices are proliferating throughout the healthcare landscape, especially with the advent of the Internet of Things and the myriad new products that come with it.

The medical device arena is undergoing a lot of change, in fact, as new technologies and calls for greater security push manufacturers to upgrade their products - and the next generation of medical devices could see many new features and functions.

As medical devices continue evolving, the top health IT areas manufacturers and hospitals will be ramping up include security, clinical workflow integration, data management automation and patient experience.

Device security a key priority

It's no secret that medical device security has become a key priority across the industry. The U.S. Food and Drug Administration in mid-April released the Medical Device Safety Action Plan, with the goal of making devices safer.

Similar to how computer networks are vulnerable to security issues, exposing medical device vulnerabilities could put patients at risk, compromise how a medical device functions or allow an unauthorized user to access a provider's network, said John Schoew, a managing director at consulting giant Accenture.

More medical devices today are network-connected with the ability to transmit data wirelessly and often integrated within the hospital's clinical workflow.

"With the clinical integration of connected devices, health systems will need to assess if changes are needed within their IT infrastructure."
John Schoew, Accenture

"What this means: While health systems have often seen this area as a standalone component, medical device risk must be addressed holistically with a coordinated governance approach across security, patient safety, supply chain and biomedical engineering," Schoew said. "Business and security leaders are increasingly focused on interlocking security strategy and cyber defense capabilities to strengthen business resilience and brand trust that are so essential in today's connected world."

On another front, as EHR interoperability deepens across clinical functions, connected medical devices are becoming more common. As this happens, health systems must augment their technology and processes to establish integration of medical devices within the clinical workflow.

"With the clinical integration of connected devices, health systems will need to assess if changes are needed within their IT infrastructure," Schoew said. "As with any new connected device, health systems should assess potential privacy and security risks such as PHI, data management/handoffs, confirm basic provisions such as encryption and credentialing, embedded functionality such as firmware updates, and how it connects to the existing IT infrastructure such as the EHR."

And with a growing ecosystem of devices and applications within health systems, so grows the complexity and cost of system management. Implementing robotic process automation to scale processes in an efficient and cost-effective manner is proving effective for building resilience in complex technology environments and in taking out costs associated with routine processes and maintenance of systems, Schoew said.

Real-time analysis of device data

Brian Lawrence, chief technology officer at Hill-Rom Welch Allyn, which offers many technologies in categories including nurse communication, falls prevention, vitals, cardiopulmonary, retinal imaging and medical devices, said it is critical that companies in the medical device industry - and in healthcare settings generally - start to think differently about the data generated by these devices: What data is being captured? How is this information accessed? Are isolated parameters being studied but others that could be of tremendous value being ignored?

"The very first next-generation feature we need to look at is creating an ecosystem that enables the real-time capture, access to and predictive analysis of the rich data coming off our devices," Lawrence said. "The average age of data entered into an EHR is five hours - too old to be of any predictive use for a patient who needs care now. Enabling real-time capture and access to key patient data is essential to helping patients get better care."

"Enabling real-time capture and access to key patient data is essential to helping patients get better care."
Brian Lawrence, Hill-Rom Welch Allyn

The second next-generation area is sensing - and getting more out of the technology, Lawrence said.

"Our industry has created brilliant hardware, software and algorithms that can sense literally hundreds of patient parameters from basic vitals to more complex and subtle measurements," he said. "Unfortunately, we often don't make full use of the capabilities we already have and aren't attune to what we could be doing technologically."

An example: Most advanced hospital beds today can weigh a patient. The organization takes the relevant parameter, a patient weighs X number of pounds, and enters that into the EHR. And that same bed might also be outfitted with a bed-exit alarm. So the parameter studied is whether the patient is in or out of bed. But using the same weight-sensing technology perhaps with more advanced algorithms, the organization can capture the dynamic aspect of the patient's movements in real time to anticipate an adverse event or otherwise ease their comfort and safety.

"In other words, with technology already available, but using a different perspective, sensing can offer variable, as opposed to static, data - and help caregivers use that data efficiently and effectively," Lawrence said.

Total care: The patient experience

The third next-gen development is patient experience. Healthcare has to look at people as needing total care - physically and emotionally, including their ability to be comfortable, connected and generally empowered with a sense of control over their care environment.

"We need to design devices with simple patient controls that are easy to access; devices that are more comfortable and quiet - blood pressure cuffs and beds are two good examples," Lawrence said. "Blood pressure cuffs that take measurements on the inflate cycle versus the deflate cycle are far more comfortable for patients while maintaining high accuracy. Beds designed with ergonomic controls to make patients feel empowered over their environment, less like prisoners and more like VIPs, incorporating conveniences that address today's needs such as mobile devices, help patients stay connected, and even addressing issues like incontinence in discrete ways, preserve dignity."

These seemingly little advances in patient comfort and satisfaction have a huge impact on the overall patient experience, translating directly to enhanced outcomes, he added.

A big dynamic in healthcare is the promise of data science, which is often lumped under headings like artificial intelligence and some of its tools, such as machine learning or deep learning. Healthcare executives can think of these tools in much the same way people thought about microprocessors in the 1980s. Suddenly, there is a new technology that allows designers to be significantly more agile in the development of capabilities.

"Machine learning is the CPU of the current decade, adding an entirely new range of capabilities: Auto interpretation of images and waveforms; automation of workflow; gamification as a replacement for traditional education/learning; and so on," said Paul Mullen, GE Healthcare acute care general manager. "But a key difference is that in the 1980s, only a handful of companies - Intel, Motorola, to name two - had the capabilities to produce microprocessors. Today, many organizations have machine learning capabilities."

A new appreciation for health data value

Nearly every academic healthcare provider has on-campus production capabilities for new algorithms, Mullen added. That can shift the buyer-supplier relationship dramatically. Notably, some major healthcare providers are aligning themselves with large academic sites. GE Healthcare's partnerships with UCSF and Partners are examples. But exactly how the collaboration and competition dynamic will play out is still an open question.

"Machine learning is the CPU of the current decade, adding an entirely new range of capabilities."
Paul Mullen, GE Healthcare

"Along with the explosion in algorithms comes a new appreciation for the value of healthcare data," Mullen said. "There is little debate that the ultimate owners of data are the patients themselves, but the data owners, often healthcare providers, exercise a kind of proxy ownership. As these institutions discover the value of the data, the common refrain will be, 'I'd love to share my data, but...'"

The "buts," Mullen said, come in three flavors: "I'd love to share my data, but it cannot leave my country or region." The Europeans are out in front on this and the implementation of General Data Protection Requirements adds new rigor to this trend. The second is, "I'd love to share my data, but I don't trust anyone to manage privacy." The U.S. Congress' interrogation of Facebook CEO Mark Zuckerberg in April of this year highlights the generalized ignorance of modern data practices and the anxiety that comes with such uncertainty.

The third but is, "I'd like to share my data but my data is gold-plated, and you should pay a lot for it." This posture will be most common among the academic powerhouses. None of the three of these are sustainable positions. Expect that the models for data sharing will change dramatically, Mullen said. A collection of data puddles may become much more common than huge data lakes, he predicted.

Rethinking design

Mullen also said that what constitutes an exemplary medical device will be completely reshaped.

"Today's designers over-value signal quality: Another micron of image resolution, an improvement in ECG signal fidelity, a more sensitive measure of respiration - these are the reflexes of today's device designers," he said. "But consumer devices are probably good enough for many medical applications and many designers will find themselves frustrated as users choose lower traditional quality sensors for many applications."

A mobile phone can read a urine dipstick as well as a traditional device, Mullen said. Today, one can buy a simple ECG device for one's mobile phone, as well. These may not be good enough in traditional thinking, but they're likely to have more value than today's designers suspect.

"It may be helpful to consider the difference between diagnosis, screening and surveillance as three forms of testing - the first requiring the most traditional fidelity and the last requiring the lowest cost of deployment," he explained. "When confronted with whether a cheap substitute might serve in the place of an expensive traditional device, designers and consumers will have to ask, 'What would I have to believe in order to consider that 'inferior' solution?' Where have we over-designed and what can we rethink?"
Twitter: @SiwickiHealthIT
Email the writer:bill.siwicki@himssmedia.com

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Next-gen medical devices: Security, AI, rethinking design for patient experience

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Medical devices are proliferating throughout the healthcare landscape, especially with the advent of the Internet of Things and the myriad new products that come with it. The medical device arena is undergoing a lot of change, in fact, as new technologies and calls for greater security push manufacturers to upgrade their products - and the next generation of medical devices could see many new features and functions.

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March 2019 Vol. 14 No. 3

Author(s): Tanna L. Nelson, MSN, RN-BC, CPHIMS, and Cheryl D. Parker, PhD, RN-BC, CNE, FHIMSS

Informatics nurses increase efficiency, reduce costs, and enhance patients' lives.
Takeaways:

Informatics nurses expand their reach beyond direct patient care but still experience the rewards of helping people and the profession.

Informatics nurses use the electronic health record to support knowledge and wisdom development.

Informatics nurses work in a variety of settings, including transitional and subacute care, clinics, consulting and staffing firms, and state and national government agencies.

The American Nurses Association (ANA) defines informatics nursing as the integration of "nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice." That definition is accurate, but it doesn't fully explain the breadth of opportunity that exists for nurses considering an informatics career. This real-world story offers a concrete example:
In 2018, the CHRISTUS Trinity Mother Frances Health System in Tyler, Texas, received the Southwest Transplant Alliance (STA) with the Life Champion Partner Gold Award for its organ transplant conversion (88%) and effectiveness (81%) rates. The increased rates were the result of tools the informatics team developed and implemented within the hospital's electronic health record (EHR). The tools saved nurses about 30 minutes when inputting information and making referrals to STA, which provided them with time to provide better patient care and support.
Nursing informatics is broad, accommodates a diverse array of nursing strengths and interests, and impacts virtually every aspect of healthcare where technology integrates with clinical practice, no matter the setting. Nurses who choose informatics as a career expand their reach beyond direct patient care, but they still experience the rewards of helping people and advocating for their profession.

Background

The adoption of EHRs in 2004, under President George W. Bush's strategy and funding to improve patient safety, spurred significant growth in informatics nursing. In 2009, President Barack Obama further advanced the use of EHRs through Medicare and Medicaid incentive programs that reward hospitals and providers who demonstrate meaningful use of EHRs. As a result, implementations escalated across the nation, and informatics nurses have since been on the frontlines of EHR application and optimization to improve patient care and enhance clinician experience.

Since the adoption of EHRs, healthcare technology continues to advance, and informatics nurses' roles are evolving quickly. Organizations are moving past implementation-related strategies to focus on trimming documentation burdens, streamlining processes for high reliability, and identifying the EHRs' true value by generating new knowledge and improving care through evidence-based practice.

Healthcare impact

Informatics nurses embrace the use of data generated from EHRs to support knowledge and wisdom development. Before digitization, data were extracted manually, an expensive and time-consuming process. Using EHRs and other clinical systems, informatics nurses can gather data rapidly, creating opportunities for innovation.

Because they are well positioned to recognize healthcare gaps and find transformative ways to guide practice, informatics nurses lead initiatives that improve patient well-being. At John Peter Smith Hospital in Fort Worth, Texas, informatics nurses developed and operationalized an algorithm for recognizing intimate partner violence and red flags for human trafficking. The algorithm fits seamlessly into the emergency department (ED) nurse workflow, provides step-by-step instructions to the nurse, and includes a narrative to use if the patient screens as positive. Patients are offered assistance immediately.

At the same organization, informatics nurses maximize the use of mobile technology to bring healthcare to the homeless. Clinicians bring the benefits of EHR technology into the field, where they create walk-in visits, provide treatments, prescribe and arrange for delivery of medications, offer education and follow- up care, and monitor health conditions. The program has reduced unnecessary ED visits and preventable complications.

Informatics nurses use advanced analytics skills to quantify the true value of the work clinicians do each day. At Texas Health Resources in Dallas-Fort Worth, informatics nurses show how sending vital signs from the machine directly into the EHR on medical/surgical and telemetry units saves hours of manual documentation each day. These same nurses are combining clinical expertise with advanced analytics strategies to develop predictive models. Their work with predictive modeling enhances and saves lives, identifying sepsis risk to readmission risk, and even helps recognize people who may benefit from palliative care.

Specialty insight

Every 3 years, the Healthcare Information and Management Systems Society (HIMSS) conducts a nursing informatics workforce survey to gain insight into the specialty. We've summarized the data gathered from the 2011, 2014, and 2017 surveys that will help with considering an informatics career.
Clinical experience
Clinical experience is integral for success in informatics nursing; 82% of respondents reported working in a clinical setting for more than 5 years before switching to informatics. The most commonly reported care settings were medical-surgical, critical care, emergency, pediatrics, and administration. Of the informatics nurses who responded, 80% are highly satisfied with their career choice.
Training and education
On-the-job training was common just a few years ago, but the current trend is toward master's and doctoral degrees and postgraduate certificates. The ANA classifies two formal roles for the specialty: informatics registered nurse (with experience working in health information technology [IT]) and informatics nurse specialist (with health IT experience and a master's or doctorate degree). Board certification through the American Nurses Credentialing Center, professional certification through HIMSS, and project management certifications are common. Informatics nurses perceive that these certifications benefit their careers.
Roles and responsibilities
Informatics provides a tremendous opportunity to advance nursing science. The initial boom in EHR implementation is winding down in acute care, but design and implementation responsibilities continue to grow, as does healthcare technology innovation. (See Where can you work?) In some cases, healthcare organizations are replacing their original EHRs with systems better suited to their needs. In other cases, healthcare organizations are searching for value, efficiency, a seamless experience for clinicians, and creative solutions to healthcare challenges within their existing EHRs. Informatics nurses will continue to spend significant time creating and implementing systems that maintain the clinician's voice within their design. Roles requiring data analysis, visualization, and presentation skills are in demand. In addition, informatics nurses will continue to play supportive and educator roles as processes change and improve.
Compensation
Base salaries for informatics nurses are on the rise. Nearly half of 2017 survey respondents reported earning a base annual salary over $100,000, an increase from the onethird who reported six-figure salaries in 2014. Informatics nurses who obtain certification or postgraduate education earn the highest salaries. Those who earn the most are consultants or work for healthcare vendors, positions that require significant travel and are considered high-stress.
Networking and membership
The best way to get involved in the nursing informatics community is through professional organizations. Employers want to see potential employees who are actively involved in local informatics projects within their current practice settings and who participate in local or regional informatics chapters. Most professional organizations are politically active and need informatics nurses to advocate for legislation that improves healthcare technology interoperability. (See Build a network.)

The future of informatics nursing

Informatics nursing provides challenges and opportunities to transform healthcare in meaningful ways. The work of informatics nurses supports those who provide direct care by advocating for effective practice through appropriate technology. Opportunities are available to impact healthcare at local, state, national, and global levels. How will you choose to expand your practice? Is an informatics career in your future?
Tanna L. Nelson is a nursing informatics specialist at Texas Health Resources Dallas-Fort Worth and 2018 American Nursing Informatics Association (ANIA) Chapter President. Cheryl D. Parker is a clinical assistant professor and educational technology specialist at the University of Texas at Tyler School of Nursing and 2019 president-elect of the ANIA National Board of Directors.
Selected references

American Nurses Association (ANA). Nursing Informatics: Scope and Standards of Practice. 2nd ed. Silver Spring, MD: ANA; 2014.

American Nursing Informatics Association. ania.org/about-us

Beaudoin J. The decade of health IT. Healthcare IT News. December 20, 2013. bit.ly/2RH6TFq

Certified health IT product list. chpl.healthit.gov/#/search

CHRISTUS Mother Frances Hospital-Tyler earns GOLD recognition organ for transplant conversion rates. October 19, 2018. tmfhc.org/about-us/news-media/2018/christus-mother-frances-hospital-tyler-earns-gold-recognition-/

Dunbar D. Street medicine: North Texas hospital helping the homeless. CBS DFW. January 19, 2018. dfw.cbslocal.com/2018/01/19/street-medicine-jps-helps-homeless/

Healthcare Information and Management Systems Society. himss.org/about-himss

HIMSS 2017 Nursing Informatics Workforce Survey. himss.org/sites/himssorg/files/2017-nursing-informatics-workforce-full-report.pdf

JPS program hopes to identify, assist victims of violence. JPS Health Network. July 12, 2018. jpshealthnet.org/news/jps-programhopes-identify-assist-victims-violence

Promoting innovation and competitiveness: President Bush's technology agenda. The White House. January 20, 2004. georgewbush-whitehouse.archives.gov/infocus/technology/economic_policy200404/chap3.html

Rust L, Nelson T. Vital Sign Integration on Med/Surg Units: Challenges, Successes and Unintended Consequences. community.ania.org/HigherLogic/System/DownloadDocument-File.ashx?DocumentFileKey=591d3f31-e206-c98e-da43-660fde841397&forceDialog=0

Staggers N, Thompson CB. The evolution of definitions for nursing informatics: A critical analysis and revised definition. J Am Med Inform Assoc. 2002;9(3):255-61.

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Nursing informatics: The EHR and beyond - American Nurse Today

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March 2019 Vol. 14 No. 3 Author(s): Tanna L. Nelson, MSN, RN-BC, CPHIMS, and Cheryl D. Parker, PhD, RN-BC, CNE, FHIMSS Takeaways: Informatics nurses expand their reach beyond direct patient care but still experience the rewards of helping people and the profession. Informatics nurses use the electronic health record to support knowledge and wisdom development.

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The future of nursing

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Predictions from Dr. Geeta Nayyar, MD, MBA

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The healthcare analytics market is booming and will be worth close to $54 billion worldwide by 2025, according to a March 2018 report from Grand View Research.

Given the need to achieve the Triple Aim, along with the rise of precision medicine and the move toward value-based care, data analytics have never been more important to healthcare provider organizations.

As the technology continues to grow and mature, here's the pressing question for healthcare and IT leaders: How will analytics tools evolve - and what should they expect to come next?

We asked experts from across the industry about major shifts on the horizon. Here's what they said healthcare decision-makers should be tracking now.

We're getting closer to a 360-degree view

Healthcare providers have long sought the elusive 360-degree view of the patient, and soon the healthcare industry will get it, said Brandon Purcell, a senior analyst at Forrester Research who specializes in analytics.

"Because analytical models and artificial intelligence are only as good as the data used to teach them, healthcare providers will make significant investments in the creation of foundational data assets that link patient data from disparate sources," Purcell said. "The completeness and quality of this 'single source of truth' will be the key to differentiation for healthcare providers, enabling them to provide proactive care, personalize services and reduce operational costs."

Purcell also said that unstructured information will become more commonly used.

"Text, image, audio and video data have long been analyzed in a vacuum, typically by a human being," Purcell explained. "Solutions like Watson Health that are able to diagnose results from medical images are just the start of a trend in healthcare toward using deep learning to analyze unstructured data."

Technology now allows for conversations with patients - whether in person or on the phone - along with text from emails and SMS messages and all types of image and video data now can be analyzed by neural networks. The results of this analysis: structured data points that can be added into the holistic view of the patient.

"Healthcare providers should look to adopt solutions that have been trained in their specific use case and offer the ability to further customize models through the process of 'transfer learning,'" Purcell added.

Longitudinal records are a foundation

Healthcare is an industry rich with data, yet many provider organizations continue to focus on single vertical views of that information - for example, analyzing outcomes at just one site of service or thinking about data in terms of individual care encounters.

Instead, health systems must look to analytics technology to provide a holistic view of the patient experience over time and across all sites and episodes of care, said Garri Garrison, RN, vice president of performance management at 3M Health Information Systems, which develops analytics and other healthcare technologies.

"To take advantage of new analytic tools, healthcare organizations must have access to patient-centric records that encompass the full spectrum of clinical care."
Garri Garrison, RN, 3M Health Information Systems

"These analytics tools exist today, but their success depends on the creation of the longitudinal record," Garrison said. "This is the next step in the evolution of analytics technology. To take advantage of new analytic tools, healthcare organizations must have access to patient-centric records that encompass the full spectrum of clinical care."

By applying advanced analytics to aggregated data from across all visits, episodes of care and patient populations - and evaluating it against key performance measures - organizations can identify inefficiencies and uncover interdependencies between sites of care and between caregivers that may be causing poor outcomes or high costs, she said.

"With advancements in machine learning and artificial intelligence, we'll see a transition from descriptive analytics to predictive analytics," she added. "Integrating machine learning or AI with risk stratification methodologies will create a new set of analytic tools that support real-time interventions in care delivery."

Robust analytic capabilities will also advance performance measurement, providing meaningful information that can be used to promote real and sustainable improvements in healthcare quality and cost - especially as analytic tools incorporate social determinants of health to provide a more complete understanding of patient populations, Garrison said.

Emerging technologies beget more data

Jennifer Esposito, worldwide general manager for health and life sciences at Intel, points to some technological shifts that will affect analytics that healthcare CIOs need to understand.

"We are starting to see convergence in High Performance Compute, or HPC, and AI workloads," Esposito explained. "As data sets get larger and more complex, the lines between scientific computing and analytics are blurring. HPC clusters are well-suited to the increasingly parallel nature employed by AI-enabled analytics. An HPC approach to analytics drives additional architectural considerations such as high-bandwidth interconnect fabric between CPU nodes and the use of parallel file storage systems."

"As data sets get larger and more complex, the lines between scientific computing and analytics are blurring. HPC clusters are well-suited to the increasingly parallel nature employed by AI-enabled analytics. "
Jennifer Esposito, Intel

On another technological front, healthcare provider organizations will need to be planning for how analytics strategies change as the world becomes connected by 5G, she said. The move to deliver more care outside of the hospital is a trend seen worldwide, and 5G is going to open amazing opportunities to deliver new services and reimagine how patients are engaged, she added - adding even more information that can be analyzed.

"Examples of this could be immersive real-time virtual reality rehabilitation sessions in the home, virtual visits augmented by complex sensor data or field robotics controlled by centralized specialists," she explained. "Clearly, it will still be some time before 5G becomes a widely used platform. But it is coming, and it has the potential to generate orders of magnitude more data than what is being generated today."

Lesson learned: Data governance matters

In the end, it is important to remember that the first step to driving forward an analytic strategy is to identify potential sources of data and information available to an organization. Data acquisition is a laborious effort within healthcare due to its system designs, but necessary to have a complete picture of care and the opportunity to improve performance.

"We have been on this journey for approximately 18 months and have connected a few hundred data sources - EHRs, billing files, claims - all while knowing we have just begun to scratch the surface," said Derek Novak, division vice president and COO at Iowa's Mercy Accountable Care Organization. "However, we already are starting to see benefits of this work as we have created a uniform dataset that incorporates all aspects of patient, payer and provider information."

One mistake the ACO made early on was to jump right into analytics - only to later discover that the quality and consistency of the data was problematic.

"Having an analytics platform partner to work through the process to ensure a correct aggregation of data and ensure quality data is a crucial step in the process. "
Derek Novak, Mercy Accountable Care Organization

"Pushing bad data out to executives and providers ultimately leads to a lack of trust and a lot of wasted energy for the organization," Novak said. "Having an analytics platform partner to work through the process to ensure a correct aggregation of data and ensure quality data is a crucial step in the process."

Novak said that providers looking to the future and getting into analytics should select a platform from a vendor that is willing and able to work with their data sources and has the ability to grow with their needs.

The platform should be able to work with all types of systems and users," he said. "It can't be yet another closed-off system with no access. Your analysts and other applications need to be able to access the data so you can actually scale for your organization."

For Mercy, the work enabled it to incorporate data across six regional chapters, spread out in over 400 locations and 3,500 providers. It afforded Mercy the ability to scale to 18 value-based arrangements and 310,000 members.

"While we didn't start with this number of lives when we started our engagement, over time as our needs grew, we needed to be sure that our data platform had the ability to grow with us under an economically sustainable model," Novak said.

The big (data) takeaway

As analytics products continue advancing from descriptive to predictive and, in turn, to prescriptive functionality, hospitals will have more tools - including but not limited to technologies such as artificial intelligence, high performance computing and 5G - to more effectively use as much data as they can to establish longitudinal records with a 360-degree view of the patient.

That will mean connectivity to literally hundreds of data sources, including EHR, text, imaging, audio, billing and claims, just to name a few.

And yes, that will require sizable financial investments and heavy lifting to make sure the technology infrastructure is in place. But the opportunities for return on investment, through new revenue and cost-savings, are significant too.
Twitter: @SiwickiHealthIT
Email the writer:bill.siwicki@himssmedia.com

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Next-gen analytics: Here's what's coming in the future

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The healthcare analytics market is booming and will be worth close to $54 billion worldwide by 2025, according to a March 2018 report from Grand View Research. Given the need to achieve the Triple Aim, along with the rise of precision medicine and the move toward value-based care, data analytics have never been more important to healthcare provider organizations.

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Health Informatics Online Masters | Nursing & Medical Degrees

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Summary: Learn about the impact of clinical informatics in the future.

Transcript

As I mentioned previously, Clinical Informatics is brand new. October was the first time people could sit for the Board in Clinical Informatics. As we in the future the concept of Clinical Informatics is going to spread. Right now there is only a few hundred Board Certified Clinical Informatitions, over the next few years it is going to increase.

How is that going to affect the overall Health Industry, as you see different hospitals? The concept of a Chief Medical Information Officer, or maybe even to the Sub-Specialty or to the Sub-Divisions in medicine, or maybe a Chief Cardiology Information Officer. The concept of a Clinical Informatition and how they apply into the overall Health Care System. Since we are at the beginning phases, we are still in the process of creating the jobs, creating the knowledge structure, and we do have some overall structure within hospitals, like the Chief Medical Information Officer, or the Chief Health Information Officer.

As data becomes more important for reimbursement purposes, as data becomes more important for quality metrics, as data becomes important and is more heterogeneous between patient data, lab data, physician data, all the different Health Professions. These types of positions are going to be critical for both the success of Hospitals and Physician groups in general, but they will also help bring value. Only through understanding the data and using the data in novel ways can we both get better out comes as well as lower cost. We all want to do right by the patients, but because of the Clinical Informatics is only those who are practicing medicine, who have the additional Informatics training can really harness the value of the EHR data.

We have just spent billions and billions of dollars in deploying all of these electronics Health Records, but are people really asking the tough questions? Are people asking the innovative questions in order to figure out how you actually get from the data we have now in order to help design better Health Systems? As well as use the data to help target patients who maybe higher risks for re-admissions, or maybe target them for more additional tender loving care to make sure they don't end up back in the hospital. How do we stratify patients to figure out who are the ones who are going to be fine by themselves, who need more work. Who are the ones we can detect eight hours ahead of times before someone breaks out with an iatrogenic Infection through the data we collect through an EHR?

These are the wonderful and awesome questions now that we have this wealth of data. When you know the Clinical Presentation of these diseases and you see them on a day to day basis, we now have access to the data in a real time. If you can ask the interesting questions and literally drive the research, and drive Health Practice. We can change the way Health Care is practiced in the U.S. and across the world.

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The Future of Clinical Informatics - Andrew Boyd, MD - Health Informatics Online Masters | Nursing & Medical Degrees

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Summary: Learn about the impact of clinical informatics in the future. As I mentioned previously, Clinical Informatics is brand new. October was the first time people could sit for the Board in Clinical Informatics. As we in the future the concept of Clinical Informatics is going to spread.

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Perspectives on the Future of Person Health Records

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Perspectives on the Future of Person Health Records

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Looking into the Future

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Advantaged of Virtual Reality in Medicine

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Advantaged of Virtual Reality in Medicine

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Virtual reality is used in many areas of healthcare which range from diagnosis, treatment, e.g. surgery, rehab and counselling. It is also used to train the next generation of doctors, paramedics and other medical personnel and has shown a range of benefits from doing so.

So what are the advantages of virtual reality in healthcare? There are several which are related to medical/surgical training, preventative medicine, counselling and architectural design of new hospitals.

Virtual reality medical training

Let's start with virtual reality as a means of training healthcare professionals. It is used in medical schools and other similar settings as a means of education and instruction. It enables medical students to acquire knowledge and understanding about the human body by means of interaction within a virtual environment.

Medical students can perform 'hands on' procedures but in a safe and controlled setting. They are able to make mistakes - and learn from them but in an environment where there is no risk to the patient. They interact with a virtual patient and as a result of this, learn skills which they can then apply in the real world.

Virtual reality dentistry

But virtual reality isn't only confined to medical schools. Dentistry is another area in which it plays a part. For example, there is a system known as 'HapTEL' which is based upon haptics (Greek for touch) in order to train new dentists. This virtual dental chair includes a training scenario in which the student is shown a 3D set of teeth that they work on.

They perform a range of procedures, e.g. a filling using a virtual drill which replicates the movement and pressure of a real drill by means of force feedback. This feedback takes the form of subtle changes of pressure which enables the student to adjust their technique accordingly.

This is discussed further in our virtual reality in dentistry article.

Virtual reality and paramedic training

It is also used to train paramedics and other similar personnel who need to learn life saving skills but without placing themselves and their patients at risk. They are able to do this by interaction with a simulated accident or emergency in a virtual environment but with minimal risk. These scenarios are realistic and enable them experience a high pressure situation and respond accordingly.

Virtual reality preventative medicine

Virtual reality is used to educate patients about positive lifestyle choices, such as stopping smoking, moderate alcohol intake, healthy eating and exercise. There is an emphasis on educating people to make positive changes about their health which will reduce the risk of illnesses, many of which are preventative.

Both desktop and fully immersive CAVE systems can be used to demonstrate the effects of negative lifestyle choices, e.g. smoking on health with the aim of changing people's behaviour.

Virtual reality counselling

Counselling is another area where virtual reality has been utilised. A classic example is phobia treatment, for example a fear of public speaking where the sufferer is able to learn skills and build up their confidence in a virtual environment.

This is discussed in greater detail in our virtual reality in phobia treatment article.

It also used to treat people who have developed post traumatic stress disorder (PTSD) as a result of a life threatening situation. One example is that of soldiers who have served on the front line in Afghanistan and have become traumatised as a result. They are taught a range of techniques for dealing with the symptoms of their condition using virtual reality. This takes the form of a pair of virtual reality glasses or head mounted display (HMD), data glove and input device, e.g. joystick.

Find out more in our virtual reality treatment for PTSD article

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Virtual reality architectural design

Virtual reality is used by architects and the construction industry to design and test new buildings. It enables them to walkthrough a virtual model in order to evaluate this which saves both time and money.

One example of this is the design and build of a new clinic which can be explored using a virtual reality headset, data glove and input device. The user moves around the building in the same way they would in the real world and are able to assess various aspects whilst they do so. This is a safe and controlled way of doing so which is also cost effective.

To summarise: the main benefits of virtual reality in medicine include:

Safety

Time

Money

Ability to re-use on a regular basis/skills refresh

Can be used remotely

Efficiency

Realistic

These benefits appear in many of the individual articles related to this section.

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Advantages of virtual reality in medicine - Virtual Reality Society

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Virtual reality is used in many areas of healthcare which range from diagnosis, treatment, e.g. surgery, rehab and counselling. It is also used to train the next generation of doctors, paramedics and other medical personnel and has shown a range of benefits from doing so. So what are the advantages of virtual reality in healthcare?

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Nursing Informatics are Driving the Future of Healthcare

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Nursing Informatics are Driving the Future of Healthcare

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Virtual Reality in the Healthcare Industry

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Virtual Reality in the Healthcare Industry

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Virtual Reality in the Healthcare Industry

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From developing new life-saving techniques to training the doctors of the future, VR has a multitude of applications for health and healthcare.