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I liked this image because it includes a lot of the issues that come up when considering the use of electronic health records.

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The Need for Ethics in Digital Health Research 

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The Need for Ethics in Digital Health Research 

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BMC Medicine 17, Article number: 137 (2019) Cite this article

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Abstract

The digital revolution is disrupting the ways in which health research is conducted, and subsequently, changing healthcare. Direct-to-consumer wellness products and mobile apps, pervasive sensor technologies and access to social network data offer exciting opportunities for researchers to passively observe and/or track patients 'in the wild' and 24/7. The volume of granular personal health data gathered using these technologies is unprecedented, and is increasingly leveraged to inform personalized health promotion and disease treatment interventions. The use of artificial intelligence in the health sector is also increasing. Although rich with potential, the digital health ecosystem presents new ethical challenges for those making decisions about the selection, testing, implementation and evaluation of technologies for use in healthcare. As the 'Wild West' of digital health research unfolds, it is important to recognize who is involved, and identify how each party can and should take responsibility to advance the ethical practices of this work. While not a comprehensive review, we describe the landscape, identify gaps to be addressed, and offer recommendations as to how stakeholders can and should take responsibility to advance socially responsible digital health research.

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Background

The digital revolution is disrupting the ways in which health research is conducted, and subsequently, changing healthcare [ 1, 2, 3]. The rise of digital health technologies has resulted in vast quantities of both qualitative and quantitative 'big data', which contain valuable information about user interactions and transactions that may potentially benefit patients and caregivers [ 4]. Digital data 'exhaust', or the traces of everyday behaviors captured in our digital experiences, are of particular interest because they contain our natural behaviors gathered in real time. No doubt, important societal conversations are needed to shape how these sociotechnical systems influence our lives as individuals, as well as the impact on society [ 5]. While not a formal review, this opinion essay provides a selective overview of the rapidly changing digital health research landscape, identifies gaps, highlights several efforts that are underway to address these gaps, and concludes with recommendations as to how stakeholders can and should take responsibility to advance socially responsible digital health research.

Direct-to-consumer wellness products and mobile apps (e.g., Fitbit, Strava), wearable research tools (e.g., SenseCam, ActivPAL), and access to social network data offer exciting opportunities for individuals [ 6], as well as traditional health researchers [ 7], to passively observe and/or track individual behavior 'in the wild' and 24/7. The volume of granular personal health data gathered using these technologies is unprecedented, and is increasingly leveraged to inform personalized health promotion and disease treatment interventions. The use of artificial intelligence (AI) tools in the health sector is also increasing. For example, electronic health records provide training data for machine learning that inform algorithms, which can detect anomalies more accurately than trained humans - particularly in the fields of cancer, cardiology, and retinopathy [ 8]. The digital therapeutics sector is also seeking to expand and bring products into the healthcare system, with the goal of complementing or providing an alternative to traditional medical treatments [ 9]. While the digital health revolution brings transformational promise for improving healthcare, we must acknowledge our collective responsibility to recognize and prevent unintended consequences introduced by biased and opaque algorithms that could exacerbate health disparities and jeopardize public trust [ 10, 11]. Moreover, it is critical that the minimal requirements used to make a digital health technology available to the public are not mistaken for a product that has passed rigorous testing or demonstrated real world therapeutic value [ 12].

Although rich with potential, the digital health ecosystem presents new ethical challenges for those making decisions about the selection, testing, implementation and evaluation of technologies in healthcare. Researchers began to study related ethical issues over 20 years ago, when electronic health records technology was being conceptualized [ 13], and as new forms of pervasive information communication technologies produce data, guiding principles and standards are emerging within academic research centers [ 14, 15, 16] and industry sectors [ 17, 18]. Accepted ethical principles in health research, including respect for persons, beneficence and justice, remain relevant and must be prioritized to ensure that research participants are protected from harms. Applying these principles in practice means that: people will have the information they need to make an informed choice; risks of harm will be evaluated against potential benefits and managed; and no one group of people will bear the burden of testing new health information technologies [ 19]. However, ethical challenges arise from the combination of new, rapidly evolving technologies; new stakeholders (e.g. technology giants, digital therapeutic start-ups, citizen scientists); data quantity; novel computational and analytic techniques; and a lack of regulatory controls or common standards to guide this convergence in the health ecosystem.

It is of particular importance that these technologies are finding their way into both research and clinical practice without appropriate vetting. For example, we have heard that, "if the product is free, then you're the product." This means that our search terms, swipes, clicks and keyboard interactions produce the data that companies use to inform product improvement. These 'big data' are used to train algorithms to produce, for example, tailored advertisements. Consumers allow this by clicking "I Accept" to confirm their agreement with the Terms and Conditions (T&C), which are not necessarily intended to be easy to read or understand. Why does this matter? When an algorithm is used to serve up a reminder about that yellow jacket you were eyeing, or the summer vacation you mentioned to a friend the other day, it may seem 'creepy', but it might be nice in terms of convenience. Sometimes the AI gets it right, and other times it is not even close. For example, if you were to write something on Facebook that its proprietary AI interprets as putting you at serious risk, it may send the police to your home! Is Facebook getting it right? We do not know: Facebook has claimed that, even though its algorithm is not perfect and makes mistakes, it does not consider its actions to be 'research' [ 20]. Aside from threats to one's privacy, we should question the process of informed consent, whether there is an objective calculation of risk of harms against potential benefits, and whether people included in the product testing phase are those most likely to benefit.

Governance in the 'wild west'

Those involved in the development, testing and deployment of technologies used in the digital health research sector include technology developers or 'tool makers', funders, researchers, research participants and journal editors. As the 'Wild West' of digital health research moves forward, it is important to recognize who is involved, and to identify how each party can and should take responsibility to advance the ethical practices of this work.

Who is involved?

In the twentieth century, research was carried out by scientists and engineers affiliated with academic institutions in tightly controlled environments. Today, biomedical and behavioral research is still carried out by trained academic researchers; however, they are now joined by technology giants, startup companies, non-profit organizations, and everyday citizens (e.g. do-it-yourself, quantified self). The biomedical research sector is now very different, but the lines are also blurred because the kind of product research carried out by the technology industry has, historically, not had to follow the same rules to protect research participants. As a result, there is potential for elevated risks of harm. Moreover, how and whether research is carried out to assess a product's effectiveness is variable in terms of standards and methods, and, when the technology has health implications, standards become critically important. In addition, not all persons who initiate research are regulated or professionally trained to design studies. Specific to regulations, academic research environments require the involvement of an ethics board (known as an institutional review board [IRB] in the USA, and a research ethics committee [REC] in the UK and European Union). The IRB review is a federal mandate for entities that receive US federal funding to conduct health research. The ethics review is a peer review process to evaluate proposed research, and identify and reduce potential risks that research participants may experience. Having an objective peer review process is not a requirement for technology giants, startup companies or by those who identify with the citizen science community [ 10, 21]; however, we have a societal responsibility to get this right.

What questions should be asked?

When using digital health technologies, a first step is to ask whether the tools, be they apps or sensors or AI applied to large data sets, have demonstrated value with respect to outcomes. Are they clinically effective? Do they measure what they purport to measure (validity) consistently (reliability)? For example, a recent review of the predictive validity of models for suicide attempts and death found that most are currently less than 1%; a number at which they are not yet deemed to be clinical viable [ 22]. Will these innovations also improve access to those at highest risk of health disparities? To answer these questions, it is critical that all involved in the digital health ecosystem do their part to ensure the technologies are designed and scientifically tested in keeping with accepted ethical principles; be considerate of privacy, effectiveness, accessibility, utility; and have sound data management practices. However, government agencies, professional associations, technology developers, academic researchers, technology startups, public organizations and municipalities may be unaware of what questions to ask, including how to evaluate new technologies. In addition, not all tools being used in the digital health ecosystem undergo rigorous testing, which places the public at risk of being exposed to untested and potentially flawed technologies.

Demonstrating value must be a precursor to the use of any technologies that claim to improve clinical treatment or population health. Value is based on the product being valid and reliable, which means that scientific research is needed before a product is deployed within the health sector [ 12]. We should also not move ahead assuming that privacy and the technology revolution are mutually exclusive. We are in a precarious position in which, without standards to shape acceptable and ethical practices, we collectively run the risk of harming those who stand to benefit most from digital health tools.

Decision-making framework

While there are discussions about the need for regulations and laws, and incremental progress being made on that front, until some consensus is reached, it is essential that stakeholders recognize their obligation to promote the integrity of digital health research [ 23]. The digital health decision-making domains framework (Fig. 1) was developed to help researchers make sound decisions when selecting digital technologies for use in health research [ 24, 25]. While originally developed for researchers, this framework is applicable to various stakeholders who might evaluate and select digital technologies for use in health research and healthcare. The framework comprises five domains: 1, Participant Privacy; 2 Risks and Benefits; 3, Access and Usability; 4, Data Management; and 5, Ethical Principles. These five domains are presented as intersecting relationships.

Digital health decision-making framework and excerpts from the companion checklist designed to support researchers [ 24]

The domains in this framework were developed into a checklist tool to further facilitate decision-making. The checklist was informed via developmental research involving a focus group discussion, and a design exercise with behavioral scientists [ 25]. To demonstrate how the decision-making domains can be put into practice, we present a use case to illustrate the complexities and nuances that are important for stakeholders to consider.

Use case: MoodFlex for mental health

MoodFlex is a private startup technology company that has developed a mobile app to detect signals of poor mental health by analyzing a person's typing and voice patterns from their smartphones. MoodFlex is negotiating with several municipalities to integrate their product within the public mental healthcare system, with the goal of delivering better services to people with mental illness through predictive analytics. Since MoodFlex does not claim to provide a clinical diagnosis or treatment, approval from the US Food and Drug Administration is not necessary. The vendor claims to have a proven product; however, there are no publications documenting evidence that it is safe, valid or reliable. The only research that is formally acknowledged involves an evaluation of the implementation process and uptake of the product by health providers within the state mental health system. The patient will be invited to download the app after reviewing the vendor's T&C - no other consent process is proposed. The algorithm is proprietary, and therefore, an external body is unable to determine whether the algorithm that resulted from a machine-learning process was trained on representative data, or how decision-making occurs. Data captured about people using the app are owned by the vendor.

Brief analysis

Before introducing MoodFlex into the public healthcare system, decision makers - particularly the funding organization - should evaluate evidence supporting the efficacy of this product. Reproducible evidence is the hallmark of evidence-based practice, and is the first step prior to dissemination and implementation. If a product is supported by evidence, the logical next step is the translational phase, in which a 'dissemination and implementation' (D&I) design is appropriate. Unfortunately, many health apps move straight into a D&I phase before the evidence exists to support that direction.

Lacking evidence that the product is effective, decision-makers should recognize that a testing phase is necessary. As with regulated research involving people, a research plan should be developed and reviewed by an external and objective ethics board (i.e., REC or IRB) that will assess the degree to which people who are invited do not bear an inappropriate burden (justice), potential risks are offset by the benefits (beneficence), and individuals are provided with an ability to make an informed choice to volunteer (respect). At this early stage, it is reasonable for the vendor to provide the sponsor with a robust data management plan, with explicit language regarding data ownership, access, sharing and monitoring. When involving vulnerable populations, such as those with a mental health diagnosis, additional precautions should be considered to ensure that those involved in the study are protected from harms - including stigma, economic and legal implications. In addition, it is important to consider whether some people will be excluded because of access barriers. For example, it may be necessary to adapt the technology to be useful to non-English speakers. Informed consent must also be obtained in a way that results in a person making a choice to participate based on having adequate and accessible information - this demonstrates the principle of 'respect for persons', and is a hallmark of research ethics. Placing consent language for a research study in the T&C is unacceptable. For patients who become research participants, it is particularly important for them to understand the extent to which the technology will support their healthcare needs. Patients might falsely rely on the technology to provide the care they believe they need when, in reality, they may need to see their healthcare provider.

Digital research gaps and opportunities

This use case reflects the shift in health research associated with digital technologies, in that traditional methods of developing an evidence base may be pushed aside in favor of what appears to be exciting innovation. The landscape is unsettled and potentially dangerous, which makes governance important. We have identified three notable gaps: 1, disciplinary/sector challenges; 2, issues of data and technology literacy; and 3, inconsistent or non-extant standards to guide the use of AI and other emerging technologies in the healthcare settings.

Inter/trans/cross-disciplinary and sector challenges

Emerging technologies and AI systems require diverse expertise when applied to digital medicine, which introduces new challenges. Technology makers may not understand patients' needs, and develop tools with limited utility in practice [ 25, 26]. Computational scientists may train AI using datasets that are not representative of the public, limiting the ability to provide meaningful assessments or predictions [ 27]. Clinicians may not know how to manage the depth of granular data, nor be confident in decisions produced by AI [ 28]. Research is needed to examine this disconnect, and identify strategies to reduce gaps and improve meaningful connections between these groups that are integral to digital health research and the use of AI in the health care sector.

Digital/tech-literacy

The idea that keystrokes and voice patterns can be used to aid diagnosis of Parkinson's disease remains impressive, but now it may also be possible to use keystroke dynamics, kinematics and voice patterns to detect mental health problems [ 29]. Knowing this information may create public concern if not communicated in a way that is useful and contextual, adding to fear, skepticism and mistrust. The 'public' includes policy-makers, educators, regulators, science communicators, and those in our healthcare system, including clinicians, patients, and caregivers. Research is needed to increase our understanding of what these stakeholders know, what they want to know, and how best to increase their technology literacy. This information can then be used to inform educational resources targeting specific stakeholders. For example, when reviewing manuscripts reporting digital health research, reviewers and editors should be aware of how to evaluate new methodologies and computational analytics to verify the accuracy and appropriateness of the research and results.

Ethical and regulatory standards

As new digital tools and AI-enabled technologies are developed for the healthcare market, they will need to be tested with people. As with any research involving human participants, the ethics review process is critical. Yet, our regulatory bodies (e.g., IRB) may not have the experience or knowledge needed to conduct a risk assessment to evaluate the probability or magnitude of potential harms [ 30]. Technologists and data scientists who are making the tools and training the algorithms may not have received ethics education as part of their formal training, which may lead to a lack of awareness regarding privacy concerns, risks assessment, usability, and societal impact. They may also not be familiar with regulatory requirements to protect research participants [ 23]. Similarly, the training data used to inform the algorithm development are often not considered to qualify as human subjects research, which - even in a regulated environment - makes a prospective review for safety potentially unavailable.

New initiatives - what resources are available for the digital health/medicine community?

Several initiatives have begun to address the ethical, legal and social implications (ELSI) of the digital revolution in healthcare. Prominent examples of such initiatives concern AI. Specific to AI, the foci are broad, and include autonomous vehicles, facial recognition, city planning, the future of work, and in some cases, health. A few selected examples of current AI efforts appear to be well-funded and collaborative programs (see Table 1).

Table 1 AI initiatives underway to inform broad cross-sector standards

Across these initiatives are efforts to assess the potential ELSI of AI. Similar to the impact of the European Union (EU)'s General Data Protection Regulation (GDPR) in countries beyond the EU, the intention of groups assessing AI through an ELSI lens is to develop standards that can be applied or adapted globally. In practice, however, most current efforts to integrate ELSI to AI are quite broad, and as a result, may overlap in scope and lack specificity.

While AI has a place in the digital health revolutions, the scope of technologies goes well beyond AI. Other initiatives are looking more specifically at ELSI in mobile apps, social network platforms, and wearable sensors being used in digital research. These include, for example, the Connected and Open Research Ethics (CORE) initiative at the University of California (UC) San Diego Research Center for Optimal Digital Ethics in Health (ReCODE Health), the Pervasive Data Ethics for Computational Research (PERVADE) program at the University of Maryland, and the Mobile Health ELSI (mHealthELSI) project out of Sage Bionetworks and the University of Louisville. What these initiatives have in common is a goal to inform policy and governance in a largely unregulated space. These initiatives are but a few examples, and it is important to note that many laboratories and institutes are working on digital health ELSI.

Conclusion

Being mindful of new health technologies with new actors in the arena, the gap between known and unknown risks fundamentally challenges the degree to which decision-makers can properly evaluate the probability and magnitude of potential harms against benefits. Now is the time to take a step back and develop the infrastructure necessary for vetting new digital health technologies, including AI, before deploying them into our healthcare system. Selecting and implementing technologies in the digital health ecosystem requires consideration of ethical principles, risks and benefits, privacy, access and usability, and data management. New technologies have the potential to add important value; however, without careful vetting, may exacerbate health disparities among those most vulnerable.

Availability of data and materials

Abbreviations

AI:

Artificial intelligence

ELSI:

Ethical, legal and social implications

IRB:

Institutional review board

REC:

Research ethics committee

References

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Funding

This work was supported, in part, by the Robert Wood Johnson Foundation (grant number 72876, to CN, Principal Investigator [PI] 2015-2019), and by the National Institutes of Mental Health (grant number 1K23MH116130-01, to JT, PI 2018-2022).

Author information

Affiliations

1. Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA

Camille Nebeker

2. Research Center for Optimal Digital Ethics in Health, Qualcomm Institute and School of Medicine, University of California San Diego, La Jolla, CA, 92093, USA

Camille Nebeker

3. Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

John Torous

4. School of Nursing, Indiana University, 600 Barnhill Drive, Indianapolis, IN, 46202, USA

Rebecca J. Bartlett Ellis

Contributions

CN conceptualized and prepared the original manuscript; JT, RBE and CN wrote, reviewed and edited the manuscript. All authors read and approved the final version of the manuscript.

Authors' information

CN directs the Research Center for Optimal Digital Ethics (ReCODE.health) at the University of California at San Diego. Her appointment is in the Division of Behavioral Medicine, in the Department of Family Medicine and Public Health. JT directs the Digital Psychiatry Division at Beth Israel Deaconess Medical Center, and is a licensed psychiatrist and clinical informaticist. RJBE is a behavioral scientist at Indiana University who uses sensors and mobile technologies to study biobehavioral mechanisms related to medication adherence and treatment efficacy.

Corresponding author

Correspondence to Camille Nebeker.

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Nebeker, C., Torous, J. & Bartlett Ellis, R.J. Building the case for actionable ethics in digital health research supported by artificial intelligence. BMC Med 17, 137 (2019). https://doi.org/10.1186/s12916-019-1377-7
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Building the case for actionable ethics in digital health research supported by artificial intelligence - BMC Medicine

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The digital revolution is disrupting the ways in which health research is conducted, and subsequently, changing healthcare. Direct-to-consumer wellness products and mobile apps, pervasive sensor technologies and access to social network data offer exciting opportunities for researchers to passively observe and/or track patients 'in the wild' and 24/7.

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I liked this because it points out the keys reasons why infographics should be used- in the form of an infographic!

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This was a helpful article because it provides tips on what to include in an infographic to make it stand out and captivate its intended audience.

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Sure, you can pretty much create an infographic for any blog post, but that doesn't mean it will perform spectacularly. Creating a great infographic requires a great idea first and foremost.

In this guide, I break down the ideation process so that coming up with more memorable infographic ideas doesn't have to be so hard. In fact, these principles are relevant not only to infographics but any content you create.
Image source
1. Solve a burning problem

When it comes to producing high value content - shareable and link-worthy - create an infographic that solves a burning problem.

Create a problem-solving infographic to produce shareable & link-worthy content. @NadyaKhoja Click To Tweet

This approach requires you to first think about the problem that you're trying to solve or the questions you're trying to answer with your infographic story. This usually requires you to put yourself in your readers' shoes.

First, ask yourself: What are the problems my audience is facing?

Your next step is to identify or discover topics and stories from those answers.

For instance, why do you think AMAs on Reddit and Inbound.org are so popular? It gives normal people the opportunity to ask questions of those who may be more successful than them - questions they believe will lead to their own eventual success.

With infographics, content typically formatted as a how-to guide follows this principle. One example is this one by Silver Door on how to successfully manage a team while working remotely - a burning and growing problem as remote teams become more common.

The data is presented in a simple and easily digestible format, offering a solution to a pain point.

As you attempt to provide solutions to burning problems, identify the data or the information you possess that your audience wants or needs, and present it in a way which provides value but also positions you as a leader in the industry.

2. Challenge the status quo

Next, creating content that challenges the status quo is a great way to position you and your company as experts and influencers in a certain area.

Create #content that challenges the status quo to position you or your company as an expert, says @NadyaKhoja. Click To Tweet

Consider this example from our study (and infographic) where we looked at nearly 200,000 tweets using hashtags. We made the statement that hashtags are useless. This challenges the typical assumption that they actually provide value in marketing.

Much like the myth-busting principle, creating content that challenges the status quo is sure to cause some controversy and debate. But these types of pieces tend to get the conversation going, thus making more people aware of your brand.

3. Change the perspective

The next principle is to reframe the question or alter the perspective. The best way to describe this principle is by looking at an example from the Bill and Melinda Gates Foundation.

The organization wanted people to understand the importance of malaria vaccinations. Instead of simply presenting the facts and listing the impact - the death toll caused by malaria - the foundation created an infographic about the world's deadliest animals.

When you see that nearly 1 million people die every year from mosquito bites, and only 10 deaths are caused by shark attacks, the data becomes much more surprising and memorable.

By offering a comparison, and presenting the question in a different way, the foundation made the idea that a malaria vaccination is a simple way to avoid death so much stickier.

When you are using this principle, first identify the question you are trying to answer, and then approach it from a completely different angle.

4. Find origin stories

For every story you hear, chances are there is an origin story. In the book Made to Stick by Chip and Dan Heath, one chapter discusses the origin stories of certain proverbial phrases.

I believe the one they were talking about specifically was the phrase, "A bird in the hand is worth two in the bush." According to the Heath brothers, and many other sources, this proverb dates back to the 1600s. And it's still used often today.

Now, aren't you curious about the story behind this proverb, and perhaps the stories behind other common phrases that we know and use? Our curiosity and determination to find meaning are what make origin stories so popular.

Think about some common beliefs and behaviors people have today. For example, why did kale and quinoa suddenly become such health phenomena? They aren't new foods, they have existed for a long time, and their health properties have been known as well.

A common way of portraying this principle with an infographic is by creating a timeline infographic of an event, specific industry, or person.

Create a timeline infographic of an event, specific industry, or person, says @NadyaKhoja. Click To Tweet

Anna Vital does this frequently by visualizing timelines of successful entrepreneurs, such as this example of the life of Steve Jobs.

These are just a couple examples of places to start. Your goal is to discover the origin story that resonates with your audience and then visualize it.

5. Find extreme cases

Similar to identifying the origin story is discovering the extreme case. These outliers are often eliminated from surveys because they can heavily influence data and skew results.

One example might be to identify the average time people spend on Facebook. According to Business Insider, the global average is about 20 minutes a day. But for users in the United States, the average time was double. Now that makes the statistic that much more interesting, doesn't it?

You can see the headline now: U.S. Residents Spend Twice as Much Time on Facebook as the Rest of the World.

Finding the outliers like this can help inspire highly shareable content and infographic ideas. For instance, let's say you sell a product like dog treats. You survey customers and identify that dogs consume an average of 2.5 treats a day. But you also discover one dog that consumes 15 treats a day. Now you have a special story.

From this case study, you can create an infographic visualizing how many pounds of dog treats are consumed a year by your customers' pets, and highlight the outliers.

One example that stands out is a recent infographic map showcasing the median annual income for millennials across the United States.

Looking at this map, it's shocking to see how little so many millennials are making. But this data is not the average income for millennials, which is likely much higher. If you read the article, you can also see that included in the survey were millennials who were still students, and only working part time. Considering all the factors, it's not as shocking that the numbers are so low. But by only focusing on the median, the data is presented as an extreme case and viewers are more likely to read the article to learn why.

6. Go outside your immediate field

The next principle is to go outside your immediate field. Shopify offers an example of this. Technically, it's in the e-commerce business, but it produces content on a range of topics, particularly entrepreneurship. Shopify knows that many entrepreneurs have a store and sell product online (the e-commerce tie-in). Shopify sells the dream of entrepreneurship first, and e-commerce is a by-product.

Here's an example of an infographic about building long-term client relationships. Is it directly relevant to e-commerce? Not exactly. It's more along the lines of general business management, but the content is still important if you have an online store.

The point is, don't focus solely on your immediate field when thinking of content and infographic ideas. Venture outside of that tiny bubble and find out how you can tie in topics outside of your specific business.

Don't focus solely on your immediate field when thinking of #content & infographic ideas, says @NadyaKhoja. Click To Tweet

7. Mash up two or more topics

The last principle is the act of mashing up multiple ideas or topics for your infographic. Take two seemingly unrelated concepts and find an element that connects them. This is a particularly good way of combining trending topics with evergreen ideas.

DOZ, a marketing software company, mashed its tool's capabilities with a trending topic (election) in an infographic analyzing the type of language used on Twitter by some of the presidential candidates.

The infographic also became a PR win, as Adweek published it.

Think of some possible trending topics that can be mashed up with an aspect of your business. Maybe it's comparing the Lord of The Rings to your SEO strategy or Harry Potter to your company culture that lets you use the mash-up principle to appeal to a wider audience.

Conclusion

It can be discouraging to spend hours working on an infographic that you think is incredible, only to publish it and find that not even a cricket will tweet it. But just like any type of content marketing, there is a lot of competition and only the best get shared and seen. Don't just create an infographic for the sake of making it. Create one that follows the principles of great content, and it will be seen.
Get expert insight every day to expand your great content ideas and advance your content marketing program. Cover image by Joseph Kalinowski/Content Marketing Institute to the CMI newsletter.

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Sure, you can pretty much create an infographic for any blog post, but that doesn't mean it will perform spectacularly. Creating a great infographic requires a great idea first and foremost. In this guide, I break down the ideation process so that coming up with more memorable infographic ideas doesn't have to be so hard.

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This article was interesting as it reviews the top 10 gamified health apps. It notes how the introduction of gamified apps is pertinent in preventative care and health promotion. I noticed that there are a number of apps that deal with physical therapy and encouraging patients to follow through with PT at home. The app I liked the most was Mango Health, where patients earn rewards for remembering to take their medication.

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Yu-kai Chou: Gamification & Behavioral Design

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Healthcare Games Improve Lives

Technology is changing the face of healthcare as we know it. The typical habit of only going to a doctor when you have an issue is slowly fading. The medical field is now moving towards preventative care, and for good reason: according to the Partnership for Prevention, over 100,000 lives could be saved in the U.S. every year if the gaps in just 5 preventative health services were closed. Preventative healthcare improves general well-being and can save lives by catching a disease or condition before it's too late.

And Gamification is making services more accessible, fun, and impactful through preventative healthcare games.

It's no surprise that positively changing daily behaviors can help prevent disease and disorders. Eating healthier foods, maintaining an exercise routine, and remembering to complete a prescription medication regiment can ensure you enjoy a long, healthy life. While we intend to remain on top of these things, the reality is that most of us are likely to fall short of staying consistent with these habits. However, with the help of gamified tools and platforms, healthy regular activities can be fun and easier to maintain.

Here are 10 amazing companies that are changing and (even saving) lives through preventative healthcare games.

Healthcare Game #1: Ayogo

Patients with chronic conditions must be proactive about maintaining and improving their health and overall wellness. There are limits to what doctors and caregivers can accomplish on their own.

This is why a company called Ayogo has designed an app called Empower to help these patients develop new behavioral habits specific to their condition. This project received the support of partnerships with:

Joslin Diabetes Center (Harvard Medical School)

Sanofti Aventis (USC's body imaging center at the Keck School of Medicine)

Diabetes Hands Foundation

With daily prompts to help remind them, patients are required to check in every day to record their behaviors. They are assigned small activities, games and surveys and rewarded for positive changes (Core Drive #2, Development & Accomplishment).

Over time, these behaviors turn into new lifestyle habits which help patients make better progress and develop more autonomy in terms of their health.

Healthcare Game #2: Mango Health

Mango Health has designed an app which has been featured on CNN, Self, and LA Times. With this tool patients can actually earn monetary rewards simply for taking their medication.

Remembering to take one's prescription isn't always easy when you're dealing with school, work, errands, phone calls, appointments and emails.

To address this, Mango Health's app issues reminder alerts. Patients earn points every time they take their medication (Core Drive #2, Ownership & Possession). As they stay on schedule, they earn larger rewards such as $5-$10 gift cards to Target and GAP. Another form of reward even includes dollar donations to charity organizations like ASPCA. Imagine helping an animal in need just by taking your medication!

Healthcare Game #3: Reflexion Health

Reflexion Health aims to "reimagine the physical therapy experience." Co-founder and CMO, Ravi Komatireddy explains the basis for his company, "As a physician, I saw a big problem with traditional PT (physical therapy), namely that it wasn't being done by patients."

Reflexion Health developed a virtual instruction platform to solve this issue. In the comfort of their own home, patients watch an animated instructor model a particular exercise on their t.v. or computer screen.

They are prompted to follow the instructor in doing the same exercises. Motion guided technology is then able to compare the patient's performance to the sample and point out any needed adjustments (Core Drive #2, Development & Accomplishment).

Physicians can see if their patient is following through with the exercises by following their progress. Issues with form can be then corrected as needed.

Healthcare Game #4: Respond Well

Respond Well's technology is also aimed at helping physical therapy patients consistently perform their rehab exercise routines.

Like Reflexion Health, Respond Well's platform uses motion sensor technology. Their particular application utilizes Microsoft's Kinect and offers a wide array of different features to keep patients engaged and their doctors informed of their progress.

Patients can choose their virtual animated trainer, music, and 3D environment (Core Drive #4, Ownership & Possession). They earn points for proper form and can set up challenges as well as invite their friends and family to participate (Core Drive #5, Social Influence & Relatedness).

The Kinect not only monitors their motion, but also counts repetitions. Data is stored in cloud system for analysis and reporting purposes.

Healthcare Game #5: Cohero Health

The consequences of forgetting to take one's medication can be particularly dire for young asthma patients. But thanks to Cohero Health, there is now an app called Asthma Hero to help young patients stay on schedule.

The app connects to a blue tooth sensor that attaches to the inhaler with a strap. This unit communicates with the mobile app to keep track of when the medication was administered and whether or not it was taken properly.

Patients or their parents can specify:

the number of times the inhaler needs to be used

the number of puffs that need to be taken

Reminder notices are then issued based on these settings.

Asthma Hero lets the patient choose and name their own hero character and rewards points for adherence to the treatment schedule (Core Drive #4, Ownership & Possession).

Information is also stored on a cloud server. The physician is therefore able to stay informed about relevant details associated with the patient's compliance and usage of the medication.

Healthcare Game #6: Pact

Pact is an app funded by the founder of Guitar Hero. Users literally make pacts with themselves to consistently exercise and eat healthy. And they can get paid real dollars to do so.

The powerful driving force of this preventative healthcare game is that they can actually lose money when they fall off track. Therefore this is a great example Core Drive #8 (Loss & Avoidance) in action. The idea of losing money is extremely compelling and scary. After all, this is how parking tickets work. The same dynamic operates in Pact.

Players specify how much money they agree to be deducted from their credit card or Paypal account for every day that is missed (e.g. $5). This money will then go into a collective pool that issues payouts to those who do reach their goals (talk about an interesting combo of Core Drive #5, Social Influence & Relatedness and Core Drive #2, Development & Accomplishment).

Unfortunately, the game is set up to where losses are much bigger than gains. Players can chose to lose anywhere from $5-$10. However, meeting goals will only earn $0.30 to $5 a week. Yet this is still enough to perhaps indulge in an extra Starbuck's visit.

Healthcare Game #7: HubBub

HubBub's tagline is "Play Well Together." It is designed to help companies improve the health of their employees and overall productivity. After all, better health equates to sharper thinking and more energy. Yet these optimal states tend to be undermined by the typical office lifestyle of primarily sitting throughout much of the day.

HubBub believes they have the answer to this issue. They offer an innovative alternative to conventional health programs in terms of flexibility, features and most importantly, fun.

Users can even invite their friends and family in addition to playing with their co workers (Core Drive #5, Social Influence & Relatedness). This enables a lively social environment where players can encourage each other and even celebrate successes with virtual fist pumps.

Challenges can either be created or chosen. Examples include:

eating something orange

walking 8000 steps with a friend

Check-ins to record small achievements are noted. And over time, players can earn badges.

Healthcare Game #8: Cog Cubed

Cog Cubed is a company that develops healthcare games for researchers and clinicians. They develop applications which target a wide range of cognitive processes. Their particular emphasis is on executive functioning. This has to do with performing goal-directed behavior which is often impaired in patients with Alzheimers, Traumatic Brain Injury, Autism, Anxiety and ADHD.

The current flagship product of Cog Cubed is Groundskeeper. Unlike games presented as apps, websites or video consoles, Groundskeeper involves a set of hand held cubes with animated digital graphic interfaces. This unique technology was developed by MIT's Media Lab.

Players solve problems as they physically manipulate the cubes (Core Drive #3, Empowerment of Creativity & Feedback).

While Groundkeeper is designed to be fun and engaging, it's main intent is to assess individuals for ADHD. Performance data is collected to measure distractibility and attention These are analyzed and compared with those who actually have ADHD and normal executive functioning skills.

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Healthcare Game #9: Akili

Akili has designed an assessment game called Evo. It's objective is somewhat similar to Cog Cubed's Groundskeeper. Evo is mainly targeted for the purpose of detecting Alzheimer's disease.

Diagnosing this condition normally requires an expensive PET scan to find amyloid plaques in the brain. But, Evo may be a more cost effective way to tell if someone has Alzheimers.

Like Cog Cubed, researchers created standardized sets of game performance data. With Evo, this includes normal populations versus individuals with Alzheimers.

The game design for Evo tests players on how well they cope with cognitive interference (distractions) which is important for functioning in real life, especially when it comes to self care and safety.

During the game, the player tilts the ipad or iphone device in order to steer an alien down a river. Distractions appear in the form of a fish or a bird. And players need to tap the screen every time this happens (Core Drive #2, Development & Accomplishment). This performance data is then collected, assessed, and measured against the predetermined standards.

Healthcare Game #10: Synandus

Synandus offers "simulation learning technology" for patients and students. Currently, one of their applications is for patients with COPD (Chronic Obstructive Pulmonary Disease), a progressive disorder where breathing becomes increasingly difficult.

The dynamic visuals give a peak into specific areas of the body. And users are able to actually see what types of physiological changes happen when they make certain choices (e.g. drug therapy, smoking etc.) or expose themselves to various environmental factors (Core Drive #7, Unpredictability & Curiosity).

This innovative educational technology not only benefits actual patients but students of the life sciences (e.g. medical school) as well.

Healthcare Games On The Rise

In the spirit of helping to make the world a better place, healthcare games are growing to meet real needs. And with the help of gamification, it is now possible to experience fun and joy in developing a healthy lifestyle, while preventing diseases and disorders before its too late.

Please share any other preventative healthcare games that excite you below.

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Top Ten Gamified Healthcare Games that will extend your Life

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Technology is changing the face of healthcare as we know it. The typical habit of only going to a doctor when you have an issue is slowly fading. The medical field is now moving towards preventative care, and for good reason: according to the Partnership for Prevention, over 100,000 lives could be saved in the U.S.

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Creating a Health App Using Gamification 

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Creating a Health App Using Gamification 

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Gamification is a strategy used to keep people motivated and engaged in meeting their health goals. The author states that "by 2027 the healthcare gamification market will reach 35,982.7 million USD from 3,072.5 million USD in 2019 (Georgiou, 2021)." This article provides all of the important aspects and a step by step guide to creating a successful health app, using gamification. Some of the important factors that must be considered are customization, engagement, motivation and usability.

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A Step-by-Step Guide to Health App Gamification (with Examples)

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Health app gamification is the new trend to inspire people to stay healthy. We take a look at how businesses can gamify health apps with some real time case studies.

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This website explains the tele -health policies and laws by state. It's interesting to compare and contrast policies of different states. I was able to review the laws governing tele- health/telemedicine in the state of MA. I found it interesting that Ma does not allow "Store and Forward" or remote patient monitoring.

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Consent Requirements

Health care services provided via telehealth shall conform to the standards of care applicable to the telehealth provider's profession and specialty. Such services shall conform to applicable federal and state health information privacy and security standards, as well as standards for informed consent.

SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Sept. 2021)

Definitions

"Telehealth", the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient's physical health, oral health, mental health or substance use disorder condition.

SOURCE: Massachusetts Senate No. 2984. (Accessed Sept. 2021).

Telehealth is the use of electronic communication and information technologies to provide or support clinical care at a distance. The delivery of services through telehealth involves the use of secure interactive audio and video telecommunications systems that permit two-way, real-time communication between a patient and a provider.

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Sept. 2021).

Email, Phone & Fax

"Telehealth", the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient's physical health, oral health, mental health or substance use disorder condition.

The rate of payment for telehealth services provided via interactive audio-video technology and audio-only telephone may be greater than the rate of payment for the same service delivered by other telehealth modalities.

SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Sept. 2021)

Live Video

POLICY

The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall provide coverage for health care services delivered via telehealth by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth.

The rate of payment for telehealth services provided via interactive audio-video technology and audio-only telephone may be greater than the rate of payment for the same service delivered by other telehealth modalities.

Coverage that reimburses a provider with a global payment shall account for the provision of telehealth services to set the global payment amount. See services section below for behavioral health services specific requirements for payment.

SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Sept. 2021)

Telehealth is a modality of treatment, not a separate covered service. Providers are not required to deliver services via telehealth.

The bulletin does not apply to services under the Children's Behavioral Health Initiative (CBHI) program, which may continue to be delivered via all modalities currently authorized in applicable program specifications.

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Sept. 2021).

ELIGIBLE SERVICES/SPECIALTIES
Health Care Services
The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall provide coverage for health care services delivered via telehealth by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth.

SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Sept. 2021)
Behavioral Health Services
The division shall ensure that the rate of payment for in-network providers of behavioral health services delivered via interactive audio-video technology and audio-only telephone shall be no less than the rate of payment for the same behavioral health services delivered via in-person methods; provided, that this subsection apply to providers of behavioral health services covered as required (see text for applicable behavioral health providers).

SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Sept. 2021)

The division of medical assistance shall ensure that rates of payment for in-network providers for telehealth services provided in pursuant to MA law (see text) are not less than the rate of payment for the same service delivered via in-person methods.

Source: Massachusetts Senate No. 2984. Section 68 (Accessed Sept. 2021)

Community Health Centers, Community Mental Health Centers, and Outpatient Substance Use Disorder providers (provider types 20, 26 and 28) may deliver the following covered services via telehealth:

All services specified in 101 CMR 306.00 et seq.; and

The outpatient services specified in the following categories:

Opioid Treatment Services: Counseling;

Ambulatory Services: Outpatient Counseling; Clinical Case Management; and

Services for Pregnant/Postpartum Clients: Outpatient Services

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Sept. 2021).

MassHealth lists specific codes that may be used by community health centers for services delivered through telehealth. See Transmittal Letter for details.

SOURCE: MassHealth Transmittal Letter CHC-113, p. 6-11 & 6-12, Feb. 2020. (Accessed Sept. 2021).

ELIGIBLE PROVIDERS

Coverage shall not be limited to services delivered by third-party providers.

SOURCE: Massachusetts Senate No. 2984. Section 40 para. 632 (Accessed Sept. 2021)

ELIGIBLE SITES

A health care provider shall not be required to document a barrier to an in-person visit nor shall the type of setting where telehealth services are provided be limited for health care services provided via telehealth; provided, however, that a patient may decline receiving services via telehealth in order to receive in-person services.

SOURCE: Massachusetts Senate No. 2984. Section 40 para. 655 (Accessed Sept. 2021)

GEOGRAPHIC LIMITS

A health care provider shall not be required to document a barrier to an in-person visit nor shall the type of setting where telehealth services are provided be limited for health care services provided via telehealth.

SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Sept. 2021).

FACILITY/TRANSMISSION FEE

No Reference Found

Miscellaneous

Medicaid contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician shall not meet network adequacy through significant reliance on telehealth providers and shall not be considered an adequate network if patients are not able to access appropriate in-person services in a timely manner upon request.

SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Sept. 2021)
Behavioral Health Services
A provider may prescribe Schedule II controlled substances via telehealth only after conducting an initial in-person examination of the patient. Ongoing in-person examinations are required every three months for the duration of the prescription.

SOURCE: MassHealth All Provider Bulletin 281, p. 2, Jan. 2019. (Accessed Sept. 2021).

Out of State Providers

No Reference Found

Overview

Massachusetts introduced major revisions to the state's Medicaid telehealth policy that took effect in January 2021 and established coverage for health care services, and parity for behavioral health services. Massachusetts has also revised its definition of telehealth in statute. Even though the new definition of telehealth includes remote patient monitoring, there is not yet evidence that Medicaid is implementing RPM reimbursement at this time. Additionally, MA Medicaid Bulletins do not yet reflect the expansions to telehealth reimbursement made in law, with the latest one on permanent policy being dated January 2019. Based on official Massachusetts's government public releases related to the new law, the MassHealth telehealth expansion of primary care and chronic disease management will expire in two years.

SOURCE: Massachusetts Office of Governor. (Accessed Sept. 2021).

Remote Patient Monitoring

POLICY

No Reference Found

CONDITIONS

No Reference Found

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

No Reference Found

Store and Forward

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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Massachusetts State Telehealth Laws - CCHP

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Health care services provided via telehealth shall conform to the standards of care applicable to the telehealth provider's profession and specialty. Such services shall conform to applicable federal and state health information privacy and security standards, as well as standards for informed consent. SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Sept.

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I liked this inphographic as it describes the different components and definitions of tele-health and telemedicine. I believe a lot of people use the terms interchangeably but there is a difference. Telehealth is more of an umbrella term that includes the technology and services provided, while telemedicine is the actual clinical care that is provided. As it is stated in the infographic, telemedicine is a form of tele-health.

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Information Health Technology Put to Use 

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Information Health Technology Put to Use 

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This CDC page is an example of how HIT can put public data to use. This particular page found on the CDC is from its COVID-19 Data Tracker. One is able to access weekly COVID-19 cases and deaths by geographic location. It can be further broken down by age, race, and sex.

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Meaningful Use of an EHR: What Meaningful Use Is & How It Can Save You Money

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The US Health IT market for EHR/EMR systems is generally dominated by a group of large EHR companies such as Cerner and Epic Systems. These companies are producing excellent EHR solutions for all sorts of medical practices and large hospitals, but there are other vendors in the market who are offering quality EHR/EMR systems at far lower costs and more customizable functionalities. So, here is a list of top 10 EMR software for 2020 according to the software experts at EMRFinder who have ranked various EHR systems according to their number of physician practice implementations.

The ambulatory healthcare EHR technology provided by Allscripts is an open-platform EHR solution developed to consolidate all clinical information sources into a single reliable and connected network. Allscripts EHR is focused on streamlined administration, care coordination and electronic prescribing (e-Rx), and prioritizes optimizing patient-physician interaction. The system also offers integrated clinical and financial solutions that mitigate the administrative burden on clinicians and free up time for patient care.

athenahealth offers physicians a Cloud-based EHR Software that is easily accessible from any location. The system offers Health IT support to multiple specialties such as Urology, Family Medicine, Cardiology Nephrology, & Pediatrics. athenahealth also features an integrated Practice Management module designed to simplify the medical billing and administrative operations of medical practice. The EMR solution also includes features such as built-in specialty clinical content and e-Prescribing (e-Rx).

Developed by Cerner, PowerChart is an Ambulatory Care EHR that provides integrated financial and clinical solutions focused on cost and time-efficient healthcare delivery, that effectively meets regulatory requirements while optimizing patient outcomes. The system supports over 40 medical specialties and also offers a Patient Portal to boost patient engagement through secure messaging, clinical information viewing, appointment scheduling, and built-in patient education resources.

Epic Systems EHR features a comprehensive patient health record system designed to enhance patient safety, optimize efficiency, and to reduce cost. The main motive behind all this is to improve patient health outcomes. The system offers personalized applications and workflows that fit clinician's needs. The clinical decision support and predictive data analytics tools embedded in the software further assist clinicians in their daily tasks. Epic also offers mobile apps that ensure that patient information and other support tools are always immediately accessible to providers no matter where they go.

Practice Fusion is a cost-free cloud-based EHR system offering features such as customizable templates developed to reduce information re-entry through shortcuts, e-prescribing (e-Rx) to boost medication accessibility to patients, and automated 'favorite' lists that allow clinicians to review frequently-used orders. Practice Fusion's EHR further offers services such as insurance eligibility confirmations, automatic patient appointment reminders and HIPAA-compliant electronic faxing. All these services are also available on smartphones and handheld devices such as tablets or iPads.

AdvancedMD is a Cloud-based EMR and Practice Management (PM) solution offering clinicians an industrial-grade computing experience. The system offers secure access, speedy processes, and quality customer support. The web-based nature of this software keeps you away from paying any extra software installation and maintenance costs. Quality Features of this system include Documentation, Scheduling, ePrescribing (e-Rx), Revenue Cycle Management (RCM), and Financial Reporting.

This system is a complete ambulatory EHR suite featuring Electronic Medical Records (EMR), Practice Management (PM) and Revenue Cycle Management (RCM) solutions along with quality tools such as patient portal and e-prescribing. The system allows clinicians to electronically develop patient medical charts via an extensive library containing specialty-specific terminologies. The software is also supported with customizable templates, macros, SmartFields, and other tools allowing providers to complete a patient medical record in less than 90 seconds.

Prime Suite is an integrated EHR and practice management system offering administrative, clinical, data analytics and financial features to medical practices. The administrative duties of this system range from documentation to reporting. Quality Features of this system include specialty-specific templates, single-sign-on for practice staff for both modules, patient engagement, integrated speech-to-text mobile apps, and data analytics solutions. The EHR system prioritizes regulatory preparedness to assist clinicians to meet federal medical reporting requirements, usability and data reporting and aggregation for value-based payment programs.

Designed by physicians in collaboration with IT experts, NextTech gives the central focus to patient care. It serves over 90,000 providers in the US alone and offers them interoperability solutions designed to boost data sharing and optimizing coordination of healthcare between providers, health registries, patients, payers, and other healthcare organizations. The system further empowers medical practices with clinical solutions such as population health and patient engagement and aims at improving care quality across the healthcare continuum.

Kareo is a web-based Electronic Health Record (EHR) and Practice Management (PM) solution that also offers dependable Revenue Cycle Management (RCM) services. This Health IT system is ICD-10 ready and Meaningful Use Stage 2 Certified and has been built to be customizable and easy to use. It features a comprehensive dashboard, electronic superbills, allows simple charting, supports e-prescribing (e-Rx), lab interfaces, an integrated patient portal, and even offers a secured messaging system designed for enhanced interoperability.

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The US Health IT market for EHR/EMR systems is generally dominated by a group of large EHR companies such as Cerner and Epic Systems. These companies are producing excellent EHR solutions for all sorts of medical practices and large hospitals, but there are other vendors in the market who are offering quality EHR/EMR

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Benefits of Clinical Decision Support Tools-Inferscience

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I found this infographic interesting as it breaks down laws protecting health and education information. HIPAA refers to a patient's health information/ records and FERPA refers to a student's education records. It spells out the specific information that is protected and who can access it.

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Initially, when I heard "informatics", I became intimidated because my mind jumps to computers and technology, which are both intimidating to me. I found this video interesting and helpful because it demonstrates how bedside nursing skills are transferable to nursing informatics. While I'm not a bedside nurse, I often wonder how one makes the transition into informatics. This video describes how nursing skills such as strong communication, multi-tasking and problem solving provide a platform for success in informatics.

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Nursing Informatics: 3 Bedside Nursing Skills You Use As an Informatics Nurse #nursing

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Demand & Growth in the Healthcare Analytics Market

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Demand & Growth in the Healthcare Analytics Market

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This article caught my attention as it highlights the power of healthcare data analytics. This market is projected to grow by $37.39 billion by 2026. One of the driving forces in this growth is big data and healthcare analytics. Key sectors that are in high demand are security products, easy access to data and patient information management. One concern, however, is data security and may be a factor in slowing the projected growth down.

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NEW YORK, Nov. 26, 2021 /PRNewswire/ -- Technavio's latest research report on the Healthcare Analytics Market offers a comprehensive analysis of new product launches, the latest trends, drivers, and challenges. The healthcare analytics market is expected to grow by USD 37.39 billion, progressing at a CAGR of 21.11% from 2021 to 2026. 39% of the market's growth will originate from North America. The US is the key market for healthcare analytics market in the region. The demand for security, easy access to data, and the need for effective patient information management will facilitate the healthcare analytics market growth in North America.
For more insights on the healthcare analytics market - Download a free sample now! Market Dynamics
Factors such as the growing interaction of big data with healthcare analytics, increasing pressure to curb healthcare spending and improve patient outcomes, and the growing capital investments will drive the growth of the Healthcare Analytics Market. However, increasing data security and privacy concerns might hamper market growth. The holistic analysis of the drivers will help in deducing end goals and refining marketing strategies to gain a competitive edge.
Company Profiles
The healthcare analytics market is fragmented and the vendors are deploying organic and inorganic growth strategies to compete in the market. Some of the companies covered in this report are Allscripts Healthcare Solutions Inc., Cerner Corp., Health Catalyst Inc., Inovalon Holdings Inc., International Business Machines Corp., McKesson Corp., Medeanalytics Inc., Oracle Corp., SAS Institute Inc., and UnitedHealth Group, etc.
Few Companies with Key Offerings

Allscripts Healthcare Solutions Inc. - The company offers healthcare analytics through its business unit Veradigm.

Cerner Corp. - The company offers a healthcare analytics solution named HealtheAnalytics.

Health Catalyst Inc. - The company offers healthcare analytics through its data operating system.

Competitive Analysis
The report includes the competitive analysis, a proprietary tool to analyze and evaluate the position of companies based on their industry position score and market performance score. The tool uses various factors for categorizing the players into four categories. Some of these factors considered for analysis are financial performance over the last 3 years, growth strategies, innovation score, new product launches, investments, growth in market share, etc.
Market Segmentation

By Deployment, the market is classified into Cloud-based and On-premise. The Healthcare analytics market share growth by the cloud-based segment will be significant

By Geography, the market is classified as North America, Europe, APAC, South America, and MEA. North America will have the largest share of the market.

Related Reports
Healthcare Revenue Cycle Management (RCM) Software Market -The healthcare revenue cycle management (RCM) software market has the potential to grow by USD 27.43 billion during 2021-2025. Download a free sample now!

Laboratory Information Management System (LIMS) Market -The laboratory information management system (LIMS) market has the potential to grow by USD 637.40 million during 2021-2025, and the market's growth momentum will accelerate at a CAGR of 10.04%.Download a free sample now!

About Us
Technavio is a leading global technology research and advisory company. Their research and analysis focus on emerging market trends and provide actionable insights to help businesses identify market opportunities and develop effective strategies to optimize their market positions. With over 500 specialized analysts, Technavio's report library consists of more than 17,000 reports and counting, covering 800 technologies, spanning across 50 countries. Their client base consists of enterprises of all sizes, including more than 100 Fortune 500 companies. This growing client base relies on Technavio's comprehensive coverage, extensive research, and actionable market insights to identify opportunities in existing and potential markets and assess their competitive positions within changing market scenarios.
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SOURCE Technavio

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Healthcare Analytics Market to grow by USD 37.39 billion from 2021 to 2026 |Evolving Opportunities with Allscripts Healthcare Solutions Inc. & Cerner Corp. |17000+ Technavio Reports

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Technavio's latest research report on the Healthcare Analytics Market offers a comprehensive analysis of new product launches, the latest trends, drivers, and challenges. The healthcare analytics market is expected to grow by USD 37.39 billion, progressing at a CAGR of 21.11% from 2021 to 2026. 39% of the market's growth will originate from North America.

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Insight on COVID Breakthrough Infections Using Big Data

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Insight on COVID Breakthrough Infections Using Big Data

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Through the collection of big data from various US hospitals, Truveta was able to identify patterns of breakthrough COVID infections in 1.7 million chronically ill, fully vaccinated patients. These patients were immunocompromised, or suffered from diabetes, chronic lung disease or kidney disease.  It was found that these patients are nearly twice as likely to be hospitalized from breakthrough COVID-19 infections than the average vaccinated population. This article exemplifies how big data collection can be used to inform healthcare.

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Truveta, a startup that pools and analyzes patient data for research and drug development, launched its platform Tuesday with $200 million in funding and new research on COVID-19 breakthrough infections.

Created earlier this year, the company is backed by 20 health systems including big names like Tenet Health, Providence and CommonSpirit Health, representing more than 16% of patient care in the U.S.

The Seattle-based startup collects and sells data from its provider groups, with the information normalized and de-identified to protect patient privacy and security.

The startup previously landed $95 million in its series A funding round in July. At its launch Tuesday, the company said its total funding had risen to $200 million.

Truveta uses machine learning to structure clinical data into an FHIR model for faster insights, and the platform updates daily with new data.
RELATED: Tenet, Providence, other health giants band together to form new health data startup
The company also released insights from COVID-19 data collected from the partnering health systems. Due to the siloed nature of clinical data in the U.S., many decisions made for managing the COVID-19 pandemic relied on data from other countries that may not reflect the country's diverse population, said Terry Myerson, Truveta CEO and former Microsoft executive.

"With the moral imperative to address this significant gap, Truveta was born from innovative health systems who came together to deliver an unprecedented national dataset for U.S. health," he said in a statement. "Now, Truveta is sharing the first COVID-19 insights in the U.S. using real-time data, representing a major step forward in realizing our vision of saving lives with data."

An analysis of 1.7 million fully vaccinated patients on Truveta's platform showed vaccinated people with diabetes, chronic lung disease or chronic kidney disease or who are immunocompromised are nearly twice as likely to be hospitalized from breakthrough COVID-19 infections than the general vaccinated population.

The startup also found that 9% of Pfizer vaccinated patients and 15% of Johnson & Johnson vaccinated patients who have COVID-19 breakthrough infections are hospitalized.
RELATED: Health systems-backed Truveta lands investment from Microsoft, cloud partnership
However, adverse events occur in less than 1% of fully vaccinated patients, the results showed, meaning the risk of severe illness due to COVID-19 in a vaccinated person is far less than 1%.

"In just under two weeks, our team was able to ask and answer important medical questions using one of the largest comprehensive real-time datasets of fully vaccinated Americans," said Nick Stucky, M.D., Ph.D., director of clinical research at Truveta and an infectious diseases physician at Providence Portland Medical Center. "I'm energized by the opportunity the Truveta Platform can offer to physicians like me and clinical researchers around the world to discover solutions to health problems at new levels of speed and accuracy. We invite other researchers to join us to explore and expand on these insights."

Truveta plans to continue to expand its platform in the coming months. The startup announced a partnership with Microsoft in September to use its Azure cloud for Truveta's clinical data platform.

Microsoft also invested an undisclosed amount in the startup.

The tech giant, along with other big tech players like Google and Amazon Web Services, has continued its push into healthcare with this partnership and other strategic moves to provide cloud computing and data storage technology to hospitals and health systems.

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Truveta's health data platform launches with $200M, insights on COVID breakthrough infections

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Truveta was created earlier this year by some of the country's biggest health systems to pool and analyze de-identified patient data. Tuesday, the platform launched with $200 million in funding and new results from an analysis of those patient data on COVID-19 breakthrough infections.

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I found this video helpful as it demystified informatics and the use of technology and data collection in healthcare. Butte uses the example of the collection of diabetes medication data for all of the patients treated across the UCLA medical campuses. The data is collected and manipulated to project all of the treatment possibilities and trends in medication management in those with Type II diabetes.

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What Happens When We Mix Real Doctors, Big Data, and AI? | Atul Butte | TEDxHarkerSchool

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This video summarizes The Cures Act, when it was implemented and what it entails. This act is an effort to improve patient health outcomes, allowing them access to their electronic medical records. It also facilitates the sharing of medical information between patients and providers, empowering patients to be active participants in their care.

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Wellness 101 Show - What is the Cures Act

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While IoT in medicine has made major advances, data security continues to be a concern. Healthcare facilities are a hot spots for ransomware attacks and security breaches due to the nature of the information stored on its systems. Many hackers are using this sensitive stolen information to gain access to government health benefits, obtain prescription medications, etc. I found it interesting that the average cost for a healthcare facility to fix a security breach is about $408 per health record. Even though IoT is a major advance and could hugely benefit healthcare, it's scary to think of how vulnerable healthcare facilities are to attacks, given the sensitive nature of the data they store.

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Over the month of March, nearly one million people in the United States had their medical files exposed in data breaches, according to HIPAA Journal. And after a ransomware attack forced a medical center in Michigan to close it is evident that healthcare organization's become an attractive attack target among hackers.

The reason for that is clear: the vast amounts of personal information that hospitals and other healthcare organizations store and transfer electronically. This valuable data can be used to obtain expensive medical services and prescription medications, as well as to fraudulently acquire government health benefits.

The proliferation of IoT medical devices (IoMT) will increase security vulnerability in hospitals and clinics in an proportionate manner. This means that a new paradigm is required in order to provide full threat prevention to these organizations

Make no mistake... IoT devices make our lives easier. Smart home technology, for example, can help users improve energy efficiency by enabling them to turn appliances on and off with the tap of a touchscreen. Likewise, organizations across all industries have also rapidly adopted them to improve operational efficiency.

However, in our recent report into Cloud, Mobile and IoT platforms, IoT devices were recently identified as one of the weakest links in an IT network.
Why is this?

IoT devices are often built on outdated software and legacy operating systems that leave them vulnerable to attack.

IoT devices are increasingly collecting and storing vast amounts of data which makes them an attractive target for cyber criminals.

IoT devices serve as an easy entry point for attackers looking to move laterally across an IT network and gain access to more sensitive data. Alternatively, the device could be attacked directly and shut it down to highly disruptive effect.

The healthcare industry is one industry in particular that has moved towards the Internet of Medical Things (IoMT) in a big way. By some estimates, 87% of healthcare organizations will have adopted IoT technologies by the end of 2019 and there will be almost 650 million IoMT devices in use by 2020.

Take ultrasound machines, for example. Ultrasound technology has made huge advancements over recent years to provide patients and doctors alike with detailed and potentially lifesaving information. Unfortunately, though, these advancements have not extended to the IT security environment in which these machines sit, are now connected to and transfer images within.

Check Point Research recently highlighted the dangers this could pose by getting their hands on an ultrasound machine and investigating what takes place under the hood. They discovered the machine's operating system was Windows 2000, a platform that, like most other IoMT devices, no longer receives patches or updates and thus leaves the entire ultrasound machine and the information it captures vulnerable to attack.

Due to old and well known security gaps in Windows 2000, it was not difficult for our team to exploit one of these vulnerabilities and gain access to the machine's entire database of patient ultrasound images.
Video Demo of Hacking an Ultrasound machine The Financial Motivation for Attack
Cyber attacks on hospitals occur on an almost weekly basis. The latest example being that of a ransomware attack on the Melbourne Heart Group which saw the hospital's data scrambled by hackers and held to ransom. Other significant attacks seen last year include Singapore's health service, SingHealth, suffering a massive data breach that saw the Prime Minister's health records stolen followed by 1.4 million patient records stolen from UnityPoint a few weeks later. In addition, May 2017 saw the massively disruptive WannaCry attack that caused 20,000 appointments in the UK's NHS to be cancelled and over £150 million spent on remedying the attack. Interestingly, it was unpatched Windows systems that lead to such damage.

However, it is primarily not mass disruption that motivates cyber criminals to target the healthcare industry. Due to the vast amounts of personal information that hospitals and other healthcare organizations store and transfer electronically, these institutions make for attractive targets to attack. This valuable data can be used to obtain expensive medical services and prescription medications, as well as to fraudulently acquire government health benefits. It is no wonder then that this information can fetch as high as $60 per record on the Dark Web.

Although there are many articles describing the personal danger of cyber attacks to patients, the financial damage is far more realistic and is what lies at the heart of cyber attacks on the healthcare industry.

According to the Ponemon's Cost of Data Breach Study, at $408 per health record, the healthcare sector demands the highest cost by far to remedy a data breach. This stands in contrast to the average of $225 per record paid by other organizations. These costs include fees to investigate and repair the damage caused by an attack as well as paying fines or ransoms or any stolen funds themselves. Attacks can also result in a loss of patient records and information as well as cause long-lasting damage to the health institution's reputation.
The Security Problem
The risk of a cyber attack on healthcare organizations is huge. Such attacks could lead to loss and sharing of personal data, altering a patient's medical information regarding medicine, dosages, etc and hacking of MRI, ultrasound and x-ray machines in hospitals.

The critical nature of healthcare environments also means that many of those involved in the healthcare process often require immediate access to patients' data across a large range of devices and applications. As a result,

downtime to update or patch systems is not an option that is easily afforded. In addition, this large range of medical devices from many different manufacturers makes for an IT security manager's nightmare to not only monitor them but also integrate a security policy that incorporates them all.

From the hospital management's perspective, downtime to update or patch systems not only affects the operational flow of the hospital itself but can also hit their financial bottom line too. Having spent very large amounts on important healthcare equipment, it is vital that management sees a return on their investment by having that equipment up and running in order to be able to cover their costs through claims from patients' medical insurance policies.

From a regulatory point of view, the inherent vulnerabilities that come with operating healthcare devices, such as a lack of encryption of sensitive data as well as hard-coded or default login credentials, prevent IT professionals from even implementing security patches, should such patches even exist.
The Secure Solution
The above mentioned security vulnerabilities highlight the importance healthcare organizations must place on their IT security posture. While there are still issues and vagueness when it comes to security protocol standardization across Internet of Medical Things (IoMT) devices, there is still much that healthcare organizations can do to protect their patients' data.

Healthcare organizations must remain alert to the multiple entry points that exist across their network. There can often be hundreds, if not thousands, of devices connected to the IT network, any one of which containing security vulnerabilities in either the hardware of software used by such devices. Catching every one of these vulnerabilities is impossible, however, so it is essential healthcare organizations have an advanced prevention security solution in place to catch the inevitable attacks that will attempt to exploit these vulnerabilities.

In addition, segmentation can never be overstated. Separating patient data from the rest of the IT network gives healthcare IT professionals a clearer view of network traffic to detect unusual movement that might indicate a breach or compromised IoMT device. Segmentation would also enable these organizations to prevent data stealing or encrypting malware from propagating further across the network and instead isolating the threat.

Finally, segmentation should also apply to healthcare personnel within the organization with access to those systems provided only to those who actually require them to carry out their roles.
Conclusion and Takeaways
The benefits that connected medical devices offer cannot be ignored. They provide patients and healthcare providers with potentially life-saving information and enable an efficient way of handling this information. However, healthcare organizations must be aware of the vulnerabilities that come with these devices that increase their chances of a data breach. Network segmentation is a best practice that allows IT professionals in the healthcare sector the confidence to embrace new digital medical solutions while providing another layer of security to network and data protection, without compromising performance or reliability.

Once best practice cyber hygiene is implemented and enforced, IT security teams can rest assured their patients' records, and in turn their organizations' finances and reputation, are safe.

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Healthcare Breaches Affected Nearly One Million US Patients: The Security Risks of Medical IoT - Check Point Software

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Over the month of March, nearly one million people in the United States had their medical files exposed in data breaches, according to HIPAA Journal. And after a ransomware attack forced a medical center in Michigan to close it is evident that healthcare organization's become an attractive attack target among hackers.

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I found this article interesting because it discussed IoT in terms of healthcare. It notes that as a result of COVID-19 and the stay at home order, IoT came in handy with tele-health visits. There are improvements that are much needed in terms of interoperability with other systems in order for IoMT to be effective post pandemic. Another aspect that was discussed was the evolution of IoMT to be more predictive and not just informative, meaning IoMT devices could be used in primary prevention.

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The Internet of Medical Things (IoMT), a subset of Internet of Things (IoT) technologies, comprises inter-networked devices and applications used in medical and healthcare information technology applications. IoMT devices connect patients, doctors and medical devices - including hospital equipment, diagnostic gear, and wearable technology - by transmitting information over a secure network.

Much like general IoT devices, IoMT, also known as healthcare IoT, uses automation, sensors and machine-based intelligence to reduce reliance on human intervention during routine healthcare procedures and routine monitoring operations. By providing patients and providers with enhanced access to a patient's healthcare information, IoMT reduces the need for unnecessary doctor's office and hospital visits. IoMT also lowers costs for both patients and providers.

In 2017, Frost & Sullivan projected that the Internet of Medical Things (IoMT) market would grow at a compound annual rate of 26.2%, hitting $72 billion by 2021. That estimate appears quite low today. The COVID-19 pandemic has driven an exponential rise in IoMT, with quarantine and stay-at-home orders dramatically accelerating trends in telemedicine and telehealth. As the IoMT market matures, telehealth and telemedicine will continue to transform healthcare as we know it, allowing for more thorough and accurate diagnoses, more timely care and cost savings for consumers and providers alike.

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What is the Internet of Medical Things (IoMT)? | Splunk

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The Internet of Medical Things (IoMT) comprises inter-networked devices and applications used in medical and healthcare information technology applications.

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This is a good infographic that explains the difference between EMRs, EHRs and PHRs.