I recently attended an NHS IT Conference – it was about Innovation, new technology, a paperless service and digital technology. They all are right, but the thing that struck me was how everything looked the same as it always has. Vendors displayed their latest versions of tried and tested (old and outdated) software and it all looked just a little bit different from what I saw last year, and the year before. There is a slow evolution going on, like a mountain range moving over eons, while the consumer led revolution that is happening outside seems to have passed the NHS by. How many times do I have to hear “our nurses can’t use technology…”
Now some readers at this point will refer to the examples of Virtual Reality headsets being used for stroke rehabilitation, Augmented Reality for training doctors and the truly amazing work of robotic surgery and they would be right, but this simply highlights the IT Bi-polar disorder that the NHS suffers from.
On the one hand, the NHS leads the world in innovation and has been at the forefront of medical research since its inception.
On the other hand, we have PAS systems, EPRs and EMRs that vehemently uphold the zeitgeist of functioning as no more than a giant unstructured database. These systems suit certain administrators and select members of non-clinical staff and historically, this was fine, as these were the only users interacting with the systems.
Now, however, we see a dramatic shift in the role of IT within the hospital. Unfortunately, this change in function has not translated into a change in functionality.
So back to the title, what do Millennials expect from IT and work? Millennials are reshaping expectations from IT departments and if they don’t get what they believe is a basic human right, they will leave and that is a major issue for an NHS that is already facing drastic staff shortages.
A generation who have known mobile technology all their life are being served by the very people who tell me their staff can’t use mobile devices and new technology.
As much as us millennials hate to admit it, millennial technology is not just for millennials anymore. More mature generations are embracing it in every aspect of their daily lives. The fact that we all, regardless of age, carry smartphones in our pockets when we enter the hospital just accentuates the dichotomy that exists between IT use in and outside our hospitals.
Let’s consider Helen. She’s a highly experienced, dedicated nurse of 30 years. Last night, Helen used her iPad to book her latest well-earned holiday using her credit card. On her way into work this morning she paid for her coffee using her smartphone. After that, she quickly did some internet banking, where she verified her identity with fingerprint technology. As she changed in the changing room, she shared her bank details with her sister who owes her a few quid from last week.
Helen sits down at her desk in the Nurse’s station, and is met with an antiquated, outdated user interface that doesn’t meet her needs. Her patient’s care is siloed and she’s completely cut-off from surrounding hospitals and departments. She and her team resort to paper to fill the gaps produced by the system her managers claim she wouldn’t be able to work without.
Ask Helen to recall a case of patient safety concern caused by lack of data sharing, and she’ll have a plethora from which to choose. Her clinical experience is littered with cases where better communication between clinical staff could have improved patient care. Now ask Helen to recall a case where a patient was put at risk because their physicians communicated with each other too easily, too freely, and with too much fluidity.
There are none.
We live in a consumer led technological revolution. Some of you might be old enough to remember that you got the best gadgets and tech at work, (remember the Blackberry RIM 850?) and personal computing at home was slow, expensive and tied to a cable in the wall.
Now in many industries, the NHS being a case in point, it’s like you watch Colour TV at home and come to work and watch Black & White (Yes TV used to be in Black and White!). There are pockets of great innovation and ideas in the NHS and Doctors love to write Apps, but they often fail to gain widespread uptake and adoption and that is a shame, so we need to look to the wider world and what drives consumer uptake, one word – Usability!
So how do we change this? How do we attract and retain the Doctors and Nurses we need for the future? Caring people enter the profession as a vocation but increasing numbers are leaving when the reality bites. Consumer led, mobile first technology has changed the world and the NHS needs to catch up – it needs to put the needs of its staff at the heart of what it does and given the tools and time they will put patients first; that is the nature of the vocation these people have. Put Millennials on your Board, in your IT Departments and listen to what they need, don’t pretend to tell them what they can have – that is not how the world of Millennials works – if they want a taxi, a pizza, to transfer money, buy cinema tickets, anything… it’s all just a fingerprint scan and a click away.
The pressure on costs seems to be never ending for those involved in the delivery of Healthcare to an ever-aging patient population, especially with increasing co-morbidities and therefore complexities for our clinicians to address. Often the words ‘cost reduction’ are seen as very negative and the view is often that cost reduction will lead to a decrease in the quality of care and therefore the two words quality and cost should not be seen together such as in the title of this Blog!
In the NHS 5 year forward view (1) the definition of quality in health care, includes three key aspects: ‘patient safety, clinical effectiveness and patient experience. A high quality health service exhibits all three.’ Part of the aims of the 5 year view were ‘to narrow the gap between the best and the worst, whilst raising the bar higher for everyone’.
It’s this clinical effectiveness that I’d like to focus on to address the challenge of this Blog. Improvements from clinical effectiveness can come from many areas but as someone who has spent the past 18 years involved in enterprise IT solutions, I passionately believe that good clinical IT systems can save clinicians a tremendous amount of time, help to accurately and quickly diagnose morbidity and support the standardisation of care, all of which should lead to an increase in treatment quality which ultimately leads to a reduction in cost.
In a recent report on variations in care, the Advisory Board found that ‘High-quality hospitals deliver lower-cost care for 82% of diagnoses’ (2). The article goes on to say “Clinical leaders have long sought to improve care quality by reducing unwarranted care variation.” and the article notes that health system CEO’s and SFO’s are actively pursuing the reduction in CVR (Clinical Variation) as a necessary avenue for withstanding the cost pressures on hospital revenues.
So if delivering better quality care doesn’t necessarily mean more expense overall why isn’t everyone achieving this? In his book, ‘Best Care at Lower Cost’, Dr Mark Smith, founder and former President and Chief Executive Officer of California HealthCare Foundation, wrote in 2013 that “about 30 percent of health spending in 2009, was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state”. Dr Smith goes on to say “Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better”.
So we have evidence that higher quality hospitals deliver lower costs and a clear call that better use of data is a critical element in the desire to deliver better care at a lower cost.
Complex enterprise IT systems, EHR’s, EMR’s and EPR’s (select the most appropriate for your organisation but you almost certainly have one) have all promised much, and I truly believe they are part of the digital healthcare solution. However, they are often seen to fail to deliver on the clinical promises that they were sold on.
They can accurately record patient data, albeit often creating a silo of data that then needs to be integrated into yet another larger silo, but clinicians complain that they aren’t intuitive to use and state that they increase the time taken to record patient information, leading to less time available to care for the patient. Often the cost of the software is far outweighed by the cost of deployment and configuration, the latter being seemingly bespoke for each hospital.
Isn’t it time for a system that doesn’t have to be taught each workflow, that gives more time to clinicians by allowing them to interact normally with their patients as part of their consultations and that supports them during that consultation with intelligent prompts? Here at Infocare we believe so.
Junior doctors enter the profession wide eyed, stethoscoped up, and ready to put their years of book-worming to good use. In many cases, however, we find ourselves doing something completely different.
A role less “House” and more “House-keeping”.
As Junior Doctors, we are the file carriers, the blood runners, the phone callers, and the form fillers. We run from wards to A&E departments and back again, occasionally fitting in a patient here and there.
We learn to weave our way around the various IT “solutions” which act only to silo our patient’s information and obstruct our clinical workflow. At some point during all of this, we eventually manage to provide care to our patients, as well as maintain our endless string of exams and competencies.
This is not what we signed up for, it’s not what we’re trained to do, and it’s not what our patients need… so why do we tolerate it?
Why are there so many disgruntled Junior Doctors frustrated with an outdated, disjointed IT system they didn’t create and can’t change, longing but unable to perform the role they’re so desperately needed to fill. I would argue that we have no shortage of Junior Doctors. Instead what we have is, in effect, an excess of medically-trained IT administrators.
Our egos, and perhaps some self-preservation, will tell us we do these errands because we just want to get the job done. We have convinced ourselves that by acting as the sticky plasters required to keep a failing system running, that we are doing a service to those who rely on it. Through years of learned helplessness, we Doctors have given up on trying to change the system and now find ourselves tolerating an IT system that doesn’t work for us.
What other industry would tolerate this?
As seen on a recent BBC program “The Computer Will See You Now”, the world’s biggest IT companies are battling it out to create Artificial Intelligence capable of doing the work of Doctors. While distilling down the Doctor’s role, they came up with three key skills: information gathering, communication, and analysis.
Teams of highly paid professionals devised this list, which you’ll notice has absolutely no mention of secretarial skills or in-depth working knowledge of a hospital’s various login codes.
If IT companies, with billions of pounds at stake, have come up with this simple list, why don’t we follow suit? Let’s start treating Doctors like Doctors and not IT administrators.
As a Junior Doctor, information gathering is central to my role. It’s also in my interest to make this process look effortless, to keep the façade of coping maintained and to most importantly, never complain. A difficult ask in a system where information is siloed among a myriad of disparate IT systems.
That said, we do complain to each-other. I’ve never sat in a hospital staff room for more than 5 minutes without hearing a complaint from a frustrated colleague. We have (private) Facebook pages, Instagram accounts, online boards and WhatsApp groups dedicated to providing a safe space for junior doctors to vent their frustration. But on the wards we change from keyboard warriors to glorified secretaries, unpaid porters, and prescription pad pen- pushers.
Have we ever stood back to wonder how it got like this? Why aren’t more of us holding our hands up and saying “enough” to the latest “solution”? Who among us has recently looked up from the leaking helm to ask who’s steering the ship?
The reason we’re not acting to shape a healthcare IT system that works is because we’re too busy being the sticky plasters holding the current one together. While we login and type and push and pull and phone and phone again, it’s the Consultants, the IT managers, and the CEO’s making the decisions that impact us and our patients most.
So what does a hospital IT system need to do? Ask a CIO and they’ll rattle off a list from their latest tender process. Ask a Consultant and they’ll cite the latest journal articles on optimum Healthcare Information Technology.
Ask a junior doctor, and you’ll get what boils down to one simple answer: Integration.
The CIO has worked hard to provide the hospital with all the solutions it needs. Through working with the consultant, he’s ensured the various solutions are in line with the latest research. The only stakeholders not consulted during this process are the everyday users of these disparate systems: Junior Doctors, Nurses, Pharmacists etc. Sure, they’re invited to
the meetings, but the bitter irony is that these people are far too busy wrestling with the existing disparate systems to offer their input regarding the latest addition. And so the problem deepens.
What do we do? Add another solution to the mix? Definitely not.
We need to add a single solution on TOP.
The one place IT can make the biggest impact remains a niche market, where only a handful of pioneering, physician-led tech companies are based. We don’t need another labs system, we don’t want another clinical portal, and we certainly don’t care which big IT company bought out the other to provide these solutions.
We just want to treat our patients.
What our IT system needs is a common user interface which takes the data from the numerous systems and provides physicians with a one-stop- shop for clinical workflow. A single user interface where we sign in once and have everything at our fingertips. Let the big tech companies figure out the intricacies of data sharing, let the CIO worry about data integrity, and let the Doctors get back to their job: being a Doctor.
Before we implement one more IT solution, let’s answer the silent cries of frontline staff, and make a genuine effort to integrate.
Driven by the Affordable Care Act, which was put into law in 2010, electronic health records (ehr’s) and their usage has soared. According to the Centers for Medicare and Medicaid Services statistics, approximately 95% of hospitals and over 60% of ambulatory practices attested for meaningful use in 2016 using a certified EHR. Out of the drive for EHR adoption, came the need and desire for Point of Care (PoC) documentation. PoC documentation provides the ability for clinicians to document patient findings and assessments, as well as plans of care while at the patient’s bedside or while in the exam room. Documenting real time while interacting with patients, creates many benefits as well as some challenges. Nearly all electronic medical record vendors supply some form of PoC Documentation which is defined as documenting the patient’s clinical findings while in the room with the patient or at their bedside.
PoC documentation provides numerous benefits to both clinicians and patients. Integrity and accuracy of data is increased by entering it “real-time”. No longer is there a need for hand written notes or simply to “remember” the details of the patient interaction. Timeliness of making the patient’s encounter findings available is also improved as documentation is immediately made available to other care givers, which is critical in settings where patients are attended to by multiple disciplinaries within the same encounter.
Efficiencies in assessing and billing are improved due to both accuracy and timeliness. By providing the appropriate tools at PoC, Providers (who are the most qualified to enter problems and diagnosis) can complete the documentation potentially eliminating downstream adjustments to visit diagnosis. PoC also increases the speed of getting such information to billing for processing and submission.
As healthcare moves closer to a shared risk, pay for quality model and farther away from a fee-for-service model, management of the patient’s problem list and degree of “sickness” will become more critical. Contracts will be executed based on the “sickness” level of a population and if not accurately described by the problem list, institutions will potentially lose millions of dollars by underestimating the cost for caring for their population. By providing PoC documentation, providers and other care givers can be provided with the tools to quickly and accurately manage patient risk scores and measures of estimated care which are needed from a financial perspective.
In many instances, PoC documentation systems are not user friendly. They require too many “clicks” to navigate, information is buried and difficult to obtain and tools are difficult to use to capture critical patient information. Obstacles such as these serve only to undermine the benefits as described above. Studies have shown that providers spend more than 50% of their clinic day using the EHR as opposed to interacting with the patient. Too much time is spent on finding information while trying to describe what is currently going on with the patient.
Also access to the EHR can cause problems. Firstly having to find a workstation and then traditional workstation setups require the provider to turn their back to the patient in an attempt to document the findings
In order to achieve the benefits of PoC documentation and minimize the obstacles for adoption, healthcare IT vendors must take responsibility in creating tools and applications that allow providers and other clinicians, the ability to document easily and efficiently at the PoC. It is critical that the right information at the right time or the right place is made available. No longer should users have to hunt for information but rather it should be immediately in front of them and even predictive in nature.
PoC solutions must also be flexible in their approach. The user should not have to adapt to the system but rather the system should adapt to the user. Making documentation flexible and adaptive to changes of circumstances is a critical feature. Templates should be flexible enough to allow the user to adapt to the data collected through the patient consultation without requiring the user to switch “templates”. It must also be intelligent in predicting the needs of the users. Certain diagnosis and problems generate the need to review specific data. The system should be intelligent enough to present that data to the user at the appropriate time and place without intervention from the user.
These systems must also provide a number of different entry mechanisms. These include point and click, typing, voice to text, copy and paste and conversion of handwritten to text. Providing the correct choice for users will minimize the need for dictation methods which although complete the documentation, provide no benefit for discrete data collection or analytics. Systems must also provide a variety of platforms from which the user can gain access. Waiting for a terminal at the nurses’ station or having to login to workstations in every exam room provides workflow complications that potentially slows the care delivery system. Users must have the flexibility to utilize mobile devices as well as workstations in order to complete their work.
As artificial intelligence develops and the requirements of taking care of our patients in a safe, efficient and cost-effective manner increase, it is critical that we continue to look for future development and improvement in the solutions that are being offered.
Year in and year out we have been used to hearing about the winter pressures that the NHS and indeed, other Healthcare systems are facing. We predict them in advance and then respond to them with the funding available, often with annual re-occurring emergency funds (how often does an emergency fund have to re-occur yearly to be considered as normal funding?). Targets for A&E waiting times of 4 hours for 95% of patients are quietly put to one side as the immediate challenges are met with the stoic attitude of ‘best foot forward’, ‘let’s get through this’ and ‘we can rest in between winter seasons.
The reality is though, that as measured since 2011 by the Kings Fund, the UK’s performance to the 95% target has continued to decline to the point where for a type 1 A&E (A consultant led 24 hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients) we are at 77% of that target during the winter pressures and around 85% at other times. And as you can see from the graph this is declining year on year.
There used to be a collective sigh of relief as we climbed out of the busiest periods during the cold winters into the welcoming spring days where everything seemed so much brighter, patient numbers tailed off seemingly in proportion to the hours of sunlight in the day and the pressure was able to be released until later in the year when Autumn brought the reverse effect and everything started again.
But chat with the heroes of our A&E departments today, as well as the rest of the hospital clinical staff (A&E are the gatekeepers, but what happens downstream is directly related to what happens in A&E) and they will tell you about a worrying change over the past couple of years which is perhaps reflected in the overall downward trend of the statistics above. Simply put, there isn’t the recovery period anymore, it doesn’t slacken off, there is no chance to take a breath, they simply grin and face the next crisis.
This then of course means that as A&E is the primary entry point for emergency admissions into the hospital (71% in the UK in 2013), that all wards downstream of A&E are also being pushed to stretching point.
There is also another dimension to these statistics, nationally in the UK in 2013 patients were recorded as receiving no treatment or advice only in approximately 47% of attendances at A&E departments and no investigation in 41% of attendances. Furthermore, reviews have concluded that between 38% – 47% of visits to A&E could have been dealt with by a Primary Care visit instead of a visit to A&E. When you couple this with the knowledge that by percentage of visits, GP’s are referring less and less to Secondary Care, then you can see why a big focus of the NHS Forward View is around Primary care and which promises to deliver ‘more convenient access to care, a stronger focus on population health and prevention, more GPs and a wider range of practice staff, operating in more modern buildings, and better integrated with community and preventive services, hospital specialists and mental health care’
The eHealth Ireland strategy of ‘Shift left, stay left’ mirrors this and ‘advocates innovative technology solutions to support specialised, integrated care from acute settings to community to a home setting more quickly or to avoid trips to hospitals at all’. This borrows heavily from IT terms to create a ‘Moore’s law’ for Healthcare in Ireland by shifting services from Acute to Primary/Community and Home Care with a desire to focus on prevention/proactive Healthcare in the future. It remains to be seen how the monolithic procurements of the past will make way to allow this innovation to take place….
So how are we doing with this shift in thinking from Secondary Care to Primary Care?
Well for example, in England I recently needed to seek out of hours (weekend) treatment for a medical issue that wouldn’t wait till my GP surgeries still archaic opening times (8 – 6 Monday to Friday, non-urgent appointments bookable online by prior arrangement (typically in 2 weeks’ time), emergency appointments by phone, 1 person answering the phone, normally a 30 min wait, no call back facility. I called NHS Direct on 111 and after answering the various questions they decided that they wanted me to be seen by a Primary Care Physician within 4 hours. They then contacted the local Urgent Care Centre (5 miles as opposed to 30 miles for A & E) who contacted me within the hour with an appointment time in 2 hours time.
So, it’s a failure for my local GP and a success for the 111 telephone service and an example of an Urgent Care pathway rather than a more expensive A&E visit? Not quite, you see although the diagnosis process and waiting time (essentially in my own home till it was time to drive to the Urgent Care Centre for my appointment) was very efficient when compared to waiting 4 hours in a drafty A&E department, what didn’t work was the flow of information. My Urgent Care Centre was ready for me and dealt with me quickly and efficiently but didn’t have a clue what was wrong with me in advance as none of my records were available to the clinician who finally treated me. Worse still when I did finally visit my GP to renew my prescription, they knew nothing about either my 111 referral or the treatment I got at the Urgent Care Centre (less than a mile away from the GP surgery).
So, a failure in integration? As a previous Blog mentioned, no Junior Dr to run around making sure that all of the relevant information, forms and results were available for all concerned! I do think that the concept of moving less ill patients away from the Acute setting to Primary or Community is a good one, but we have to start understanding that integration, not building bigger data silos, is going to be at the heart of the challenge and we have to ensure that if we want to innovate to address these problems then we have to find a different way to evaluate the solutions available, that doesn’t see yet another purchase of dated, monolithic IT solutions that are expensive to procure and even more expensive to make work, without a Junior Dr running around to provide the integration.
Only a few years ago, conversations around ‘who owns the patient record’ were not such a big issue, nor as widely discussed. If anything, it rather related to physician data ownership than recognising the voice of the patient. For a long time, I never even knew that I could ask for access to my record, or that of my children, let alone demand access to it!
I have full control over my personal bank account; I can access it wherever, whenever. I can use most ATMs worldwide, or even do banking whilst paying for my milk. My card, my bank app and online accounts give me the freedom to bank with ease whilst being 100% informed and up to date – what bliss! It is simply preposterous that I never knew I could demand the same for my health and well-being.
The new reality is that we, the consumer, will be managing our own health records. We will be given the opportunity to navigate the health care system at last – see provider options, choose who we will make an appointment with, possibly rate providers and their service (at last!), be allowed to make more informed choices around the plans of care we embark on, share experiences peer to peer as well as motivational encouragement, whilst also understanding health insurance benefits and costs. But how far away from this new health ecosystem are we currently?
Healthcare needs to adopt and learn from other industries how to personalise care and interlink healthcare experience.
Too often, our care is not well coordinated. Providers do not cross over; rarely ensure that proper communication or data sharing occurs. We do not readily have access to unbiased research we can trust, showing us which treatments are most effective, which medications could provide which benefits or possibly effect us negatively. Everyone seems to assume the new expensive drug or treatment is the way to go, because the Dr said so, or was it just Big Pharma propaganda? Financial kickbacks? How did it affect my peers on a similar health journey as myself? How did others experience the care from this particular provider putting me on this care pathway? Actually, thinking about it, where does all the money go?
A study from the Institute for New Economic Thinking published in May 2017 states that Americans now spend over $3.3 trillion a year on healthcare, roughly $10.000 per person per year . The statistics also suggests that one in every three dollars go to unnecessary tests, over priced drugs and treatments that provide little or no benefits at all. This waste disaster was substantiated through nearly three decades of research by Doctors at Dartmouth’s medical school . Others, including McKinsey, the New England Institute of Medicine, and Dr. Donald Berwick, former acting director of the Centers for Medicare and Medicaid, confirm their estimate: 30 percent of the money we lay out for medical products and services does nothing to improve patients’ outcomes . I find this quite alarming!
Some interesting findings showed that the ordering of more tests and surgeries did not have any positive effect on patient outcomes. Everyone is aware that medical spending is rising, with an ageing populating, it is expected that by 2050, one-fourth of the population will be aged 60+ in all major areas of the world except Africa . In all countries, both health and long term care will drive up public spending.
When you start reading up on the shift in healthcare delivery taking shape, it seems to put the consumer at the center. As the world changes rapidly, it will be looking towards disruptive, innovative technologies to support more cost effective healthcare delivery options. At the same time empowering the patient for active engagement to handle the prospects of longer term care over population lifespans, which includes social networks, lower cost digital, mobile and tele-health expansions.
As we become more informed, more included in our healthcare delivery process, do we stand at the door of a revolution? We will know more about our own health track record, we will understand more about our medications, what they do for us, why we use them and what others have said about using them, we will have more access to clinical networks that we like engaging with, so that we can care for ourselves better, even if purely remote. We will hopefully make smarter choices, which are more informed and better managed. I foresee that this will truly overturn the current health system globally.
It all sounds terribly positive, indeed it sounds like we are on the verge of a breakthrough, were it not for the huge barriers to actually obtain and share my record between different providers.
There are many problems in giving patients access to their records, and disruptions occur due to patients experiencing delays in getting hold of or transferring medical record between providers, or possible even incurring cost. Despite the adoption of expensive EHR, EMR systems, that should allow the access to my digital record, it almost never happens and interoperability is still just a term being used very flippantly in PR talk. Even in 2018, it could take months for patients to get real usable data from one provider to the next, even in the same demographic area, possibly even using the same medical record system. Plus patients do not receive the necessary verification or information to assist them in understanding the information received. This makes getting a second opinion really difficult, or trying to research conditions or alternative treatments, thus making it difficult to engage and take ownership of our healthcare decisions. Also, care providers only release some or parts of the information. Some patients are even pushing to receive their labs information at the same time as the provider and do not want to receive filtered information.
As costs of healthcare rise (including huge increases in my medical insurance) I, the consumer, who am so used to controlling other areas of my life and my personal information and the choices of services I engage with, need more control over my health record. It is predicted that this growing consumer group is likely to become the majority and thus put pressure on the health ecosystems to really start pushing for the change it so desperately needs. Just a few months ago, I was taking part in a workshop where this issue was raised, and I was amazed at how many participants felt very strongly about continued filtering of information to patients.
A case study published by the New York Times , reveals quite the contrary. It follows the story of a businessman in his 50’s that requested a copy of his medical records to bring to a specialist for a second opinion, which he assumed would be straight forward. It took multiple trips to his Dr’s office, the hospital, signing of permission forms, paying for copies that took days, then finding out it was incomplete, more payments, more trips to the providers. The whole situation became terribly negative and he felt that the hospital and providers were trying to make it very hard for him. The rest of the article points to more research studies that concluded positive outcomes for providers and patients that actively engaged with their records and care plans, whilst disproving any of the dreaded pre-conceived ideas of negatively impacting patients to have full transparency of their record.
Taking into account how many providers are still hesitant to open up to us (the patients), it seems some wheels do turn very slowly. I will most definitely be supporting the change we so desperately need, asking our GPs and Providers for access and challenging them to provide it. With access to more information I will be able to understand and manage my own health and that of my family better. Will you?
1/3-It’s Not Just Profit Wrecking American Healthcare, By Maggie Mahar, MAY 15, 2017
When we say AI, depending on your age you will either think of Metropolis, Hal from 2001 or Terminator. What you might not think of is a calculator but in essence AI right now is a computer doing something really really fast – just like a calculator. From little Acorns grow…!
AI is hard to define but the best definition I have seen is this; Computer Looks at loads of data using human defined algorithms – Computer Learns and adapts original algorithms – computer equals Artificial Intelligence. Most of what we see today is only at step one; decision support, image scanning, analytics, etc are using the immense and increasing power of computers to do in seconds what would take humans hours, days even years to do. So that is not to be sniffed at – but is it AI? And more to the point does it matter? Microsoft’s CEO has said artificial intelligence has the potential to “change the trajectory of healthcare” if it can be scaled successfully across the NHS.
He went on to say “It’s not about the whizz-bang technologies, but the people behind it who take this technology and translate it into real action,”
“The biggest proviso is seeing this all, in action – how is the technology all being used? Now of course AI is developing and there are real examples of Computer Learning and without question we stand at the precipice of a huge leap forward in how we use and interact with computers in every aspect of our lives. Amazon seems to know what I want to order before I do, I see suggestions for movies, holidays and recipes pop up on my multiple screens all the time and I think “how does IT know?” – who IT is I don’t seem to know, but IT sure is clever.
It is a worry for many people and we feel that our lives are being invaded, controlled even, but we then appease our fears when we get cheaper goods and services delivered in the blink of an eye. We see and feel the benefit every day across of lives so we feel better about IT. In healthcare we see computers being used every day, throughout every interaction to record data which for years sits in a database, never talking to other databases but at least it’s safely stored away. We are thus more wary of it since we don’t see and feel the same benefit, we also worry about our health data being shared or lost more than losing our credit card details. Whilst we might be happy to use tools to help us keep well and deal with minor ailments the same is not true when we are truly ill or suffering, we need that connection with a person and group of care givers. Healthcare needs Human interaction. So back to Microsoft’s point, how do we use this technology, what role does AI play, will we see automated Doctors capable of a full consultation and diagnosis? For me the answer is Yes and No. Yes it will be capable, but I hope we don’t lose that human connection that we need and grave as a species. AI has the power to aid and assist our care givers, Decision Support for example should be the same as your Doctor sitting down and consulting with the best medical minds in the world, trawling across shared knowledge and learning and coming up with the best consensus diagnosis and treatment plan available. Your Doctor will be able to do that from their tablet in moments via AI, as the data grows so the system learns more answers.
This is a key point, machine learning relies on data to learn and adapt, let alone simply store good answers to questions. Data is spread across multiple systems right now and that is one of the biggest challenges in healthcare today – it is a much discussed topic and so we don’t need to replay it here, needless to say systems must share. Human interaction will elicit the best data possible, through questioning, observing and testing so we must make it easier to record data from multiple sources and input methods into the database feeding AI. Doctors needs to be able to work the way they do now; talk, dictate, type, draw pick lists whilst working with the patient – not with their back turned while they type endlessly into an electronic health record that sits forever in the proprietary system supplied to the Hospital – but at least its electronic and safe right? AI needs to be fed and the best way to feed it is via human and machine interactions. Data from across the care continuum is valuable so long as it is valid and structured so let’s make it easier for Doctors, Nurse and Care givers to record that data at the point of care in a mobile way – the way they live their life outside of work. We don’t have to worry about the term Artificial Intelligence and what it actually means to benefit from the immense processing power IT offers. Furthermore we need to accept that every vendor is going to use AI to describe one part or other of their solution – so what? The one thing we do have to agree on though is that machines, machine learning and AI need to support and enhance human interactions to deliver the most effective and compassionate healthcare system we, as humans, deserve.
It is an irony of the times we live in, that, while the need for securing our data becomes more urgent and the consequences for failing to do so become more dire, the internet is becoming a more dangerous place. The number of companies suffering data breaches has grown steadily over the last 10 years and so has the size and scope of these attacks. Consider the attack in 2017 on Equifax 1 which leaked details of half the American population, or on Marriott 2 which leaked the details of half a billion guests. It is essential nowadays to guard ourselves and our data more carefully and diligently than ever.
Data breaches have real, financial consequences. Sony received a fine of $400,000, while Equifax received one of $660,000 for their failure to protect users. If that doesn’t grab your attention, then consider the eye-watering $148 million fine meted out to Uber by US authorities after a successful attack on their systems in 2016 3. There are other, less tangible consequences for failing to properly secure your systems. The loss of reputation. The loss of customers trust. The very real harm that can be inflicted on individuals whose private medical, or financial data finds its way into the sticky fingers of the highest bidder on the dark web.
So, what can we do to protect systems from these threats? There are many approaches and philosophies, depending on your area of expertise. Since I am a software engineer, I will give my thoughts from this perspective.
Security must be baked into your system from the beginning. It cannot be bolted on at a later stage. It is never too early to start thinking about how to secure your system. There are 4 stages to implementing good security:
This is the phase most people are familiar with. Simply put, it involves preventing unauthorised people from accessing your system. We have all encountered the basic tools of this phase: strong passwords and pin numbers. Or more recently fingerprint scanners and facial ID, as on newer Apple devices. But going deeper, there is a responsibility on designers to protect against the common attacks that are deployed by hackers, such as cross-site scripting or SQL injection. Essentially these are attack’s that target websites or other endpoints that are unprotected and do not prevent rogue actors from executing malicious commands in your system. Geographical fire-walling is another common technique. If your customer is based in Europe, then you should not be allowing computers from China to connect! Tying sessions to IP addresses is a good way of stopping hackers from hijacking an innocent user’s session to infiltrate your network. All these protections are designed to ensure that only people who have a right to access your system and the data it contains, may do so. The result should be a layered system, where, if the attacker breaks through one of your defences (e.g. they acquire a user password), they are still faced with the next wall.
The only thing worse than a breach, is a breach you don’t know about! Apart from making you extremely vulnerable to multiple attacks, you run the risk of a PR disaster when your users first hear about it in the press or from a blackmailer. Any secure system must be able to detect attacks, both successful and unsuccessful. This allows you to respond quickly, assess the damage and close the hole to future intrusions.
Logging is the most basic requirement of a secure system. Log everything! Every logon attempt, every user interaction, every request for data. If something goes wrong then you have a record of what/when/how. Monitoring tools can provide alerts for suspicious activity via emails, texts or instant messaging. If you are lucky you can block the attack before it succeeds. If not, at least you can shut it down quickly and assess the damage. Many countries/districts now have laws in place requiring companies to disclose details of any breaches. Such a task is made much easier if you actually have a record to what happened. To quote a cliché, ‘knowledge is power’, even if sometimes that knowledge is the unpleasant awareness that you are under attack.
However, as the numerous, widely reported breaches in recent years have unfortunately shown, even the best protected systems may be infiltrated. If companies like Microsoft 4 and Sony 5 can be victims of hackers, then it is reasonable to prepare for such an event in your system. Damage control means limiting the harm if a breach does occur.
Encryption is the most common tool here. If a hacker does access your data, if it is encrypted, it is of far less value to them. Never store passwords or security answers in plain text, store them as hashes instead. Then if they are leaked they are of little use to anyone. For extra protection, you can add salt and pepper to the hashes making them even more secure. This means simply adding extra randomness to your encryption to make it harder to crack.
Siloing is another common method for limiting data loss. A well designed system should place different data in different, independent locations or silos. Medical records do not belong in the same database as financial data. Then if a bad actor does gain access to part of your system, they will at least be limited to just the data in the area they breached.
Permissions can also mitigate losses in the event of a successful attack. Users should only have permissions to access parts of the system that are relevant to them. If a user account is hijacked, then the attacker will only be able to access the same areas that the user could, and not the entire system. The end goal is to limit the data lost and the damage done to a system in the unfortunate case that your defences are overcome.
The final link in the armour of secure software is constant re-evaluation. Over time, threats evolve, new ones emerge and the systems they target change. A system that is not maintained cannot stay secure forever, or in today’s world, for very long. It is therefore essential that you constantly re-evaluate your security. Regular penetration testing by an independent expert can test your system to spot any holes that changes or updates might have introduced, as well as testing out new forms of attack to check for undiscovered vulnerabilities. Finding a security issue in your own system is always preferable to a hacker finding it first. This will give you time to fix it before it can be exploited.
At Infocare, it has been apparent from the beginning, that since we were dealing with such sensitive data, security has to be of paramount importance in our designs. The decision to use the iPad for our mobile app, was based partly on Apple’s well known and rigorous security requirements for their devices 6,7. All data stored on the iPad is automatically encrypted and Infocare also adds further encryption on top of this. We use all of the techniques mentioned above, and more to prevent unauthorised access to our system; strong passwords, IP address checking, fire-walling as well as other barriers to intruders. Highly sensitive data like passwords or security answers are never stored in plaintext in our system. Rather they are stored as cryptographic hashes which have been peppered to make them even more secure. All our data is siloed and permission protected. We have extensive logging, making sure that nothing happens in our system that we do not know about and any suspicious activity will immediately trigger alerts for us to investigate. We regularly employ trusted companies to perform penetration testing on the Soteria® system to ensure that it remains as protected as possible.
Data security should never, ever be taken for granted or neglected. The harm that can be done to the individual victims and to the companies they trusted is simply too great in the digital age for us to be anything but at our most vigilant. Soteria® is designed to be a safe, protected system for our users and we strive to keep it that way, whatever the future holds.
“Don’t ask Doctors what they want, they have no idea what they want!”
As a Doctor new to the industry of software development, this statement irked me somewhat. Of course doctors know what they want! As do nurses, pharmacists, and the wealth of other highly-trained professionals working in our hospitals.
More specifically, they know that what they’re currently getting is not meeting their needs.
I came to realise the problem isn’t that Healthcare IT users don’t know what they want, the problem is they don’t know how to communicate their needs to those who are choosing their software for them.
The result is usually a well-meaning buyer implementing an expensive system that infuriates and frustrates the users as it falls short of their poorly communicated needs.
This 5 point checklist is intended to bridge the chasm between these buyers and the end users. When evaluating a new system, it can be applied quickly to avoid headaches down the line. Consider it a form of preventative medicine, for Healthcare IT systems implementation.
Interoperability This is the ability of computer systems to exchange and make use of information. From a technical perspective, interoperability can take a foundational, semantic, structural and/or operational form. For the end user this means taking all of the different elements of a patient’s care and collating them into one place where they are easily accessed by the user, regardless of their location.
Government and other Healthcare Management Organisations are recognising the value of interoperability on both an individual and population health basis. Interoperability not only streamlines the frontline user’s experience, but it allows for holistic, contemporaneous data capture. This feeds epidemiological analytics, fuelling more informed decision making and resource allocation. Before implementing any EHR system it is critical to evaluate how it is addressing this key requirement.
Actively involving clinical users in this appraisal is crucial, and often overlooked by Healthcare IT buyers. Clinical users will provide you with real-world insights around how interoperability can be catered for in the context of their practice.
Trusted, Actionable Data Ask yourself: is this system providing me with trusted, actionable data, or is it simply a “digital paper record”.
If it is the latter, your organisation is missing out on the wealth of clinical data that could be informing analytics, updating registries, informing research, managing point-of-care billing, providing targeted guidelines, and much more. Far too often, users are presented with data which is siloed, unstructured, and “flat”. This leads to duplication of effort; either in an attempt to verify untrusted results, or as a consequence of unrecognised previous efforts buried in the quagmire of the “digital record”.
By taking user entries and mapping the clinical findings to unique ID’s, modern healthcare IT systems provide users with a single, verified, actionable instance of the truth. By providing a single point from which all users draw information and to which all users enter data, one has the luxury of a single, trusted instance of the truth. There is elimination of effort duplication, reducing the clinical and administrative burden caused by untrusted, unstructured data.
Usability There are three considerations that fall under this checklist item; single sign-on capability, user interface, and flexibility.
Your users will not want a system that adds another silo to the mix. They will want a solution that does the opposite.
True interoperability should exist in your solution. Users want to access all of the patient’s data from a single point, eliminating the burden of password management and adding to the concept of a single source of the truth.
Whilst accessing the various systems from one point, the user should be presented with a single user interface which has been designed specifically with healthcare professionals and their workflows in mind. This interface should be structured enough to allow accurate data collection, yet flexible enough to facilitate the nuances in healthcare practices. Your clinical users won’t tolerate a “solution” which is overly prescriptive in its implementation or method of data capture, so either should you.
Any modern system will also facilitate efficient healthcare provision by mapping clinical workflows. Once again, actively involving your clinical users in the decision process can yield fantastic insights here.
Let them pick up the solution and play with it, you’ll know instantly whether the interface is going to work for them (and even more instantly if not!).
Patient Platform Does this system account for the most important person in the room? Does it recognise that this person is not the clinical user?
If not, why not?
Users want a solution that not only delivers for them, but also delivers for their patients.
Let’s consider the modern patient. I use the term “modern” rather than “young”, because many of our more senior patients are becoming just as adoptive of modern technology as their youthful counterparts.
The modern patient makes use of the devices available to them to augment every aspect of their life. Banking, socialising, leisure activities, communicating, updating and shopping can now be done securely from a device in their pocket.
These users are ready, willing and able to utilise this same technology to augment their healthcare.
Patients want to become real partners in their healthcare, they may not want to be in the driving seat, but they want to be right up there in the cockpit beside their healthcare provider, overseeing decisions that will profoundly impact them.
Clinical users want to mine the wealth of information that is being lost between clinic visits or hospital admissions. By utilising technology this could be achieved, and the wonderful thing is that all the building blocks already exist. For example, we already have methods of ensuring secure, trusted data transfer thanks to financial software, so why not cherry pick what we need and devise a system that empowers our patients?
The challenge here lies in engagement; How do we initiate and then maintain patient engagement in the patient platform.
“Friendliness” and usability are oft cited as the main reasons patients initially engage with their clinical portal app, with face-to-face human interaction being a key reason for them to come back.
Does the solution offer patients the components required to not only grab their attention, but to maintain it over time? If so, you are sitting on a potential goldmine of patient generated data, patient empowerment, patient education, and preventative medicine.
Enhance, rather than replace Finally, consider that the answer to your user’s woes may not be to replace existing system(s) completely, but rather to add a solution which works with the current ones to fulfil the user needs highlighted in this blog.
Consider that the costs of adding another system to enhance what is currently in place may be entirely justified when compared to the potential costs – financial, time and human – of removing entire IT eco systems and replacing it with another.
We in healthcare IT need to evolve from the antiquated idea of utilising a “Jack of all Trades”. Very often, the answer lies in effective and co-operative collaboration by a number of “Master of One” solutions, united through a shared ethos of interoperability.
I don’t envy the task of decision makers within healthcare IT today. There are a myriad of solutions all vying for our attention, all promising the moon and stars.
The purpose of this blog is to bridge the gap that so often exists between those choosing healthcare IT solutions and those using it, so as to hopefully ease the burden felt by these well-intending decision makers.
Users DO know what they want, and they should be listened to.
At Infocare we work hard to “Get it Right” for our Users, by providing a solution through which all five of these checklist items can be achieved.
I never really considered the history and impact of X-rays, until my awareness grew around radiation exposure and its effects on children. I was fascinated and decided to do a bit of research on the subject, not knowing where this would lead.
Tim Newman posted an interesting article titled ‘Are X-rays really safe?’ on Medical News Today, 9 January 2018. Tim’s article was definitely one of the best I came across, it also helped me put a lot of the positive and the possible negative into perspective.
Did you know: • A German mechanical engineer and physicist, Wilhelm Röntgen, was credited as producing and detecting electromagnetic radiation in a wavelength range known as X-rays or Röntgen rays, an achievement that earned him the first Nobel Prize in Physics in 1901. • Just weeks after he discovered that they could help visualize bones, X-rays were being used in a medical setting. • The first person to receive an X-ray for medical purposes was young Eddie McCarthy of Hanover, who fell while skating on the Connecticut • River in 1896 and fractured his left wrist (https://www.ajronline.org/doi/pdf/10.2214/ajr.164.1.7998549). • X-rays are a naturally occurring type of radiation. • They are classed as a carcinogen. • The benefits of X-rays far outweigh any potential negative outcomes. • CT Scans give the largest dose of X-rays compared to other X-ray procedures. • In X-rays, bones show up white, and gasses appear black. • Everyone on the planet is exposed to a certain amount of radiation as they go about their daily lives. Radioactive material is found naturally in the air, soil, water, rocks, and vegetation. The greatest source of natural radiation for most people is radon. • Additionally, the Earth is constantly bombarded by cosmic radiation, which includes X-rays. These rays are not harmless but they are unavoidable, and the radiation is at such low levels that its effects are virtually unnoticed. • Pilots, cabin crew, and astronauts are at more risk of higher doses because of the increased exposure to cosmic rays at altitude. • There have, however, been few studies linking an airborne occupation to increased incidence of cancer (I was not yet able to know if these studies are actually being conducted though…)
Importantly, and something that has been crossing my mind: Have you ever wondered how many x-rays and scans are safe in a lifetime? We all agree that in the world of medicine, science and technology, the most commendable accomplishments are medical imaging. The process of passing rays through the body to get images of the inside of the body, has helped doctors diagnose the severity of diseases with the right accuracy. X-rays, magnetic resonance imaging (MRI) and computerised tomography (CT) scans are the most prominent imaging technologies that we have at our disposal. However, the radiation that these imaging technologies pass through our bodies can impact our health.
All individuals are actually exposed to some sort of radiation every day. Natural background radiation comes from different things including the ground, air, food, and even from outer space in the form of cosmic radiation. Apart from this natural radiation we come into contact with every day, each x-ray we receive as well as nuclear medicine tests adds an additional dose to one’s exposure to radiation. The dose level of radiation varies depending on the medical examination done. X-ray exposure of the teeth, chest, and limbs usually have small radiation doses while exams involving more extensive use of x-rays like CT scans and fluoroscopy have higher radiation doses.
In my research, I found another interesting article by DoctorNDTV that helped me delve deeper into my questions: ‘Know all about the number of X-rays, MRI and CT scans you can get done in a lifetime to avoid risks of developing cancer’ – Updated: Mar 30, 2018
Studies indicate that maximum radiation risks are posed by CT scans – CT scans are done by an X-ray technique which is aided by the computer. Unlike the images produced by normal X-ray technique, CT scans give cross-sectional images of body parts and organs. Body’s exposure to radiation in CT scans is quite harmful.
X-rays are passed through the body. In order to get good quality image of the tissues, a dye or a contrast medium – made up of iodine or barium – is injected in the body. Since X-rays are passed through the body, they may pose a risk to our health because of exposure to radiation.
There is no radiation risk posed by MRIs. These scans work by using a magnetic field and radio waves which help in producing images of the internal structure of the body. The scan is done by creating a temporary magnetic field on a person’s body. The magnetic field is created by passing an electric current through coiled wires around the body. The transmitter or receiver sends and receives radio waves. The signals are used to produce scanned images of the body. Since MRI scan involves no radiation, it is a safe and pain-free process to scan any part of the body.
In the article, they ask Dr. Gita Prakash about how harmful these scans can be. She says: “These scans do not increase the risk of cancer. You get them done because you worry about the risk of cancer. You have to be sensible about them and get them done only when needed. During pregnancy, you have to be careful that you don’t get any X-rays done and don’t expose the mother to any radiations.”
Measuring radiation in terms of natural radiation: Low levels of ionising radiation are used to produce images in CT scans and X-rays. Ionising radiation is considered to be more harmful for the body as compared to non-ionising radiations.
The units in which we can measure radiation is known as millisieverts (mSv). Apart from the radiation through these imaging scans, our body is also exposed to radiation in the environment. The body is exposed to around 3.1 mSv of radiation through natural resources – states the United States Nuclear Regulatory Committee.
A single chest X-ray makes our body exposed to 0.01.4 mSv radiation. This is equivalent to 3 days of radiation from natural resources. An X-ray of the abdomen exposes our body to 0.7 mSv radiation, which is equivalent to 4 months of radiation through natural resources.
A CT scan of the head exposes our body to 2 mSv radiation, which is equivalent to 1 year of exposure through natural resources.
The next bit of the article was really where I realized it was not that simple at all – it asks the question: Can more CT scans increase your risks of cancer?
The safety of scans is determined by examining the dose of radiation as compared to the frequency of the scan. MRIs, as mentioned above, do not pose any risks of radiation.
Radiation exposure in a CT scan depends on the number of scans done, the patient’s size, the design of the scanner used, the time or rotation and/or exposure.
Risks of cancer depends on the age and sex of the patient, along with the type of scan and even type of scanner.
A radiation study says that of the 270 women who underwent CT coronary angiography at the age of 40, 1 can develop cancer from that CT scan. The CT scan will pose cancer risks to 1 in 600 men. A routine CT scan poses cancer risk to 1 in 8,100 women at the age of 40. A routine CT scan poses cancer risk to 1 in 11,080 men at the same age. The risks of developing cancer are double in people aged 20 years. For patients aged 60 years, the chances of cancer risks were 50% lesser. (Study: Radiation Dose Associated with Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer. Published in final edited form as: Arch Intern Med. 2009 Dec 14; 169(22): 2078–2086.)
The safety angle, according to experts, is that the damage done to the body, because of radiation done during a CT scan, is likely to get repaired within 1 year. This is because the radiation dosage is usually below the safe numbers. Nonetheless, it is still important for a person to understand the effects of radiation and take necessary steps to minimise exposure. (Dr Gita Prakash is a Family Physician at Max Multi Speciality Hospital, Panchsheel Park)
X-rays are believed to promote formation of free radicals in the body causing cell injury or cell death. Cells can either repair themselves with no damage done or there is also the possibility of cells improperly repairing themselves leading to changes in the cell’s structure and function. Reproductive organs, blood-forming organs, and digestive organs are considered to be the most sensitive to radiation while the muscle tissues, connective tissues, and the nervous system are through to be the least sensitive. The effects of radiation on the body depends on several factors including radiation dose, radiation energy, part of the body exposed, and cell sensitivity.
Common medical procedures that involve the use of x-rays usually have negligible to low risk. To be able to make an estimate of the likely effect of these examinations, you simply add the risks for each test together. It doesn’t make much of a difference if you have 10 chest x-rays this year, or if you have two chest x-rays per year over five years as the amount of x-ray radiation is what matters, and not the frequency.
It is clear in all my reading that awareness and knowledge is the greatest means to reducing exposure. We need to inform our doctors about X-rays or isotope scans we had in the past, so that unnecessary x-ray exposure from medical exams can be avoided. Parents need to be aware that risks of x-ray radiation exposure is greater in children, especially unborn babies.
X-rays can be valuable and have generally low health risks. Keeping track of medical examinations using x-rays that you have already undergone can be useful information for your doctor when deciding if more examinations should be avoided or not. In most cases, there is a higher risk from not having an x-ray examination or isotope scan compared to the risk of radiation itself. (Copyright: 2015, Anand Diagnostic Laboratory)
In a dedicated study around the effects of radiation in children, researchers followed 337 children under the age of 6, who had surgery for heart disease at Duke University Medical Center in North Carolina. The team, led by Dr. Kevin Hill, cardiologist and assistant professor of pediatrics at Duke, says they studied children with heart disease because they are exposed to more imaging tests than children in most other groups. The imaging procedures the children underwent totaled nearly 14,000. This includes X-rays, computed tomography (CT) scans and cardiac catheterization procedures using video X-rays – known as fluoroscopies.
Overall, the team found that the cumulative dose of ionizing radiation for the average child in the study was lower than the annual background exposure in the US. Though this finding can certainly put many parents’ minds at ease, the team did find that some children with complex heart disease, who are exposed to large cumulative doses of radiation have increased lifetime risks of cancer – up to 6.5% above baseline.
Commenting on their findings, Dr. Hill says:”There are definitely times when radiation is necessary. But it’s important for parents to ask and compare in case you can avert potentially high exposure procedures. Often there are alternative or modified procedures with less radiation, or imaging may not actually be necessary.” “Simple awareness is one of the greatest means to reducing exposure,” he says. “Health care providers should consider tweaking protocols to limit radiation doses and balance risks and benefits of every imaging study they do.” By Marie Ellis , Published Tuesday 10 June 2014
In 2013, Medical News Today reported on a study that suggested an anti-cancer compound present in cruciferous vegetables, such as cabbage, cauliflower and broccoli, protects rodents from radiation damage.
So, maybe that answer is more than we need, but we need to be more aware of what an X-ray is. Why it is needed? How does it compare to other tests for my condition? How much radiation is required? Answer these questions and weigh it against the benefits.
Far too long have we just accepted everything as fact – I never questioned a single scan, not for myself or my children.I never thought to ask questions about it, nor evaluated risk benefit . To be frank, the first time I started to really think about it, was when a friend’s physician opted to talk to her about not sending her young son for an x-ray, and took the time to explain to her the risk/benefit factors for young children. It was interesting to the both of us and hats off to that wonderful physician to take the time to bring this to our attention. It was only when I started to trawl through blogs, websites and studies that I realized the complexities.
Some practical take-aways: The question: ‘How much medical radiation is too much?’ has no definitive answer. A better question is: ‘How much radiation exposure is required to take care of my condition?’ Which will depend on your medical condition.
Ask your healthcare provider and radiologist about the benefits of the exam and the amount of radiation exposure involved. Ask your physician two questions: 1. What do we expect to learn from the x-ray exam? 2. Will decisions about my healthcare be determined from my imaging exam? You and your healthcare provider must work together to decide what is necessary and best for you.
One follow-up question to ask might be: Is an x-ray, CT scan or nuclear imaging exam the best exam, or would other exams like ultrasound, magnetic resonance imaging (MRI) or lab tests, work as well? Your physician can then explain the different examinations, their benefits, risks and results in line with your condition.
Asking questions can help us understand why we need an imaging exam and which one is best for our healthcare. Effective access to our health records also allow less duplication of tests and the sharing of critical information and patient education so that we can take better control of our health and healthcare in general.
Writer – Business Development Team
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