Tag Archives: blockchain

Top Hospitals

What Makes a Top Hospital?

The truth is, there is no perfectly objective method to determine the “best hospital.”

But, there’s no denying that the highest ranked hospitals have a few qualities in common: innovation, patient care, and communication above everything else.

But how do they do it? How can we apply those lessons to hospitals around the world?

Embracing Innovation

Unsurprisingly, innovation and a willingness to adopt new technology rank high on the list.

It isn’t always about money, either. It’s about the hospitals that aren’t afraid to shake up existing processes, to educate the staff and deploy new tools to the best possible use.

Adopting Agile Hardware

Health professionals and clinicians everywhere are on their feet for days at a time, racing from room to room. As computer systems and EHR invade every inch of medical life, there simply isn’t always time to sit at a desktop computer.

Some hospitals have embraced mobile technology like medical tablets. Modern medical tablets are small, portable, and some come with hot-swappable batteries — meaning they can be in constant operation without having to sit and charge for a portion of the day. They also can be equipped with built-in barcode, RFID, and smart card scanners, removing a lot of the peripherals clogging up computer carts.

Blockchain

One of the keys of innovation is vision — as hockey legend Wayne Gretzky put it, “don’t look where the puck is. Look where the puck is going.” When it comes to data protection sharing, the proverbial puck is heading toward distributed ledgers like blockchain.

In short, blockchain democratizes information, protecting it by sharing an encrypted version of a particular file or database across hundreds or thousands of other computers on the chain. For healthcare applications, the security and accountability of blockchain make it difficult for hackers to penetrate, or for unintentional leaks to occur.

Blockchain also has fantastic applicability in drug tracking, which is required by law after the “Drug Supply Chain Security” act of 2013. And since every transaction in the shared database is constantly checked against the same copy stored on multiple servers, illegally altering the drug inventory for nefarious purposes is basically impossible.   

Interoperability

Hospitals and healthcare are heavily burdened by the twin chains of high stakes and the ensuing regulation that comes with such an important responsibility.

But, like all complex endeavors, communication is key. And not just communication between management and staff, or staff and patients — though that’s important too — but also among the hardware and software that has become ubiquitous in medical practices.

EHR Software Blues

EHR systems don’t always play nice with others, with many software companies making it actively difficult to communicate with competitor software. This is why top hospitals, and those striving to avoid these pitfalls, embrace emergent technology.

The way forward isn’t exactly clear: even Trinity Health reported a 100 million dollar fee for switching to a more unified EHR system. However, more popular EHR systems like Epic — and the medical computers with built-in Epic compatibility — have a wider reach and more options for inter-hospital communication.

Improved Patient Outcomes

Top hospitals all have one thing in common, and it’s both the most important and least-surprising component: patient quality of care, patient satisfaction, and patient outcomes.

It’s unhelpful to say “the best hospitals are the ones that have the healthiest patients.” It’s more important to dive into why these patients go home happier and healthier.

Never Too Much Information

Top hospitals do keep a weather eye on feedback and metrics.

If patient outcomes take a dip, smart administrators will research all of the changes to the hospital up to a few months before the drop. A strong system of data — perhaps stored on the blockchain mentioned earlier and accessible by any connected medical PC — can allow admin to cross-check contributing factors like management changes, new hires, equipment installation / loss, season, new epidemics, and even economic or political changes in the area.

As Sherlock Holmes would say: “Data, data, data.” You can’t make bricks without clay.

Ask the Patients

Patient care and patient outcomes go hand-in-hand, which is why user surveys are so important to top-level hospitals.

There are three great times for administering patient satisfaction surveys: when they are discharged, on the patient portal afterward, and in-room during care. While discharge and portal surveys are best left in written or digital form, a quick in-person check can provide emotional context clues.

Some hospitals have a staff manager make a quick round with every patient, asking them something simple like “how was the food?”, “were your medications explained well?” and/or “were your needs met in a timely manner?” Consider including one of your common pain points in the survey. If your hospital has been receiving negative feedback about patients feeling like they aren’t being given options, ask the current patient if they feel that way.

This in-person survey answers can either be jotted down on a clipboard by the staff member, or inputted into a medical tablet or nearby medical computer.

Patient Engagement

Studies have shown that an engaged patient is an attentive patient, one who takes responsibility for their own healthcare.

They participate as a member of the medical team, especially when given the education and support by the hospital or healthcare provider.

Improving Patient Portals

Top hospitals and healthcare providers have online patient portals, a place for patients to make and manage appointments (at a minimum). However, top facilities push even further, creating a one-stop-shop for patient education and communication.

The best portals allow patients to pursue educational videos and programs based on their conditions — if a patient is undergoing a vasectomy, for instance, a flag in the system sends the appropriate videos, statistics, and study materials to the patient’s inbox.

Consider offering voluntary quizzes or “refreshers” where the patient can demonstrate and cement their knowledge of their condition or upcoming procedure.

The Human Touch

Engagement in person is just as important.

Clinicians need to be trained to present diagnoses and treatment options in layman’s terms, verifying every step of the way that the patient is synthesizing the information and not just nodding and smiling. Ask them what they know about their condition already, and use this opportunity to (gently) correct them if they are under false impressions.

If there are any available, accessible education videos or visual aids you could show the patient on something like a medical LCD monitor, that will only help them retain information.

In performing these “educational checks,” the top hospitals in the United States (and the world) help patients make the most of their treatment, and reduce the kind of misconceptions and errors that end up putting patients right back in the hospital.

Community Importance / Engagement

While medical care will always be of primary importance, top hospitals have expanded beyond the patient’s room and out into the community.

Food insecurity has a devastating effect on patient success and long-term health, both physically and mentally. The higher-ranking hospitals usually have some kind of food bank or pantry program to help feed underprivileged members of the community. It isn’t just about charity — though that is a noble goal — it’s a natural extension of a hospital’s function. Malnutrition — especially at a young age — can lead to a host of health problems later in life.

Hospitals that provide safe playgrounds, libraries, or indoor play-spaces for community children are most effective in low-income or high-crime areas. A study by the Department of Criminal Justice at Temple University found that crime increased markedly around parks, with some areas displaying crime statistics twice as high in the park as in surrounding environs.

And since children are the most common users of park playgrounds, well-meaning attempts to have fun and get some exercise could end up exposing the most at-risk children to unhealthy experiences. Safe and supervised hospital playground spaces mitigate that damage, providing a safe space for neighborhood children to play and thrive.

Reaching and engaging the community can provide a kind of pre-emptive healthcare, giving those in need the tools and education necessary to live a long and healthy life.

Common Factors

When it comes to examining why top hospitals are so effective and laudable, it’s a smart idea to also take a look at possible contributing factors.

While the following factors may not necessarily land on this side of the causation/correlation loop, the stats don’t lie, and these factors do seem disproportionately common in higher-scoring hospitals.

The Power of Teaching Hospitals

While many might shy away from getting their haircut at a barber college, it turns out that healthcare at a teaching hospital tends to rank higher.

They even have lower mortality rates: a study posted on PubMed found that “private teaching hospitals had a significantly lower adjusted mortality rate than private nonteaching hospitals,” with an 8-point increase in survival rates for the teaching hospitals.

Some believe that since both the teachers and students are on their best behavior, and are under such stringent regulations and supervision that their care may be similarly elevated.

More experimental or rare medical procedures are often only available at teaching hospitals, allowing student doctors to experience a wide variety of solutions like bone marrow transplants and other specialized surgeries. This could explain some of the higher patient outcomes coming out of a teaching hospital — many patients who need difficult procedures end up receiving them at these educational hospitals.  

Size Doesn’t Matter

Large hospitals may have the benefit of resources, but they don’t always score higher based off size alone.

In the 2016 “100 Great Hospitals in America” listing by Becker Hospital Review, only 15% of their top-level hospitals had over 1,000 beds. And while every other hospital on the list wasn’t necessarily a three-bed hospice, it does show that “biggest guns” may not be as important to patient outcome as one would believe at first blush.

A Pinch of Salt

Remember to take hospital ratings with a healthy dose of skepticism — hospitals are simply too complicated to be easily graded. And, doing well on reviews might mean that the hospital is just good at the paperwork required by reviewing bodies.

However, the basic tenets of patient care, innovation, and communication will always hold out over the ratings on a medical blog.

To learn more about integrating the latest medical computers and how they can streamline processes in a hospital, contact Cybernet today.

blockchain healthcare data security

Is Blockchain Right for Healthcare?

You may have heard that blockchain is “the next big thing.” And while “next big things” seem to rain from the sky in the tech world, there may be some truth in this particular case.

Blockchain came on the scene in 2008, the brainchild of a still-anonymous person or team of people called “Satoshi Nakamoto.” Despite these tantalizingly mysterious origins, blockchain is well understood and implemented as a distributed ledger to both protect and disseminate important information.

But how does this apply to healthcare?

Does blockchain really have the opportunity to upend how medical computers, EMR, and even clinical studies operate?

What is Blockchain?

The “block” portion of “blockchain” refers to encrypted vaults of information, while the “chain” refers to the connections with other, similar blocks of data.

Blockchain, at its heart, is a way to safeguard digital data by sharing it with thousands of users simultaneously.

The basic idea is that blockchain keeps data safe by keeping it encrypted and redundant, not unlike how iCloud or Dropbox protects files by storing them in multiple locations.

The data is difficult if not impossible to corrupt, because it’s being compared with the same version of the file hosted on every other computer connected to the block. And this checking occurs nonstop, confirming the authenticity of each alteration and transaction.

This is where the term “distributed ledger” comes into the equation. Since everyone can see the changes and transactions done to any data in the block — and who made those changes —  the ledger is secure. It’s like having your own team of perfect, robot accountants auditing your EMR computer hundreds of times a day.

Why is Blockchain Needed in Healthcare?

Primarily, blockchain can help healthcare providers avoid the avalanche of HIPAA violations that have fallen on the industry as of late.

The number of breaches appears to be growing, and with it the price tag of the fines being levied. In 2014, Columbia University and New York Presbyterian Hospital settled a fine for a data breach to the tune of 4.8 million dollars, which at the time was the highest fine ever handed out.

In 2017, Memorial Healthcare System, a Florida-based healthcare group, suffered a data breach that compromised over 115,000 patient and staff records. They were forced to pay a $5.5 million settlement.

But in 2018, Anthem, one of the largest healthcare groups in the world, forked over a record-obliterating 16 million dollars in fines after 78.8 million member records were compromised by hackers.

Either hackers are becoming more adept, IT systems are falling behind, or the amount of digital information in unsecured storage has increased. In all likelihood, all three of these factors are responsible for the rise in both data breaches and ensuing fines.

Since laws and regulations around the country — and indeed, around the world — are only forcing more patient data to be digitized and shared, there’s only one way to securely move forward and protect both patient information and hospital liability: an encrypted, incorruptible distributed ledger like blockchain, with access availability right on the nearest medical cart computer in any exam or patient room?

Implementing Blockchain

Integration with EMR systems and EMR computers is priority one.

As it stands, many healthcare groups are on different EMR programs and standards, making transfer of medical data difficult. This transfer is also a common breach point for hackers and data thieves.

Electronic Medical Records

Unsecured transfer of data is an easy target, which is what makes blockchain so useful. Because data is encrypted, copied, and stored on every computer in the block, there’s no transfer to scoop up. There’s no single vulnerable point that can be hit by DDoS attacks or corrupted by a virus.

The implications of a secure, incorruptible system for electronic medical records point to a potential sea-change in how data is stored. Imagine storing patient consent forms like organ donor consent, living wills, and DNR directives, all easily accessible by the authorized users. Double down on security with a medical computer equipped with two-factor authentication like a smartcard (or RFID, or biometric) scanner and a quick pin code.

That’s a one-two punch of security that can make HIPAA compliance a breeze.

Clinical Trial Data

There are other, far-reaching uses for both secure and easily-accessible data. Clinical trials and medical studies, for instance, are often made difficult by the logistical issues of having to store and collate a wealth of data. In the case of multiple parties contributing to a trial or study, the problem is only compounded.

Then add in that clinicians often to have de-identify the patients in the trials (but also have the ability to re-identify them for implementation or health reasons), and you’ve got a multi-headed hydra of potential data breaches.

Storing clinical study data on a blockchain is a perfect use of the technology and something that health giants like Pfizer and Amgen are already considering.

Blockchain for Preventing Fraud

Of course, not all theft comes in the form of hacking. Both insurance fraud and drug fraud cost hospitals (and sometimes patients) millions of dollars a year.

Preventing Health Insurance Fraud

In 2014, there were 2.3 million cases of medical identity theft, and the number has only been rising ever since.

This identity theft was usually for the purposes of either scoring prescription drugs or for using a patient’s insurance for “free” medical procedures.

This particular form of fraud is particularly devastating because it affects patients and healthcare providers alike, both of whom can have their reputations and finances irreparably damaged.

And, even worse, if the thief does receive treatment, their information (blood type, risk factors, allergies, even diagnoses) can get mingled with the actual patient. If this happens, it could cause incorrect diagnoses, medication complications, or the infusion of incorrectly-typed blood which can seriously injure or even kill someone.

There are even other potential consequences of medical identity theft: a Utah woman, Anndorie Cromar, was nearly arrested (and almost had her children taken away) when an identity thief used her insurance to pay for maternal services. The thief’s baby tested positive for drugs, and since the name on the birth certificate was “Anndorie Cromar,” police and Child Protective Services descended quickly on the wrong person.

The mix-up was eventually sorted out, but not without money, frustration, and what turned out to be the scare of Cromar’s life.

Blockchain technology can mitigate some of the issues — the patient can have an encrypted ID vault on the block, one that the provider can use to make sure that the person standing in front of them is the real policyholder (or the policy holder’s authorized dependents or partner). This ID vault could contain a picture, all ID paperwork, and even biometric data depending on consent and regulations.

Then, the clinician need only check the data against the patient in front of them to prevent most forms of health insurance fraud. They don’t even need to be sitting at a computer — they could grab a nearby medical tablet and pull up the data then and there.

Tracking Drugs and Eliminating Counterfeits

The nature of blockchain’s distributed ledger is a perfect match for inventory and drug-tracking all throughout the supply chain.

The “Drug Supply Chain Security” act, established in 2013, mandates electronic drug tracking in the United States. A secure solution like blockchain is practically custom-built for verifying drug transactions, authenticating barcodes, and keeping every step of the shipping and use chain fully recorded and protected from illegal tampering.

Medical computers with integrated barcode scanners streamline the process. If you already have a USB-powered barcode scanner, medical panel PCs are capable of powering those peripherals on their own, just from the built-in batteries of the PC itself.

Those same medical PCs can also come with built-in two-factor authentication, making them compatible with the SUPPORT bill and a vital tool in combating the opioid crisis.

Combining Blockchain and Healthcare

Blockchain isn’t a perfect panacea to cure all data security problems forever, but its secure, incorruptible nature (combined with staff education and good network hygiene) makes it an excellent solution to many of healthcare’s current data-handling issues.

To learn more about integrating blockchain with EMR and secure medical computers, contact Cybernet today.

blockchain ledger

Healthcare IT and the Impact of the Blockchain Ledger

Cryptocurrencies have been trending in the news lately because of their volatile market price, security, and popularity. Investors and money moguls alike have dumped “real” money into the cryptocurrency market, turning fiction into fortune with an intangible concept of data that holds wealth in today’s world. Believe it or not, the blockchain ledger—the decentralized network of recorded transactions for bitcoin—can actually have an application towards the HIT market. It may sound strange to apply a cryptocurrency concept to something as far related as HIT, but going into the detail of what the blockchain ledger represents and how that can apply to healthcare isn’t as far-fetched as some might initially think. Here’s why.

A bit of background: the blockchain ledger is a decentralized database that records several encrypted transactions. These transactions reside on a peer-to-peer network, sharing all data between all computers—it presents a huge advantage over a centralized database network. If the central database in a network were to fail, all the data within that network would be lost. The peer-to-peer network of transactions is a stronger data integrity model because any computer failure on the network doesn’t affect the overall integrity of the data—all “nodes” of the network serve as a full record of the blockchain ledger, making data loss or corruption nearly impossible. All nodes have neutral authority. The popularity of cryptocurrencies has skyrocketed because of how highly secure these blockchain ledgers are. It’s a data interchange concept that arose out of the 2008 stock market crash when individuals lost faith in banks that used a financial system functioning similarly to a centralized database network.

So how does that fit into healthcare? Think of the blockchain ledger as an entire ongoing record of everyone’s healthcare records, and any device that records a metric for healthcare—total mileage ran, for instance—can be considered a transaction on that blockchain that cannot be altered. A visit to the doctor could record a person’s age, weight, lifestyle habits, hereditary complications, diet, and other health factors, and then record that into the blockchain as a permanent “transaction.” It may be possible to record all health-related information from a person’s birth to any given moment in time. A physician could access the HIT blockchain and compare a patient’s entire health record with that of thousands of other patients that fit their near-exact health and lifestyle record. Misdiagnosis and improper medication could virtually disappear.

It’s not only a matter of reducing misdiagnosis or improper medication either—physicians are sometimes without the complete picture of when treating a patient. They’re only able to evaluate a patient’s health via what they can sample. For example, through phlebotomy a physician finds that a patient has a huge vitamin C deficiency and symptoms align with scurvy—the patient is diagnosed with scurvy and given vitamin C supplements. That can be recorded as a blockchain transaction and be used for further diagnosis in the future from any other physician. Every future visit to the doctor for an evaluation can improve by giving the physician a more complete snapshot of a person’s health. Patients won’t require as many evaluations. Plus, the future of healthcare may evolve into the ability to predict disease based on evaluating comprehensive trends in health. Imagine predicting cancer in people 60 years ahead and tailoring entire lifestyle habits for future at-risk cancer patients to avoid the disease. Not only that, but imagine if there’s a patient with a disease that doesn’t match with similar patient records. Perhaps this unmatched disease is something new that requires research, learning, development into new medication, and higher healthcare standards.

HIPAA and The Blockchain Ledger Data

One of the double-edged swords of the blockchain is that it’s being used as a way to remain anonymous when trading cryptocurrencies. That’s why it’s attracted the interest of hackers and malicious individuals. In 2016, a Los Angeles hospital was the target of a complete system hijack from a hacker that demanded 17 thousand dollars in bitcoin. Several of these sudden system hijacks have happened where the culprits demanded ransom in bitcoin because of the nature of bitcoin—it’s not entirely anonymous, but by joining the bitcoin blockchain you can falsify information about yourself and “cover your tracks.”

However, if a blockchain ledger were to arise for healthcare IT, it would have to remain private and under HIPAA regulation. All “transactions” under the HIT blockchain would have to remain anonymous until a patient gives consent to a doctor to view their entire set of records. With a system of data interchange that gives patients the power to allow doctors they consult to view their records, it may be a revolutionizing method of keeping HIPAA violations at bay. At face value it seems like the best technology for healthcare, but there are a lot of potential hurdles and hangups. If a patient requests their healthcare records, how do they access them? If the HIT blockchain is the main method of keeping a comprehensive health record, how will businesses interact with that? Will that kind of information stay neutral to all parties accessing it? With the rise of an HIT blockchain, suddenly we’re stuffing a highly sensitive form of data that must be carefully handled onto a new network of data interchange. If there’s a method of avoiding the privacy regulations for blockchain integration, that would be ideal. It’s a matter of finding out what that method is. For now, a slow evolution into storing medical data onto the blockchain ledger is ideal, but there’s a jungle of rules and red tape to cut through.

Interoperability Revolution

Likely one of the strongest aspects of using the HIT blockchain is interoperability, which is still a sought-after capability when using certain EHR systems. It’s natural for EHR companies to snuff interoperability with other EHR systems in order to sell more product, but sometimes hospitals are at the whim of using the systems they’re stuck with and poor interoperability forces workarounds. That won’t be a problem with the blockchain. Complete and total interoperability is predicted to save HIT several billions of dollars with use of the Electronic Health Chain (EHC), a patient-controlled form of healthcare information that resides on the blockchain. All data gathered through any device that can integrate with the blockchain—whether it be from a pedometer, blood pressure cuff, diabetic testing machines, sleep habit readers, or any possible device that can provide data—can be incorporated within the EHC. This suggests that no matter what physician you see, they have a complete, unbroken record of a patient’s healthcare from the start of recording—perhaps from birth!—to the last transaction recorded, without squabble over conflicting software that won’t communicate.

Healthcare Future with the Blockchain

Medication development often hinges on clinical trial studies that can take several years to complete. Pharmaceutical companies rely on doctors to identify patients that fit specific profiles to contact and ask for a clinical trial study to see how a medication may affect them (hopefully in a positive way). Using the blockchain ledger, the process of a clinical trial can be reversed—patients can willingly sign up for a clinical trial and release their EHC to pharmaceutical companies, reducing research and development time significantly. Instead of pharmaceutical companies finding willing patients to undergo studies, the patients can give access of their entire medical history in the blockchain. The efforts to find a strong sample size for the study may be reduced.

 

By evaluating someone’s entire history of health, hereditary impacts, lifestyle choices, diet, and maybe even their genetic predispositions, physicians can reduce improper diagnoses, find new medical conditions, develop new medications, and understand more about healthcare in the future. Integrating the Internet of Things, the EHC, and total interoperability into the blockchain can push understanding of healthcare to heights never seen before. There are obvious hurdles to full integration and we won’t see full blockchain integration into healthcare at the flip of a switch, but it’s interesting to see where we could possibly take healthcare with this newfound form of data interchange. A current project in the works is called MedRec, a prototype blockchain EHR system that gives patients access to their entire healthcare history for purposes of diagnosis and research. That’s just one prototype coming out of the woodwork lately. The percentage of HIT executives integrating the blockchain into EHR systems has grown since inception, and several new networks have spawned with their own unique structures, paving the way to what might be a complete healthcare information overhaul.