This is #NPHW National Public Health Week

April 2-8 marks ​National Public Health Week (NPHW). Each day is marked with a specific public health theme:

Monday, April 2: Behavioral Health
Advocate for and promote well-being
Focus on and advocate for improved access to mental and behavioral health services. Use education and training to de-stigmatize mental health diagnoses and encourage people experiencing mental illness to seek treatment. Coverage for mental health services must be on par with physical health services in all health insurance coverage.

Tuesday, April 3: Communicable Diseases
Learn about ways to prevent disease transmission
Wash your hands. Know your HIV status. Call on employers to support and provide sick leave so sick workers can care for themselves and avoid spreading disease to others. Support comprehensive sexual health education in schools, which can reduce rates of sexually transmitted disease (as well as teen pregnancy). Keep yourself and your families immunized against vaccine-preventable diseases — and get your flu shot!

Wednesday, April 4: Environmental Health
Help to protect and maintain a healthy planet
Reduce our collective carbon emissions footprint. Transition to renewable energies. Protect our natural resources and use evidence-based policy to protect our air, water and food. Support environmental health efforts that monitor our communities for risks and develop health-promoting interventions. Call for transportation planning that promotes walking, biking and public transit — it not only reduces climate-related emissions, but helps us all stay physically active.

Thursday, April 5: Injury and Violence Prevention
Learn about the effects of injury and violence on health
Increase funding to programs that reduce and prevent community violence. Advocate for occupational health and safety standards that keep workers safe on the job. Support policies that save those struggling with addiction from a fatal drug overdose. Many injuries are preventable with the appropriate education, policy and safety measures.

Friday, April 6: Ensuring the Right to Health
Advocate for everyone's right to a healthy life
Everyone deserves an opportunity to live a life free from preventable disease and disability. The places where we live, learn, work, worship and play should promote our health, not threaten it. That’s why creating the healthiest nation requires a dogged focus on achieving health equity for all.

Thoracic Surgery Social Media Network #TSSMN

The next Thoracic Surgery Social Media Network #TSSMN Twitter chat is scheduled for Tues March 20 at 5 pm Eastern. Follow @TSSMN and the hashtag #TSSMN

The topic: resident assessment and autonomy in cardiothoracic surgery

Be sure to read the article titled, "Resident Autonomy in the Operating Room: Expectations Versus Reality" and "Teaching operative cardiac surgery in the era of increasing patient complexity: Can it still be done?"

It's great to see trainees leveraging social media to discuss important issues that need to be discussed openly.

You can read more about the spirit of #TSSMN in this article, titled "Thoracic Surgery Social Media Network: Bringing thoracic surgery scholarship to Twitter."

CMS announces MyHealthEData Initiative and Medicare Blue Button 2.0

Here is one of the biggest announcements that came out of HIMSS 2018: the MyHealthEData Initiative launched by CMS.

MyHealthEData aims to empower patients by ensuring that they control their healthcare data and can decide how their data is going to be used, all while keeping that information safe and secure. The overall government-wide initiative is led by the White House Office of American Innovation with participation from the U.S. Department of Health and Human Services (HHS) – including its Centers for Medicare & Medicaid Services (CMS), Office of the National Coordinator for Health Information Technology (ONC), and National Institutes of Health (NIH) – as well as the U.S. Department of Veterans Affairs (VA). MyHealthEData will help to break down the barriers that prevent patients from having electronic access and true control of their own health records from the device or application of their choice. This effort will approach the issue of healthcare data from the patient’s perspective.

Medicare’s Blue Button 2.0 is a new and secure way for Medicare beneficiaries to access and share their personal health data in a universal digital format. Medicare’s Blue Button 2.0 will allow a patient to access and share their healthcare information, previous prescriptions, treatments, and procedures with a new doctor which can lead to less duplication in testing and provide continuity of care. 

Trump Administration Announces MyHealthEData Initiative to Put Patients at the Center of the US Healthcare System

CMS launches “Blue Button 2.0” tool, calls on all health insurers to make data available to patients

You can also read the remarks made by CMS Administrator Seema Verma at HIMSS 2018.

FDA authorizes marketing of first blood test to aid in the evaluation of concussion in adults

Advances in technology are leading to a host of innovations around reducing and detecting concussions.

Today, the FDA authorized the marketing of the first blood test to evaluate mild traumatic brain injury (mTBI), commonly referred to as concussion, in adults.

The FDA reviewed and authorized for marketing the Banyan Brain Trauma Indicator in fewer than 6 months as part of its Breakthrough Devices Program.

The Brain Trauma Indicator works by measuring levels of proteins, known as UCH-L1 and GFAP, that are released from the brain into blood and measured within 12 hours of head injury. Levels of these blood proteins after mTBI/concussion can help predict which patients may have intracranial lesions visible by CT scan and which won’t. Being able to predict if patients have a low probability of intracranial lesions can help health care professionals in their management of patients and the decision to perform a CT scan. Test results can be available within 3 to 4 hours.

More information here.

Using heart rate data (and machine learning) to detect diabetes?

A very interesting study seems to suggest that continuous heart data could identify patients who have diabetes. You can read more about this story on Wired:

... at the annual AAAI Conference on Artificial Intelligence in New Orleans, digital health-tracking startup Cardiogram presented research suggesting the Apple Watch’s heart rate sensor and step counter can make a good guess at whether or not a person has diabetes—when paired with the right machine-learning algorithms, of course.

In 2013, researchers at UCSF launched the Health eHeart study and registered close to 200,000 participants. About 40,000 opted to link their health information with their Cardiogram app. The DeepHeart neural network was trained to spot patterns and trends linked to human disease. Using semi-supervised sequence learning (artificial intelligence), the machine interpreted patterns of heart rate variability and was able to identify patients with diabetes 85% of the time.

I find myself wondering if some of this may be related to certain pharmacologic agents such as beta blockers...

Apple Health app will link to your medical records (thanks to FHIR)

Apple recently announced that its mobile Health app will link to electronic health record (EHR) systems. This will allow patients/consumers access to their personal health record (PHR). While companies like Microsoft launched PHR platforms such as HealthVault a number of years ago, most of these PHRs were not linked to EHRs. Tethered PHRs became available when patient portals were launched by hospitals, health systems, and clinics to meet the CMS Meaningful Use requirements.

It seems that we're finally entering an era where advances such the FHIR (Fast Healthcare Interoperability Resources) Specification and other interoperability standards will allow patients and providers to link critical health information.

From the Apple Announcement:

The updated Health Records section within the Health app brings together hospitals, clinics and the existing Health app to make it easy for consumers to see their available medical data from multiple providers whenever they choose. Johns Hopkins Medicine, Cedars-Sinai, Penn Medicine and other participating hospitals and clinics are among the first to make this beta feature available to their patients.

FHIR is finally allowing true interoperability to become a reality. It took a while for health care to achieve this, but I'm sure we'll see tremendous momentum as more developers build apps that leverage FHIR.

We can also expect to see some very interesting days ahead as Amazon dives into health care. Amazon, Berkshire Hathaway and JPMorgan are joining forces to "fix" health care in our country. They're doing to start by fixing health care for their own employees, but I'm sure other large organizations will watch them closely and adopt key lessons from their successes.

Empowering patients with their own health information is one of the first steps to fixing health care in this country. As caregivers also gain access to critical health information, this may lead to more coordinated and effective care delivery (especially for those living in the "sandwich generation" and caring for their own children and their aging parents).

FDA approves pill with sensor that digitally tracks ingestion

For the past several years, we had heard about the sensor technology and patch developed by Proteus Digital Health. The FDA just approved the first pill that integrates this technology into Abilify, a drug used to treat schizophrenia.

Abilify MyCite (aripiprazole tablets with sensor) has an ingestible sensor embedded in the pill that records that the medication was taken. The product is approved for the treatment of schizophrenia, acute treatment of manic and mixed episodes associated with bipolar I disorder and for use as an add-on treatment for depression in adults.

FDA announcement.

FDA announces Digital Health Innovation Action Plan

Today, the FDA announced the formal launch of the Pre-Cert for Software Pilot Program and published their Digital Health Innovation Action Plan.

The Digital Health Innovation Action Plan (PDF) provides details and timelines for the integrated approach to digital health technology and the implementation of the 21st Century Cures Act.

The goals are to:

• enable a modern and tailored approach that allows software iterations and changes to occur in a timely fashion;
• ensure high quality medical product software throughout the life of the product by enabling companies to demonstrate their embedded culture of quality and organization excellence (CQOE); and
• be a program that learns and adapts and can adjust key elements and measure based on the effectiveness of the program.

Learn more at the FDA Blog.

Augmented reality in medical education

It's truly exciting to see how augmented reality (AR) is becoming incorporated into medical education. While virtual reality (VR) headsets are also gaining some notable traction, I see the use of AR growing much faster. AR interfaces can be built right into the clinical workflow and can even be used at the bedside. People can get a taste of AR using their mobile devices, so they don't need to purchase any sophisticated equipment. So, in addition to providing an enhanced educational experience, the use of AR could also lead to safer procedures and better clinical outcomes, especially for students and trainees.

Here's an example of Case Western Reserve and the Cleveland Clinic using Microsoft HoloLens for medical education:


The Augmented World Expo is happening in California this week and while applications range from gaming to enterprise use, the education sector is rapidly applying AR in very creative ways. From visualizing the invisible to enhancing psychomotor skills, the use of AR is here to take medical education to the next level!

"Jeopardy!" show contestant battled colon cancer and gave winnings to cancer organizations

By now, a growing number of people are hearing about the game show "Jeopardy!" contestant Cindy Stowell. She was battling advanced colon cancer and she died before her episodes aired. She won five consecutive games, then gave her winnings to the Cancer Research Institute. Her ambition and passion inspire many who are battling cancer.

Cindy Stowell - you will be missed and we offer our deepest condolences to your family and friends.

Thank you for being an inspiration to a community that understands the devastating impact of cancer.

Thank you for donating your winnings to help cancer organizations fight this disease.

Upcoming webinar about the strategic value of CME

The Physician Leadership Forum (PLF), a part of the American Hospital Association (AHA), is hosting a complimentary webinar about the strategic value of CME. The webinar is titled, "Improvement from Within: the C-Suite’s Nimble New Partner is CME."

Monday, October 10, 2016
3:00 p.m. ET (2:00 p.m. CT, 1:00 p.m. MT, 12:00 p.m. PT)
(60 minutes)

For those attuned to the evolution of accredited continuing medical education (CME), there is a dynamic opportunity for institutional leaders to build collaborative "educational homes" that address strategic system goals while nurturing the professional development—and passion—of clinicians and teams.

Join us for our next webinar, "Improvement from Within: the C-Suite's Nimble New Partner is CME" on Monday, Oct. 10 beginning at 3:00 p.m. ET. During this 60-minute webinar, Graham McMahon, MD, president and chief executive of the Accreditation Council for Continuing Medical Education (ACCME) and Josephine Fowler, MD, former chief academic officer at JPS Health, Dallas, will offer an inside look at strategies C-suite executives can use to ensure that CME is a strategic asset for institutional excellence. Through participation in this educational activity, attendees will be able to:

• Enumerate strategies for integrating CME into system improvement for safety and quality goals;
• Gain practice-based insights for creating an educational home that sustains clinicians passion for medicine, nurtures their professional development, and supports their well-being;
• Identify easy approaches to enhance the relevance and effectiveness of CME;
• Pursue approaches that use CME to help integrate system improvement needs with faculty development.

Learn more about this webinar here:
http://www.ahaphysicianforum.org/inc-plf/dhtml/webinar-reg.dhtml

Get ready for National Health IT Week Sept 26-30 #NHITWeek

Have a health IT story to share? National Health IT Week is Sept 26-30 so be sure to follow #NHITWeek and join others who are sharing their passion about health IT! Learn more here: http://www.healthitweek.org

My critique of the JAMA activity tracker + weight loss study

Originally posted on FitnessTechMD.com

Many people have seen reports of the recent JAMA study titled, "Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss: The IDEA Randomized Clinical Trial." Published in Sept, 2016, this study would appear to be a reflection of recent trends in activity tracking and weight loss strategies. However, the study used an antiquated wearable device that is no longer sold (the BodyMedia FIT which is worn on the upper arm) and it was conducted from 2010-2012. How many people in 2010 were wearing activity trackers? The popular Fitbit Flex launched in May 2013. The Apple Watch launched in April 2015.

Back in 2010, relatively few people wore activity trackers. Moreover, hardly anyone wore them on their upper arm. So although the authors acknowledge that "The multisensor wearable device was worn on the upper arm, which may not reflect the effectiveness of more contemporary devices worn on the wrist..."

The term "effectiveness" is an interesting term for this type of study, since the accuracy of worn activity trackers has wide variability. In order for a digital tool to effectively change behavior in a sustainable way, people have to use it regularly and the device should provide useful feedback to the user.

I've personally tried the BodyMedia Fit and I can attest that:

1. It draws a lot of attention (maybe not as much as Google Glass, but you'll get a lot of questions from random strangers asking, "what is that on your arm?"). How self-conscious would you be if were constantly telling everyone that you were taking part of a weight loss study? 
2. It's not something you'll be wearing 24/7 (fabric stretch band around the arm, so you probably won't be taking a shower with it, plus I don't believe that it was water resistant) - so that can impact daily adherence. Plus, the device needs to be charged on a regular basis.
3. The tracker is not very comfortable (imagine strapping a pager to your upper arm all day). 
4. The device doesn't really provide any type of useful feedback such as vibration alerts, cues, smart notifications, etc. You may eventually forget that it's there. It's not nearly as engaging as modern activity trackers that have lights, screens, and vibrating alerts.

The authors also state, "the use of wearable technology was not initiated at the onset of the intervention, which may have influenced how the participants adopted and used the technology during their weight loss efforts..." Many people are missing this point. Adoption and engagement are critical factors that can impact the success of any type of sustainable behavior change.

So, if the goal is to sustain lasting behavior changes that will lead to weight loss and healthy eating, then you need to study devices that people will easily wear daily, devices that will provide useful feedback in real-time, and devices that won't make people self-conscious about their attempt to lose weight.

Finally, keep in mind that the study began with intensive weight loss interventions for 6 months (weekly group sessions), then the groups continued to participate in monthly group sessions (and received phone calls, text message reminders, etc.) Most people who choose to purchase and use a wearable device don't gain access to this type of support and structure. Most consumers are curious or they may be in a contemplative stage where they want to see how an activity tracker may help them achieve a healthier lifestyle.

Intensive, structured weight loss programs are great ways to kick-start a new journey towards healthy living, but people need to be taught how to use tools in a way that is natural to their workflow and daily habits. If you're not accustomed to strapping a large device to your arm, then you'll be one of the first ones to stop using the device after a few weeks or months. In contrast, if you normally wear a watch and use a smartphone, then it'll be much easier to wear a device that is simple and that provides useful feedback (such as smart notifications that you can customize so that you don't run into alert fatigue).

In many ways, it's unfortunate that the JAMA article was positioned by the media as a disappointment regarding the "effectiveness" of wearable technology. It's unfortunate that many consumers may now have a misconception regarding how their activity trackers may benefit them.

I'm sure we'll see many more studies in the near future assessing the "effectiveness" of modern activity trackers. Until then, we'll have to wait patiently as people read stories with misleading titles like, "Activity Trackers Are Ineffective at Sustaining Weight Loss" or "Weight Loss On Your Wrist? Fitness Trackers May Not Help" (the BodyMedia device was worn on the arm, not the wrist!)

Ingestible origami surgical robot (a real-world Transformer)

OK, maybe not quite a Transformer. But, researchers at MIT, the University of Sheffield, and the Tokyo Institute of Technology have demonstrated how a tiny origami robot can unfold itself from a swallowed capsule and crawl across the stomach wall to remove a swallowed button battery or patch a wound. The robot is steered by external magnetic fields.

Source: MIT News

Get ready! April 4-10 Is National Public Health Week #NPHW #NPHWForum

These days, one of the big buzzwords in the health IT community is "pop health" (short for population health). Well, public health and pop health are practically sisters! This week is National Public Health Week.

Follow @PublicHealth for the latest updates this week on some exciting public health initiatives and join the conversation. Do you live in a city that's going to participate in the #HealthiestCitiesChallenge?

Advances in technology, big data analytics, and team-based care will lead to improvements in public health. Also, don't forget that public health professionals are also actively involved in quality improvement (QI) projects. The PHQIX (Public Health Quality Improvement Exchange) is a great place to read about some of those projects.

Happy Pi Day! 3.1416 (rounded)

March 14 is a fun day for math enthusiasts who celebrate Pi (3.1416 - if you round up)!

Trying to calculate the area of a circle? The circumference? You'll need Pi for those calculations.

The admissions office at MIT is famous for handing out decisions on Pi day.

Did you also know that  3.14 is Albert Einstein’s birthday?

Celebrate Pi Day with a piece of pie!

Unwinding from HIMSS16

I'm finally unwinding after having a great time at HIMSS 2016 (#HIMSS16). My personal highlight was participating in two Dell Healthcare Tweetups with @MandiBPro and @drnic1 as we chatted about some of the evolving trends in health care. We discussed how data-driven care can improve patient outcomes as long as clinicians have access to the right data at the right time and the right place. We still live in a world where interoperability remains a major barrier, but perhaps 2016 will be the year where we make some significant strides in this area through broader collaborations and partnerships across the health IT industry.

At HIMSS this year, you couldn't walk around the conference without seeing signs about population health, data analytics, and precision medicine. We discussed these topics at the Dell Healthcare Tweetups and heard different perspectives on cancer care, mental health, team-based care, and the practice of medicine in community-based settings. More patients are getting engaged in their own health care and we are generating so much health data, but clinicians need to know how to effectively tap into all this data to get meaningful and actionable information that will improve patient outcomes. We're seeing a lot of exciting advances in cancer care, especially around precision medicine and genomics. We also heard about how Dell's Cloud Clinical Archive services are integrating genomics into their core offerings. Speaking of genomics and big data, Dell has a longstanding collaboration with Translational Genomics Research Institute (TGen) and they are empowering clinicians and researchers to fight pediatric cancer. 

Make sure to follow @DellHealth for the latest in health IT and don't miss the 2016 #DoMoreHIT Healthcare Think Tank on Tue, Mar 15 2016 2:00 PM EDT -  5:00 PM EDT
http://livestream.com/Dell/2016DoMoreHIT

What is the best master's program for physicians? by @HealthcareWen

This is a guest post by Wen Dombrowski, MD, MBA

(A follow up previous post about Physicians Evolving Role in Health Care )

I am frequently asked by physician leaders and other clinicians interested in nonclinical responsibilities "What is the best master's program that I should pursue?" I am jotting down some thoughts here in hopes that it will benefit more people beyond those who I coach 1:1. This post is not meant to be an exhaustive guide, but rather food for thought for self-reflection.

My answer about what is "the best" educational program for you always depends on What are your goals: Why do you want to pursue more education? What are you hoping to get out of it? What are your short-term & long-term career and personal goals? What gaps are you hoping to fill? What are you interested in learning about?

For example, there are a myriad of different non-clinical roles that a physician participate in different settings, including:
• Hospitals or Clinics
• Managed care organizations
• Software vendors, medical device companies, pharma
• Your own startup
• Government or public health
• Teaching
• Research

Depending on what roles each individual aspires to, their interests, and personal background -- different individuals will prioritize the following differently:
• Focus on learning about healthcare challenges, healthcare regulations, and managing medical staff
• Focus on learning about non-healthcare business knowledge and skills
• Academic theories about business, technology, people management
• Practical knowledge about business, technology, people management

Choosing a master's program isn't just about the name of the school or the letters that will be on the diploma. How much each program focuses on the above domains depends in part on:
• Who is teaching the courses?
• What is the format of the courses? (e.g. focused on reading textbook, or discussing cases, or hands-on practicum)
• What is the curriculum of required and elective courses?
• Who are the classmates in the courses?

National Wear Red Day #GoRedForWomen

Today is National Wear Red Day. Are you wearing red?

Here's some history about this day:

In 2003, the American Heart Association and the National Heart, Lung and Blood Institute took action against a disease that was claiming the lives of nearly 500,000 American women each year – a disease that women weren’t paying attention to. A disease they truly believed, and many still believe to this day, affects more men than women.

Stemming from that action, National Wear Red Day was born. It’s held on the first Friday in February every year to raise awareness about heart disease being the No. 1 killer of women.

Follow tweets about #GoRedForWomen  and let's continue the fight against heart disease in women!

#IMSH2016 CAE Healthcare launches neurosurgery simulator with National Research Council of Canada

2016 is going to be the year of where Virtual Reality (VR) and Augmented Reality (AR) technologies make a dramatic impact in health care education, training, and delivery.

The term "simulation" is going to be a buzzword as the medical education, graduate education, and continuing education industries converge on the use of these technologies. Simulation used to be CPR dummies designed to teach proper CPR skills and techniques, but then technologies evolved into incorporating team-based simulations around the bedside. Now, VR/AR technologies are not just being used to teach and train. Through simulation, surgeons and other clinicians can play out different surgical scenarios and potential outcomes in order to plan the best treatment plan for patients who require complex surgeries.