Technology + healthcare: How the industry is changing


From access to healthcare to the use of AI to diagnose patients and data ownership issues, one thing is certain: technology is changing the healthcare industry. We contacted health care providers and specialists from the Southeast Missouri region to find out their perspectives on how to do this. Here they share their thoughts.

Increased awareness of mental illness and drug abuse.

Stigmatization of behavioral disorders is slowly abating as celebrities come forward to reveal their personal challenges with depression, addiction, anxiety, bipolar disorder, and other common but debilitating mental illnesses. What can you expect in the future?

"According to a 2006 study by Mathers and Loncar, depression is thought to be the leading cause of HIV / AIDS disease worldwide by 2030. Research (SAMSHA 2017 National Survey on Drug Use and Health) also shows that this is the case The case is an increase in the prevalence of mental health, particularly among younger people, with 25.8% of adolescents aged 18 to 25 years being diagnosed with mental health and 49.5% of adolescents aged 13 to 18 years being diagnosable Have mental health problems With mental health problems, including the proliferation of cyberbullying, excessive use of technology that leads to reduced sleep and social interaction, and family / social isolation: Research would suggest that people with mental health problems – or substance problems are diagnosed, continue to rise and id will continue to increase the need for mental health and substance use support services, with the mental health stigma decreasing and the number of people affected. Access to services will increase and decrease pressure on mental health and drug providers who are already overworked burst at the seams. The positive result is that stigmatization is decreasing and it is becoming more acceptable to seek help in one's own community and through other available options such as technology-based counseling support. With technology-based consulting support, you often get instant access, and access is convenient from home. This removes obstacles for individuals who often do not use traditional office-based services. The long-term optimistic outcome of improved access and reduced stigma would be people who have earlier access to mental health and substance use treatment resources, which can lead to earlier intervention that can help reduce the severity of mental illness and addiction. "

– Janice Ruesler, director of counseling and disability at Southeast Missouri State University

"In recent years, leading figures from the media, politics and entertainment have increasingly discussed the importance of discussions about healthy mental health and have helped to remove previous stigmatizations and misunderstandings that have been maintained by too many for too long.

This "normalization" of wellbeing in behavioral health initiated a cultural change at Ferguson Medical Group almost five years ago. Behavioral health professionals worked with doctors and administrators to include behavioral issues in the clinic's admission forms. They also worked with clinicians to start behavioral health discussions as part of their general patient discussions. Behavioral medicine providers work closely with clinicians to communicate with patients that feelings, emotions and behaviors are an essential and very "normal" part of a patient's overall well-being.

The team went one step further by including an expert in behavioral medicine in the discussion. The Ferguson Medical Group now has a behavioral doctor on call when needed for immediate consultation with the clinician in the same exam room during the same visit. By working with a nurse, a nurse, or someone who the family knows and trusts, these discussions can be less intimidating.

This appears to be a small step in the process, but this front-end discussion focuses on the patient's needs, schedule, and concerns. It enables behavioral health to become a natural part of the patient's overall treatment, helps patients avoid stigma that they may associate with a more traditional behavioral health referral, and streamlines follow-up examinations. We come to the patient instead of a patient coming to us.

These appointments also help treat behavioral components related to common illnesses, including obesity, chronic pain, smoking cessation, sleep disorders, drug / treatment compliance difficulties, and substance abuse.

The use of electronic patient records has dramatically improved the integration of patient care and behavioral health care. The Saint Francis Healthcare System has a powerful electronic health record system that doctors can use to improve continuity of care in all disciplines. For example, if a child is diagnosed with autism, providers can immediately begin setting up services for speech therapy, occupational therapy, psychiatry, and physiotherapy. All providers are involved and are aware of the care and progress of the patient. With interactive tools like MyChart, patients can send text or questions between appointments, postpone appointments and review treatment notes. This involves the patient and increases the likelihood of participating in a treatment program.

Improved technologies, better patient engagement, and more general discussions about healthy behaviors will help patients get the treatments they need. This is just the beginning to improve the health and well-being of our patients and their families. "

– Dr. David Dahlbeck, psychologist, Ferguson Medical Group, a medical partner of the Saint Francis health system

Big tech and healthcare.

There is a lot of talk about tech companies entering and transforming the supply space – artificial intelligence and machine learning. How will these innovations affect care, although it may take some time?

"Although the idea that artificial intelligence (AI) technologies make decisions for our healthcare is somewhat irritating, the in-depth learning and analysis algorithms of artificial intelligence can transform healthcare. Microsoft, Google, and Apple are three of them." Technology giants that have significantly advanced the use of artificial intelligence in healthcare: Microsoft has worked on a number of healthcare initiatives, one of which is a partnership with Nuance Communications to help develop artificial intelligence (AI) technologies in the environment that do so can listen in on the conversation between doctor and patient during a visit, automatically create the patient file and, if necessary, make recommendations for the care plan based on the data collected.The automatic generation of a large part of the patient file during the visit reduces part of the data exposed, and which allow them to focus more on the patient.

Google has worked to develop a number of machine learning tools that can be used to achieve human-level accuracy. Two areas in which they have made significant progress are ophthalmology and digital pathology. The algorithm developed by Google to examine fundus images of the retina to diagnose diabetic retinopathy is comparable to ophthalmologists certified by the United States. Google has also developed algorithms to help pathologists detect breast cancer from lymph node biopsies. As part of their research, Google has developed a tool called SMILY that can be used to compare and analyze digitized pathology images from a database with billions of images in a matter of seconds. This technology can help clinicians identify anomalies in tissue samples early, e.g. B. those that precede a cancer diagnosis.

Apple is ready to generate a variety of healthcare data for research purposes with its downloadable, voluntary research app. In addition, research continues on high-performance sensor development and software development kits such as ResearchKit and HealthKit. Apple is partnering with leading health and research institutions to use the vast amount of data generated by Apple products for research in areas such as heart health, hearing, and women's health. The powerful sensors on the Apple Watch and the EKG app can be used to alert users, for example, to irregularities in heart rate and rhythm. For users who have opted to participate in Apple's research studies, Apple's Noise app can help researchers investigate how long-term sound exposure and exposure affect stress, cardiovascular health, and hearing over time can. Apple is also working on a study to better understand the relationship between female cycles and behaviors and habits in different reproductive health conditions.

Microsoft, Google and Apple have partnered with leading healthcare research institutions, including Harvard, the National Institutes of Health, Stanford and the University of Chicago, to name a few. AI technologies such as those developed by these three companies have the potential to help clinicians deliver better, more prevention-oriented care with a more individual focus. "

– Dr. Dana Schwieger, Professor of Management Information Systems at Southeast Missouri State University

The balance of power between hospital systems and groups of doctors.

The roles and impact of technology on patient care.

"In the past, doctors were self-employed doctors who either practiced alone or joined together in a private practice. Very few were employed in hospitals. Hospitals relied on the doctor to refer patients to the hospital for acute care. General practitioners (PCPs) provided care the majority of their patients admitted them to a hospital and only consulted a specialist for a procedure or treatment that they could not perform themselves.

In the past 15 to 20 years, however, the relationship between doctor and hospital has developed into a symbiosis. Hospitals have taken a more active role in patient management by forming care teams and developing protocols and procedures to improve results and patient safety. As a result of this change, more and more doctors have given up their private practice and opted for employment. Today, approximately 50% of doctors in the United States are employed in hospitals, which is the core of a healthcare system.

The patient is now surrounded by a health team consisting of nurses, health professionals, social workers, etc., and is led by a treating doctor. In the background, the electronic patient record (EMR) provides, among other things, a platform for communication, order placement, decision support and information. In this "systematization" of medicine, the EMR offers the connectivity that enables the continuity of care.

Medical knowledge has grown exponentially in recent decades, creating more treatment options for a particular disease. As a result, fewer problems are treated only by a family doctor. With increasing frequency, specialties and subspecialties that did not exist a decade ago are becoming more closely integrated into patient care. Without a system that connects the specialist with the PCP, the care would be fragmented. Thanks to an integrated EMR, every medical practitioner involved in patient care can access the files. These EMRs often have treatment paths and protocols for disease entities such as asthma that open up treatment options and provide decision-making aids for a specific stage of the disease.

Of course, not all doctors, hospitals, or related professionals are in the same EMR. Health systems typically use an EMR throughout the system, which enables this connectivity and seamless care. Care that is sought outside of this system then depends on the ability of two EMRs to "talk" to each other. Although this capability has not yet been fully implemented, large EMR companies operate on the day when a patient's medical record can be seamlessly transferred between healthcare professionals and healthcare systems. In the end, it's not about balancing the forces, but about benefiting the patient. "

– Dr. Thomas S. Diemer, chief physician of the Saint Francis health system

Drug pricing and biotechnology.

How groundbreaking innovations from biotechnology and pharmaceutical companies are shifting the focus from high pharmaceutical costs to the search for new and different payment methods in order to expand access to the most innovative products.

"In the United States, the drug trend is shifting from low molecular weight drugs to drugs that are manufactured using human or animal protein. Drugs that fall into this category are defined as biological agents. 32 of the 42 new drugs introduced in 2017 concerned biological agents.

While these compounds treat diseases that affect a small percentage of the population, they also include more common medications, such as insulins. Biologics are highly specific and treat a disease at the cellular level. Some diseases include multiple sclerosis, rheumatoid arthritis, HIV / AIDS, hepatitis C, cancer, psoriasis and Crohn's disease. These are considered specialty medications and account for 1.9% of the total prescription volume, but account for 37.4% of expenditure. Biologics, also referred to as "high touch" drugs, require thorough advice regarding complex drug delivery, drug interactions, side effects, and the importance of compliance. Biologics provide better patient response and reduce disease progression.

Generics are not available to reduce costs, but there are alternatives to some biologics known as biosimilars. These reduce costs, but doctors are often concerned about changing medication if it turns out that a patient benefits from brand-specific chemicals.

Biologicals have many barriers. Often the delivery system is complex, e.g. B. Injections of syringes and pen devices. Biologicals are usually not insured without special permission. Once approved, the additional payments associated with this information are often unrealistic for patients.

However, there are strategies to make access easier for patients. Most of these biological agents have co-pay cards for privately insured patients that cover the entire cost or reduce it to a minimum. The manufacturers send out a credit / debit card that is used in the registry or as insurance and is recorded and billed in the pharmacy computer. Manufacturers' aid programs cover patients who may not be able to afford certain drugs for large amounts. The third way to support patient costs is through organizations that offer grant programs.

In the Saint Francis Healthcare System, these specialty medicines are filled by the Healing Arts and Specialty Pharmacy. Manufacturers limit sales to pharmacies that offer advice and follow-up action needed for secure administration, a service offered by Saint Francis. Specialist pharmacists initiate pre-approvals, set up patients with co-pay cards, monitor side effects, investigate drug interactions, advise patients on the administration of drugs, coordinate the delivery of drugs at home and much more. "

– Katie Bertrand, PharmD, specialist pharmacist, medicine and specialist pharmacy, Saint Francis Healthcare System

How and where is healthcare provided?

How the cost of hospitalization combined with technology activation and patient preference development changes our thinking about how and where care is delivered.

"Domestic health and insurance costs are rising rapidly. At Saint Francis Healthcare System, we are tackling this trend. In January 2019, we initiated a price reduction of 15%.

Some healthcare providers may wonder why St. Francis cuts costs, but with our commitment to exceptional quality and results, we can pass on our savings to our patients. Quality costs less – less time in the hospital after surgery, less chances of infection at the surgical site and less money for prescription drugs. It is really that easy. And price cuts are the right thing for our community.

As the largest healthcare system between St. Louis and Memphis, patients no longer have to travel to receive state-recognized care. While there are some services that we don't offer, such as treating severe burns, organ transplants, and some minor pediatric diseases. However, patients can rest assured that the quality of care in Saint Francis is not only acceptable but also exceptional.

Saint Francis brings advances in technology and education to drive our efforts to maintain and improve the health of our community. Using the latest technology and the best people, we can offer comprehensive and effective tests, treatments and services. By continuing to invest in technology and people, we are able to offer the most advanced, innovative and well-founded care.

At Saint Francis Healthcare System, we are called to serve everyone who enters our doors with dignity and compassion. Our commitment to quality through the latest technology is just one of the many ways that we accomplish our mission to serve healing, well-being, quality and love, inspired by our faith in Jesus Christ. "

– Dr. Maryann Reese, President and Chief Executive Officer of the Saint Francis Health System

Data protection, companies that are transparent and ethically correct.

Potentially questionable uses and data ownership will raise eyebrows – especially when Americans who have used DNA testing services may find that they may not have fully understood the privacy implications when they shared their genetic data Have given analysis. Who owns the data?

"In the past, ownership of personal data has been biased towards the company that owns the data. In recent years, legislative efforts have been made to change this for the benefit of consumers. The legal changes began with the European Union's General Data Protection Regulation ( GDPR)), which entered into force on May 25, 2018.

The first point of the GDPR states that "everyone has the right to the protection of personal data". Although the GDPR was written by the European Union (EU), it applies to all companies that process personal data of citizens of the EU, and even if this company is based in a non-EU country. As a result, many companies have had to change their view of who owns the data.

Two key elements of the GDPR are the "right to erasure", also known as the "right to be forgotten" and the "right to restriction of processing". These provisions allow individuals to verbally or in writing request that a company remove their personal information or how the company uses their information. The company then has 30 days to respond to the request.

While there is no equivalent to GDPR in U.S. law, although large U.S. technology companies have advocated such a law, several states have considered versions of the GDPR. In June 2018, California adopted a version of the GDPR (California Consumer Privacy Act) (CCPA) that will enter into force on January 1, 2020. The CCPA does not contain all the provisions of the GDPR, but it does contain some basic protective provisions, e.g. granting individuals the right to access the data that a company has. Organizations must also have a visible footer on websites so that individuals have the option to disable data sharing.

Momentum is clearly on the side of protecting and empowering consumers to protect their data. As more and more individuals raise concerns, we will see more laws driving this change. Even if this continues to change, everyone has to take the time to read the data protection information available on websites, as this can contain a wealth of information on how companies handle data. "

– Wayne Floyd, CISSP, CPA, MBA, Cyber ​​Security Officer, Saint Francis Healthcare System

The role of portable and other health products and their impact on health awareness and health care. How do hospitals / doctors see this trend?

Apple, Google, Amazon, Walmart and others are taking steps to enter the healthcare market. How do healthcare professionals view these devices and new technologies that put patient health monitoring and management in the hands of patients?

"At HealthPoint Fitness, we've seen a trend in which our members use apps on their phones that communicate with their smartwatches," said Amy Sutherlin, fitness manager at SoutheastHEALTH, MSA, ACSM, EP-C. "When we redesigned our Cape Girardeau fitness center last year, we deliberately created functional spaces and more open areas within the fitness center to give our members the opportunity to use their apps and have room for more functional training, which is shown in many apps. "Even if the member trains" alone "in the facility, there is still a sense of community that you don't get if you train alone at home, adds Sutherlin.

She also notes that updated bikes in the bike studio use an app that communicates with members' phones to monitor their workload in each class. It stores the information in the app so that the practitioner can see how it is developing.

"We also offer Les Mills On Demand programs that members can access anytime from home or through a mobile app," said Sutherlin. "Members can come to training with the app or stream programs at home on days when it's not possible to get to the facility."

HealthPoint's ActivTrax program generates workouts for members so they can follow the training on their phones. According to Sutherlin, it is no longer necessary to walk around with a training card. "The phone becomes a training card," she explains.

"All of these apps and technological advances can improve member training," added Sutherlin. "Despite all the technology available, it's always a good idea to meet with a personal trainer to make sure the workouts are right and that they're in the right shape. An app can't tell you things like that." A personal one-to-one session can do this, but combining the technology with the support of a personal trainer can result in better adherence to movement and lifestyle changes. "

– Sally Owen, marketing and communications specialist at SoutheastHEALTH