Thursday, August 9, 2018

Survey for usage of Health Apps

Just under two-thirds of U.S. teens and young adults have used a health-related mobile health app, according to a new survey of more than 1,300 US teens and young adults aged 14 to 22 years.
The survey, sponsored by Hope Lab and Well Being Trust, was designed and analyzed in part by Susannah Fox, a former HHS chief technology officer who also conducted similar surveys in the past as a part of the Pew Research Center. Fox was joined by former director of the Kaiser Family Foundation’s Program for the Study of Media and Health Victoria Rideout. The research was conducted earlier this year by NORC at the University of Chicago (formerly the National Opinion Research Center).
A major focus of the report was to get a grounding of understanding on the relationship between depression and social media use in teens and young adults. It found that the relationship there is complicated: teens and young people who use social media extensively aren’t significantly more likely to have symptoms of depression, but those with depressive symptoms are more likely to report both negative and positive social media experiences.
But survey results also include some insights into how young people are using digital health tools in 2018.
“A total of 64 percent of teens and young adults say they have used a health-related mobile app, with fitness apps being the most commonly reported (45 percent),” the report's authors wrote. “One in four (26 percent) young people say they have used nutrition-related apps, while one in five report using apps related to sleep (20 percent) or menstrual cycles (20 percent). About one in 10 say they have used apps related to meditation or mindfulness (11 percent) and stress reduction (9 percent). Only 4 percent say they have used apps related to quitting smoking.”
Not all demographics used health apps at the same rate. Seventy-one percent of young women had tried a health app, compared to 57 percent of men. Thirty percent said they currently used a health app, compared to 20 percent of men.
Teens with moderate to mild depressive symptoms were also more likely to use a health app — 76 percent had done so, compared with 38 percent of those with no symptoms.
“There is not yet a strong evidence base for the effectiveness of health apps,” survey authors noted. “While this survey is not able to assess effectiveness, it did ask respondents how helpful they perceived health-related apps they’ve tried. We find that, of those who have tried health-related apps, a total of 76 percent find them at least ‘somewhat’ helpful: 27 percent say they were ‘very’ helpful and 49 percent say ‘somewhat.’ While 64 percent of young people say they have ‘ever’ used health apps, 25 percent say they ‘currently’ do. It appears that many young people are using health-related apps for just a short time — to reach a goal, for example.”
The vast majority of teens use health apps for fitness and much less for accessing online health information,  including access to their health portals.
Just shy of 40 percent of respondents had gone online to look for people with a health condition similar to their own. But when it came to going online to look for information about depression, that number was much higher for those with depression symptoms (53 percent).
Women and LGBTQ youth were also much more likely to search for information about depression or anxiety online (49 percent of women and 76 percent of LGBTQ respondents had looked for information about depression, 55 percent and 76 percent respectively for anxiety).
One thing teens and young adults still aren’t doing at a high rate is using online or mobile tools to communicate with their healthcare providers. Just one in five young people in the full sample had done so. That number went up to nearly one in three (32 percent) for those with depressive symptoms.
Those interested in learning more, especially about social media use and depression, can check out the full survey here.
The full scope of the value of health IT will require point of service education, including videos and podcasts. The use of recorded videos and podcast can assist.  Direct healthprovider contact can encourage the use of a portal, as well as signage at the intake and discharge desk.

Thursday, July 26, 2018

Artificial Intelligence and the Augmentation of Health Care Decision-Making

Our recent post,  "AI faces challenges, as IBM drops Watson Health Divisionreported on the challenge IBM confronted with it's groundbreaking investment in using their Watson platform in conjunction with the Sloan-Kettering cancer research institute.  The mutual goal was to provide a suitable AI algorithm for cancer treatments..

Internal IBM documents show that its Watson supercomputer often spit out erroneous cancer treatment advice and that company medical specialists and customers identified “multiple examples of unsafe and incorrect treatment recommendations” as IBM was promoting the product to hospitals and physicians around the world.
Both institutions forecast huge success and gains using this new technology, to reduce cost and errors in cancer treatments. Given the huge advances in "personalized medicine" it was hoped the new technology would be able to keep pace with research and specific treatments for a wide variety of cancers and their specific treatments.
The New England Journal of Medicine, Health Catalyst reported the disappointing and potentially dangerous errors in relying on AI decisions for treatment. 
Background Information:
As the complexity and cost of health care increase, many health care institutions have turned to information technology as a means of improving patient care. Electronic medical records, patient portals, digitized medical devices, and even wearables are becoming more broadly used. These systems have been largely transactional, but artificial intelligence (AI) systems that are capable of machine learning go beyond traditional medical transactions and record-keeping to analyze datamake decisions, and exercise judgment.
Because AI tools perform tasks previously performed by humans, they raise concerns about large-scale job loss in health care and other industries. Our view, however, is that “augmentation” of human labor is more likely than large-scale automation.
The Potential of Cognitive Technologies in Medicine
Cognitive technologies are being been introduced in health care in part to reduce human decision-making and the potential for human error in providing care. Medical errors are the third leading cause of death in the United States, but they are not generally due to inherently bad clinicians. Instead, they are often attributed to cognitive errors (such as failures in perception, failed heuristics, and biases), an absence or underuse of safety nets and other protocols, and unwarranted variation in physician practice patterns.
The use of AI technologies promises to reduce the cognitive workload for physicians, thus improving care, diagnostic accuracy, clinical and operational efficiency, and the overall patient experience. While there are understandable concerns and discussion about AI taking over human jobs, there is limited evidence to date that AI will replace humans in health care. For example, numerous studies have suggested that computer-aided readings of radiological images are just as accurate (or more so) than readings performed by human radiologists.
But such systems are not yet in broad use, and, when they are used, they serve as a “second set of eyes.” We know of no radiologists who have lost their jobs from this form of automation. AI technologies such as IBM Watson have excited observers with their potential to treat cancer, but they don’t seem to have replaced any oncologists and, for that matter, there have been no rigorous examinations of their impact on patients. Sedasys, a semi-automated system for administering the anesthesia drug Propofol, met with poor sales and resistance from anesthesiologists and was withdrawn from the market. AI technologies may automate some medical tasks in the future, but few if any jobs have been fully computerized thus far.
Instead of large-scale job loss resulting from automation of human work, we propose that AI provides an opportunity for the more human-centric approach of augmentation. In contrast to automation, augmentation presumes that smart humans and smart machines can coexist and create better outcomes than either could alone. AI systems may perform some health care tasks with limited human intervention, thereby freeing clinicians to perform higher-level tasks.

In IBMs Watson's case, clinicians found many serious errors in recommendations for dosing and medications.  IBM attributed these errors to the integration of clinical recommendation and software programming.  
Whatever cost savings or increased accuracy in prescribing is easily offset by the unknown cost of programming development for AI.  ie, AI is not yet ready for primetime in this area.  Both of these institutions had considerable investment capital committed. Sloan--Kettering abandoned the use of Watson when it's clinicians found the errors.  IBM was premature in promoting their AI/Watson product.  It was a product looking for new business, and not yet mature. 
The saving grace is that physicians will not, in the long run, allow algorithms to treat patients without supervision, error checking and suitable references on the AI platform. It's use will not be transparent, with multiple choice type answers.
Read this primer on IBM Watson to understand what it is and how it is being used.

Mini-glossary: AI terms you should know

All is not lost.  AI has significant value for natural language processing and may contribute much to the use of the electronic health record human-machine interface.

Wednesday, July 25, 2018

Are Health Care Providers doing enough to Ensure Data Security ?

Not a day goes by when I do not read about security breaches in business, financial measurements, political elections, and health databases.

The reasons for this are open for consideration.

When Willie Sutton was asked why he robbed banks he was said to have this response.  (SUTTON's LAW) "because that's where the money is".

There are those who hack because they can. This is analogous to why climb Mt. Everest? Because it is there. 

The term 'hacking' recently has become closely affiliated with security breaches.

Definition - What does Security Breach mean?

A security breach is an incident that results in an unauthorized access of data, applications, services, networks and/or devices by bypassing their underlying security mechanisms. A security breach occurs when an individual or an application illegitimately enters a private, confidential or unauthorized logical IT perimeter.
A security breach is also known as a security violation.

Techopedia explains Security Breach

A security breach is one of the earliest stages of a security attack by a malicious intruder, such as a hacker, cracker or nefarious application. Security breaches happen when the security policy, procedures and/or system are violated. Depending on the nature of the incident, a security breach can be anything from low-risk to highly critical.
In an organization, security breaches are typically monitored, identified and mitigated by a software or hardware firewall. If an intrusion, abnormality or violation is detected, the firewall issues a notification to the network or security administrator.


AI faces challenges,as IBM drops Watson Health Division

This represents a major shift in business strategy for Watson Health, which has invested billions of dollars to win lucrative contracts from hospitals seeking to reform their payment systems to focus on patient outcomes, instead of the volume of care they provide.

IBM’s Watson supercomputer recommended ‘unsafe and incorrect’ cancer treatments, internal documents show

nternal IBM documents show that its Watson supercomputer often spit out erroneous cancer treatment advice and that company medical specialists and customers identified “multiple examples of unsafe and incorrect treatment recommendations” as IBM was promoting the product to hospitals and physicians around the world.
The documents — slide decks presented last summer by IBM Watson Health’s deputy chief health officer — largely blame the problems on the training of Watson by IBM engineers and doctors at the renowned Memorial Sloan Kettering 

Top executives of IBM’s Watson Health division told employees at a meeting on Wednesday that they are scaling back the part of their business that sells tools to help hospitals manage their pay-for-performance contracts, citing softening demand in the market, according to a source who attended the meeting.
This represents a major shift in business strategy for Watson Health, which has invested billions of dollars to win lucrative contracts from hospitals seeking to reform their payment systems to focus on patient outcomes, instead of the volume of care they provide. The effort was central to Watson Health’s efforts to help 

Citing weak demand, IBM Watson Health to scale back hospital business: