Society News

The Affinity Program of expanded benefits is available to SVS members and can connect them with individual disability plans. These plans – available through Principal Life Insurance Company, Securian and Lloyds of London – provide tax-free benefits and can protect hundreds of thousands of dollars.

If interested in learning more about your disability insurance options, contact Mark Blocker at [email protected] or at 949-554- 9936; he is available after-hours and on weekends. Learn more here.

The Affinity Program of expanded benefits is available to SVS members and can connect them with individual disability plans. These plans – available through Principal Life Insurance Company, Securian and Lloyds of London – provide tax-free benefits and can protect hundreds of thousands of dollars.

If interested in learning more about your disability insurance options, contact Mark Blocker at [email protected] or at 949-554- 9936; he is available after-hours and on weekends. Learn more here.

The Affinity Program of expanded benefits is available to SVS members and can connect them with individual disability plans. These plans – available through Principal Life Insurance Company, Securian and Lloyds of London – provide tax-free benefits and can protect hundreds of thousands of dollars.

If interested in learning more about your disability insurance options, contact Mark Blocker at [email protected] or at 949-554- 9936; he is available after-hours and on weekends. Learn more here.

If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback is now available for review on the Quality Payment Program website. Through a process called targeted review, MIPS eligible clinicians or groups can request for CMS to review their performance feedback and final score calculation. The MIPS payment adjustment you receive in 2020 will be based on your final score. Please refer to the QPP Access User Guide for additional details. The deadline to submit your request is 7 PM (CT), September 30, 2019.

If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback is now available for review on the Quality Payment Program website. Through a process called targeted review, MIPS eligible clinicians or groups can request for CMS to review their performance feedback and final score calculation. The MIPS payment adjustment you receive in 2020 will be based on your final score. Please refer to the QPP Access User Guide for additional details. The deadline to submit your request is 7 PM (CT), September 30, 2019.

If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback is now available for review on the Quality Payment Program website. Through a process called targeted review, MIPS eligible clinicians or groups can request for CMS to review their performance feedback and final score calculation. The MIPS payment adjustment you receive in 2020 will be based on your final score. Please refer to the QPP Access User Guide for additional details. The deadline to submit your request is 7 PM (CT), September 30, 2019.

Oct. 31 is the deadline for the Vascular Surgery Trainee Advocacy Travel Scholarship. The primary purpose of this award is to provide the recipient with an opportunity to participate in Capitol Hill visits and learn more about the SVS’ health policy and advocacy activities. The awardee will receive $1,500 that can be used toward the cost of travel, housing and subsistence during the visits. Reports from past recipients are available on the SVS website here. For questions, email [email protected] or telephone 800-258-7188.

Oct. 31 is the deadline for the Vascular Surgery Trainee Advocacy Travel Scholarship. The primary purpose of this award is to provide the recipient with an opportunity to participate in Capitol Hill visits and learn more about the SVS’ health policy and advocacy activities. The awardee will receive $1,500 that can be used toward the cost of travel, housing and subsistence during the visits. Reports from past recipients are available on the SVS website here. For questions, email [email protected] or telephone 800-258-7188.

Oct. 31 is the deadline for the Vascular Surgery Trainee Advocacy Travel Scholarship. The primary purpose of this award is to provide the recipient with an opportunity to participate in Capitol Hill visits and learn more about the SVS’ health policy and advocacy activities. The awardee will receive $1,500 that can be used toward the cost of travel, housing and subsistence during the visits. Reports from past recipients are available on the SVS website here. For questions, email [email protected] or telephone 800-258-7188.

The SVS PSO is looking for a part-time Associate Medical Director. This person will be responsible for assisting the SVS PSO Medical Director and the SVS PSO staff, with guidance and over site in its clinical operations. The new associate director will be nominated by the SVS PSO Executive Committee and approved the SVS and the SVS Executive Board. He or she will serve a one-year term, with the opportunity to serve two additional one-year terms. There is a modest honorary associated with this position and the potential to advance into the role of SVS PSO Medical Director. Submit your application before Oct. 11 to be considered. Read the full job description here. Please email your completed resume to [email protected].

The SVS PSO is looking for a part-time Associate Medical Director. This person will be responsible for assisting the SVS PSO Medical Director and the SVS PSO staff, with guidance and over site in its clinical operations. The new associate director will be nominated by the SVS PSO Executive Committee and approved the SVS and the SVS Executive Board. He or she will serve a one-year term, with the opportunity to serve two additional one-year terms. There is a modest honorary associated with this position and the potential to advance into the role of SVS PSO Medical Director. Submit your application before Oct. 11 to be considered. Read the full job description here. Please email your completed resume to [email protected].

The SVS PSO is looking for a part-time Associate Medical Director. This person will be responsible for assisting the SVS PSO Medical Director and the SVS PSO staff, with guidance and over site in its clinical operations. The new associate director will be nominated by the SVS PSO Executive Committee and approved the SVS and the SVS Executive Board. He or she will serve a one-year term, with the opportunity to serve two additional one-year terms. There is a modest honorary associated with this position and the potential to advance into the role of SVS PSO Medical Director. Submit your application before Oct. 11 to be considered. Read the full job description here. Please email your completed resume to [email protected].

If you are a young vascular surgeon from outside North America, consider applying for the International Scholars Program. Recipients of the award will receive a $5,000 stipend, spend two weeks in the U.S, visiting universities and clinics, and attend the 2020 VAM in Toronto. Scholars will work with a mentor to schedule various vascular program visits, including clinical, teaching and research programs. Apply before Sept. 16 to be considered. Learn more.

If you are a young vascular surgeon from outside North America, consider applying for the International Scholars Program. Recipients of the award will receive a $5,000 stipend, spend two weeks in the U.S, visiting universities and clinics, and attend the 2020 VAM in Toronto. Scholars will work with a mentor to schedule various vascular program visits, including clinical, teaching and research programs. Apply before Sept. 16 to be considered. Learn more.

If you are a young vascular surgeon from outside North America, consider applying for the International Scholars Program. Recipients of the award will receive a $5,000 stipend, spend two weeks in the U.S, visiting universities and clinics, and attend the 2020 VAM in Toronto. Scholars will work with a mentor to schedule various vascular program visits, including clinical, teaching and research programs. Apply before Sept. 16 to be considered. Learn more.

The SVS has officially announced its new Mentor Match program on its online community, SVSConnect. This program provides a simple way to match general surgery residents and medical students with vascular surgeons who will, ideally, help guide them on their career path. Our resident and student members have been awaiting a program like this, and it will only be successful if we have a large pool of Active SVS members enrolled as mentors. Mentees will be able to enroll soon, at which time the matching process will begin. Please look out for communication from us for when that occurs.  Questions? Reach out to [email protected].

The SVS has officially announced its new Mentor Match program on its online community, SVSConnect. This program provides a simple way to match general surgery residents and medical students with vascular surgeons who will, ideally, help guide them on their career path. Our resident and student members have been awaiting a program like this, and it will only be successful if we have a large pool of Active SVS members enrolled as mentors. Mentees will be able to enroll soon, at which time the matching process will begin. Please look out for communication from us for when that occurs.  Questions? Reach out to [email protected].

The SVS has officially announced its new Mentor Match program on its online community, SVSConnect. This program provides a simple way to match general surgery residents and medical students with vascular surgeons who will, ideally, help guide them on their career path. Our resident and student members have been awaiting a program like this, and it will only be successful if we have a large pool of Active SVS members enrolled as mentors. Mentees will be able to enroll soon, at which time the matching process will begin. Please look out for communication from us for when that occurs.  Questions? Reach out to [email protected].

Join us as we celebrate all vascular nurses September 8 to 14 during Vascular Nurses Week. Be sure to let your nurses know how much you value them and their important contributions to your vascular team. You may also encourage your vascular nurses to join the SVS as affiliate members. Membership benefits include discounted meeting registrations, scholarship opportunities, leadership opportunities and more. Read more about Affiliate membership for vascular nurses here.

Join us as we celebrate all vascular nurses September 8 to 14 during Vascular Nurses Week. Be sure to let your nurses know how much you value them and their important contributions to your vascular team. You may also encourage your vascular nurses to join the SVS as affiliate members. Membership benefits include discounted meeting registrations, scholarship opportunities, leadership opportunities and more. Read more about Affiliate membership for vascular nurses here.

Join us as we celebrate all vascular nurses September 8 to 14 during Vascular Nurses Week. Be sure to let your nurses know how much you value them and their important contributions to your vascular team. You may also encourage your vascular nurses to join the SVS as affiliate members. Membership benefits include discounted meeting registrations, scholarship opportunities, leadership opportunities and more. Read more about Affiliate membership for vascular nurses here.

Emerging technology has long been a driver of change in health care, and the pace of technological change has accelerated dramatically in the past decade. Physicians are being challenged to incorporate blockchain technology, virtual health care, artificial intelligence, gamification of learning, and the rapidly developing Internet of Things into their work and into their interactions with patients.

Blockchain in health care

Blockchain is a log of activity that is time stamped, tamper proof, and shared across a network of computers. Each transaction that goes into the log of activity is enclosed in a block and linked together in chronological order to form a chain, now called blockchain.

The potential applications of this emerging technology in health-care delivery are almost limitless.¹ Shared, secure, and linked data that can be accessed by all can give rise to the automation of complex problems, community-generated solutions to problems that empower patients, and an increase in trust, transparency, and incentive alignment. Currently, insurance claims, prescriptions, and payments mostly reside in sequestered computer systems, but a blockchain of the transactions among them would open up a wealth of learning and efficiency possibilities.² Hospitals, medical centers, insurance companies, clinical trials, and large practices can collaborate to create a blockchain of transactions in which all members can view access, share, and analyze the data.

Burton Lesnick, MD, FCCP, has given the topic of technology change and the practice of medicine some thought. He is a member of the CHEST Board of Regents and the former founding medical director of The Children’s Care Network, a pediatric accountable care organization of 1,800 providers in metro Atlanta area. Dr. Lesnick notes that blockchain is still in its early phases, partly because it is expensive in terms of computing power and electricity to adequately maintain a distributed ledger.

“I would see it being used in the next decade for high-value public registries, especially where the authenticity of data is critical. For instance, in Europe, we are already seeing a lot of effort to prevent counterfeit drugs from entering the pharmacy chain. We may soon see blockchain being used to track expensive drugs in our health-care system, thus ensuring chain of possession and preventing fraud,” he said.
 

Virtual care

Some traditional face-to-face encounters between doctor and patient will be replaced by virtual care of different types. Telemedicine is growing, thanks in part to advocacy from Medicare and Medicaid, although the lack of federal guidance on coverage and reimbursement could be a barrier.³ mHealth, the delivery of care via mobile devices, is being utilized for preventive services, appointment confirmation, and follow-up information, but the future of this technology will probably expand into transmission of data from patients and health devices, as well as health alerts.

According to a report by the World Health Organization, an increasing proportion of the population is accessing health information and services through mobile phones.⁴ According to the Physicians Practice 2018 Mobile Health Survey, a majority of practices that participated in the study stated they use mobile health in their practice on a weekly basis.⁵ Those still not using mHealth cite concerns over HIPAA compliance. Dr. Lesnick offers some cautionary perspectives.

“Many of us can already download data from medical devices such as CPAP machines and home ventilators. A prominent pharmaceutical company has recently gained FDA approval for an inhaler that date and time stamps when and how the inhaler has been used. Wearable health devices, such as fitness monitors and watches that can alert users about life-threatening arrhythmias are wonderful. But the potential for physicians being overwhelmed by the incoming data flow is concerning. This is especially true when physicians are already reporting high levels of burnout associated with frustration using electronic medical record systems. We can only hope that algorithms will be developed to sift the precious stones from the digital effluent.”

Despite the security concerns, health-care providers, along with the Centers for Medicare & Medicaid Services and the insurance industry, are planning to address the projected shortages in the health-care workforce with virtual care.³

Dr. Lesnick added, “Doctors need to be engaged at the level of their health-care systems and national organizations. Providers are needed to provide context and balance to ensure that new technology utilizes appropriate scope of practice, optimizes care, and reduces costs, while reducing burdens on caregivers.”
 

Artificial intelligence and the Internet of Things

Artificial intelligence (AI) in health care is the use of complex algorithms and software to approximate human analysis of complicated medical data. The applications in medicine are potentially limitless given the rapid accumulation of data related to health care.

According to Forbes, AI for health-care IT application will cross $1.7 billion by 2019.² By operationalizing AI platforms across select health-care workflows, organizations could see significant productivity gains during the next few years. Forbes also predicts more AI solutions will be used in imaging diagnostics, drug discovery, and risk-analytics applications.²

At the Icahn School of Medicine at Mount Sinai, New York, researchers use an in-house AI system known as Deep Patient, to predict risk factors for 78 different diseases. Doctors use the system to aid in diagnoses.⁹ AI is being used to diagnose patient wounds via smartphones, remotely monitor the elderly, and help health systems to digitally verify a patient’s insurance information.

Dr. Lesnick observed that chess computers started beating grand masters more than 20 years ago. However, the best chess players, in combination with a computer, can still reliably beat a computer alone. We need organizations like CHEST to help us become more adept at using technology. AI is a powerful tool but just another instrument to be employed in care of patients.

Big data and AI will combine to create a new ways of practicing medicine in the coming years, but what this trend will mean to individual clinicians remains to seen.

An area of rapid development is the Internet of Things, the extension of internet connectivity into everyday objects and devices designed to monitor and send information. Health-care devices now incorporate AI, real-time analytics, machine learning, physiologic sensors, and embedded systems.¹⁰ Physicians will increasingly have access to real-time data on individual patients. For physicians, managing, storing, and analyzing data from the personalized health-care devices of their patients will be a major challenge as the Internet of Things continues to expand into health care.

Dr. Lesnick noted, “In my collaboration with Georgia Tech [in Atlanta], one area I’m really excited about is process mining. Instead of sorting individual data points for statistical correlation, process mining looks at groups of actions and decisions. We’ve applied this to our local emergency room. I’m hoping we can find the most efficient processes and hardwire them in order sets. If we can eventually apply process mining to the health-care system as a whole, we might start to see gains in efficiencies.”
 

Gamification

Gamification is the term used to describe any tool or platform that applies game mechanics to nongame initiatives in order to encourage and increase engagement. Elements of gamification often include the use of badges, reward points, prizes, social interaction, and leaderboards. Gamification is frequently used by sales teams, marketers, employee training and performance management, onboarding, learning management, and health and wellness.¹¹

The rise in smartphone ownership and wearable technology will likely increase the adoption of gamification technologies to manage health-related concerns and issues. Patient education via gamification is a potentially powerful tool to enhance engagement around disease management. Maintenance of certification and CME are also growth areas for gamification.
 

Cybersecurity and data breaches

The rapid development of mobile devices and the Internet of Things, in addition to the transmission of health data on a massive scale, will mean more health data will be stolen for a variety of illegal purposes. Hacking and unauthorized access are now common occurrences. Privacy breaches, potential HIPAA violations, and financial damage to patients and institutions are all areas of concern that accompany technological changes.¹²

Dr. Lesnick stressed that all health-care professionals must be accountable for safeguarding patient information and using the latest security software. “Physicians can be advocates for their patients by cautioning them about the risks of placing their private medical information into public spaces, such as social media. Patients should also know that they may be waiving their privacy rights when they utilize commercial entities that collect and store DNA analyses for purposes of ancestry tracking or medical screening,” he concluded.
 

References

1. Dhillon V et al. “Blockchain in healthcare: Innovations that empower patients, connect professionals and improve care.” (New York: CRC Press, 2019).

2. Das R. Top 8 healthcare predictions for 2019. Forbes. 2018 Nov 13.

3. 2019 Predictions. Teladoc Health. 2019. http://go.teladochealth.com/predictions/3/.

4. Director-General. “mHealth: Use of appropriate digital technologies for public health.” World Health Organization. 2018 Mar 26.

5. Physicians Practice Staff. 2018 Mobile Health Survey Results. Physicians Practice. 2018 Feb 20.

6. Trend 1: Citizen AI. Accenture. 2018 May 24.

7. Siwicki B. Zocdoc appointment booking app now verifies insurance with AI. Healthcare IT News. 2017 Oct 25

8. Schepke J. What’s your healthcare gamification strategy? Becker’s Healthcare. 2018 May 31.

9. November 2018 healthcare data breach report. HIPAA Journal. 2018 Dec 20.

10. Siwicki, B. Zocdoc appointment booking app now verifies insurance with AI. HeathcareITNews. 2017 Oct 25.

11. Schepke, J. What’s your healthcare gamification strategy? Becker’s Health IT & CIO Report. 2018. May 31.

12. November 2018 healthcare data breach report. HIPAA Journal. 2018 Dec 20.
Note: Background research performed by Avenue M Group.

Emerging technology has long been a driver of change in health care, and the pace of technological change has accelerated dramatically in the past decade. Physicians are being challenged to incorporate blockchain technology, virtual health care, artificial intelligence, gamification of learning, and the rapidly developing Internet of Things into their work and into their interactions with patients.

Blockchain in health care

Blockchain is a log of activity that is time stamped, tamper proof, and shared across a network of computers. Each transaction that goes into the log of activity is enclosed in a block and linked together in chronological order to form a chain, now called blockchain.

The potential applications of this emerging technology in health-care delivery are almost limitless.¹ Shared, secure, and linked data that can be accessed by all can give rise to the automation of complex problems, community-generated solutions to problems that empower patients, and an increase in trust, transparency, and incentive alignment. Currently, insurance claims, prescriptions, and payments mostly reside in sequestered computer systems, but a blockchain of the transactions among them would open up a wealth of learning and efficiency possibilities.² Hospitals, medical centers, insurance companies, clinical trials, and large practices can collaborate to create a blockchain of transactions in which all members can view access, share, and analyze the data.

Burton Lesnick, MD, FCCP, has given the topic of technology change and the practice of medicine some thought. He is a member of the CHEST Board of Regents and the former founding medical director of The Children’s Care Network, a pediatric accountable care organization of 1,800 providers in metro Atlanta area. Dr. Lesnick notes that blockchain is still in its early phases, partly because it is expensive in terms of computing power and electricity to adequately maintain a distributed ledger.

“I would see it being used in the next decade for high-value public registries, especially where the authenticity of data is critical. For instance, in Europe, we are already seeing a lot of effort to prevent counterfeit drugs from entering the pharmacy chain. We may soon see blockchain being used to track expensive drugs in our health-care system, thus ensuring chain of possession and preventing fraud,” he said.
 

Virtual care

Some traditional face-to-face encounters between doctor and patient will be replaced by virtual care of different types. Telemedicine is growing, thanks in part to advocacy from Medicare and Medicaid, although the lack of federal guidance on coverage and reimbursement could be a barrier.³ mHealth, the delivery of care via mobile devices, is being utilized for preventive services, appointment confirmation, and follow-up information, but the future of this technology will probably expand into transmission of data from patients and health devices, as well as health alerts.

According to a report by the World Health Organization, an increasing proportion of the population is accessing health information and services through mobile phones.⁴ According to the Physicians Practice 2018 Mobile Health Survey, a majority of practices that participated in the study stated they use mobile health in their practice on a weekly basis.⁵ Those still not using mHealth cite concerns over HIPAA compliance. Dr. Lesnick offers some cautionary perspectives.

“Many of us can already download data from medical devices such as CPAP machines and home ventilators. A prominent pharmaceutical company has recently gained FDA approval for an inhaler that date and time stamps when and how the inhaler has been used. Wearable health devices, such as fitness monitors and watches that can alert users about life-threatening arrhythmias are wonderful. But the potential for physicians being overwhelmed by the incoming data flow is concerning. This is especially true when physicians are already reporting high levels of burnout associated with frustration using electronic medical record systems. We can only hope that algorithms will be developed to sift the precious stones from the digital effluent.”

Despite the security concerns, health-care providers, along with the Centers for Medicare & Medicaid Services and the insurance industry, are planning to address the projected shortages in the health-care workforce with virtual care.³

Dr. Lesnick added, “Doctors need to be engaged at the level of their health-care systems and national organizations. Providers are needed to provide context and balance to ensure that new technology utilizes appropriate scope of practice, optimizes care, and reduces costs, while reducing burdens on caregivers.”
 

Artificial intelligence and the Internet of Things

Artificial intelligence (AI) in health care is the use of complex algorithms and software to approximate human analysis of complicated medical data. The applications in medicine are potentially limitless given the rapid accumulation of data related to health care.

According to Forbes, AI for health-care IT application will cross $1.7 billion by 2019.² By operationalizing AI platforms across select health-care workflows, organizations could see significant productivity gains during the next few years. Forbes also predicts more AI solutions will be used in imaging diagnostics, drug discovery, and risk-analytics applications.²

At the Icahn School of Medicine at Mount Sinai, New York, researchers use an in-house AI system known as Deep Patient, to predict risk factors for 78 different diseases. Doctors use the system to aid in diagnoses.⁹ AI is being used to diagnose patient wounds via smartphones, remotely monitor the elderly, and help health systems to digitally verify a patient’s insurance information.

Dr. Lesnick observed that chess computers started beating grand masters more than 20 years ago. However, the best chess players, in combination with a computer, can still reliably beat a computer alone. We need organizations like CHEST to help us become more adept at using technology. AI is a powerful tool but just another instrument to be employed in care of patients.

Big data and AI will combine to create a new ways of practicing medicine in the coming years, but what this trend will mean to individual clinicians remains to seen.

An area of rapid development is the Internet of Things, the extension of internet connectivity into everyday objects and devices designed to monitor and send information. Health-care devices now incorporate AI, real-time analytics, machine learning, physiologic sensors, and embedded systems.¹⁰ Physicians will increasingly have access to real-time data on individual patients. For physicians, managing, storing, and analyzing data from the personalized health-care devices of their patients will be a major challenge as the Internet of Things continues to expand into health care.

Dr. Lesnick noted, “In my collaboration with Georgia Tech [in Atlanta], one area I’m really excited about is process mining. Instead of sorting individual data points for statistical correlation, process mining looks at groups of actions and decisions. We’ve applied this to our local emergency room. I’m hoping we can find the most efficient processes and hardwire them in order sets. If we can eventually apply process mining to the health-care system as a whole, we might start to see gains in efficiencies.”
 

Gamification

Gamification is the term used to describe any tool or platform that applies game mechanics to nongame initiatives in order to encourage and increase engagement. Elements of gamification often include the use of badges, reward points, prizes, social interaction, and leaderboards. Gamification is frequently used by sales teams, marketers, employee training and performance management, onboarding, learning management, and health and wellness.¹¹

The rise in smartphone ownership and wearable technology will likely increase the adoption of gamification technologies to manage health-related concerns and issues. Patient education via gamification is a potentially powerful tool to enhance engagement around disease management. Maintenance of certification and CME are also growth areas for gamification.
 

Cybersecurity and data breaches

The rapid development of mobile devices and the Internet of Things, in addition to the transmission of health data on a massive scale, will mean more health data will be stolen for a variety of illegal purposes. Hacking and unauthorized access are now common occurrences. Privacy breaches, potential HIPAA violations, and financial damage to patients and institutions are all areas of concern that accompany technological changes.¹²

Dr. Lesnick stressed that all health-care professionals must be accountable for safeguarding patient information and using the latest security software. “Physicians can be advocates for their patients by cautioning them about the risks of placing their private medical information into public spaces, such as social media. Patients should also know that they may be waiving their privacy rights when they utilize commercial entities that collect and store DNA analyses for purposes of ancestry tracking or medical screening,” he concluded.
 

References

1. Dhillon V et al. “Blockchain in healthcare: Innovations that empower patients, connect professionals and improve care.” (New York: CRC Press, 2019).

2. Das R. Top 8 healthcare predictions for 2019. Forbes. 2018 Nov 13.

3. 2019 Predictions. Teladoc Health. 2019. http://go.teladochealth.com/predictions/3/.

4. Director-General. “mHealth: Use of appropriate digital technologies for public health.” World Health Organization. 2018 Mar 26.

5. Physicians Practice Staff. 2018 Mobile Health Survey Results. Physicians Practice. 2018 Feb 20.

6. Trend 1: Citizen AI. Accenture. 2018 May 24.

7. Siwicki B. Zocdoc appointment booking app now verifies insurance with AI. Healthcare IT News. 2017 Oct 25

8. Schepke J. What’s your healthcare gamification strategy? Becker’s Healthcare. 2018 May 31.

9. November 2018 healthcare data breach report. HIPAA Journal. 2018 Dec 20.

10. Siwicki, B. Zocdoc appointment booking app now verifies insurance with AI. HeathcareITNews. 2017 Oct 25.

11. Schepke, J. What’s your healthcare gamification strategy? Becker’s Health IT & CIO Report. 2018. May 31.

12. November 2018 healthcare data breach report. HIPAA Journal. 2018 Dec 20.
Note: Background research performed by Avenue M Group.

Emerging technology has long been a driver of change in health care, and the pace of technological change has accelerated dramatically in the past decade. Physicians are being challenged to incorporate blockchain technology, virtual health care, artificial intelligence, gamification of learning, and the rapidly developing Internet of Things into their work and into their interactions with patients.

Blockchain in health care

Blockchain is a log of activity that is time stamped, tamper proof, and shared across a network of computers. Each transaction that goes into the log of activity is enclosed in a block and linked together in chronological order to form a chain, now called blockchain.

The potential applications of this emerging technology in health-care delivery are almost limitless.¹ Shared, secure, and linked data that can be accessed by all can give rise to the automation of complex problems, community-generated solutions to problems that empower patients, and an increase in trust, transparency, and incentive alignment. Currently, insurance claims, prescriptions, and payments mostly reside in sequestered computer systems, but a blockchain of the transactions among them would open up a wealth of learning and efficiency possibilities.² Hospitals, medical centers, insurance companies, clinical trials, and large practices can collaborate to create a blockchain of transactions in which all members can view access, share, and analyze the data.

Burton Lesnick, MD, FCCP, has given the topic of technology change and the practice of medicine some thought. He is a member of the CHEST Board of Regents and the former founding medical director of The Children’s Care Network, a pediatric accountable care organization of 1,800 providers in metro Atlanta area. Dr. Lesnick notes that blockchain is still in its early phases, partly because it is expensive in terms of computing power and electricity to adequately maintain a distributed ledger.

“I would see it being used in the next decade for high-value public registries, especially where the authenticity of data is critical. For instance, in Europe, we are already seeing a lot of effort to prevent counterfeit drugs from entering the pharmacy chain. We may soon see blockchain being used to track expensive drugs in our health-care system, thus ensuring chain of possession and preventing fraud,” he said.
 

Virtual care

Some traditional face-to-face encounters between doctor and patient will be replaced by virtual care of different types. Telemedicine is growing, thanks in part to advocacy from Medicare and Medicaid, although the lack of federal guidance on coverage and reimbursement could be a barrier.³ mHealth, the delivery of care via mobile devices, is being utilized for preventive services, appointment confirmation, and follow-up information, but the future of this technology will probably expand into transmission of data from patients and health devices, as well as health alerts.

According to a report by the World Health Organization, an increasing proportion of the population is accessing health information and services through mobile phones.⁴ According to the Physicians Practice 2018 Mobile Health Survey, a majority of practices that participated in the study stated they use mobile health in their practice on a weekly basis.⁵ Those still not using mHealth cite concerns over HIPAA compliance. Dr. Lesnick offers some cautionary perspectives.

“Many of us can already download data from medical devices such as CPAP machines and home ventilators. A prominent pharmaceutical company has recently gained FDA approval for an inhaler that date and time stamps when and how the inhaler has been used. Wearable health devices, such as fitness monitors and watches that can alert users about life-threatening arrhythmias are wonderful. But the potential for physicians being overwhelmed by the incoming data flow is concerning. This is especially true when physicians are already reporting high levels of burnout associated with frustration using electronic medical record systems. We can only hope that algorithms will be developed to sift the precious stones from the digital effluent.”

Despite the security concerns, health-care providers, along with the Centers for Medicare & Medicaid Services and the insurance industry, are planning to address the projected shortages in the health-care workforce with virtual care.³

Dr. Lesnick added, “Doctors need to be engaged at the level of their health-care systems and national organizations. Providers are needed to provide context and balance to ensure that new technology utilizes appropriate scope of practice, optimizes care, and reduces costs, while reducing burdens on caregivers.”
 

Artificial intelligence and the Internet of Things

Artificial intelligence (AI) in health care is the use of complex algorithms and software to approximate human analysis of complicated medical data. The applications in medicine are potentially limitless given the rapid accumulation of data related to health care.

According to Forbes, AI for health-care IT application will cross $1.7 billion by 2019.² By operationalizing AI platforms across select health-care workflows, organizations could see significant productivity gains during the next few years. Forbes also predicts more AI solutions will be used in imaging diagnostics, drug discovery, and risk-analytics applications.²

At the Icahn School of Medicine at Mount Sinai, New York, researchers use an in-house AI system known as Deep Patient, to predict risk factors for 78 different diseases. Doctors use the system to aid in diagnoses.⁹ AI is being used to diagnose patient wounds via smartphones, remotely monitor the elderly, and help health systems to digitally verify a patient’s insurance information.

Dr. Lesnick observed that chess computers started beating grand masters more than 20 years ago. However, the best chess players, in combination with a computer, can still reliably beat a computer alone. We need organizations like CHEST to help us become more adept at using technology. AI is a powerful tool but just another instrument to be employed in care of patients.

Big data and AI will combine to create a new ways of practicing medicine in the coming years, but what this trend will mean to individual clinicians remains to seen.

An area of rapid development is the Internet of Things, the extension of internet connectivity into everyday objects and devices designed to monitor and send information. Health-care devices now incorporate AI, real-time analytics, machine learning, physiologic sensors, and embedded systems.¹⁰ Physicians will increasingly have access to real-time data on individual patients. For physicians, managing, storing, and analyzing data from the personalized health-care devices of their patients will be a major challenge as the Internet of Things continues to expand into health care.

Dr. Lesnick noted, “In my collaboration with Georgia Tech [in Atlanta], one area I’m really excited about is process mining. Instead of sorting individual data points for statistical correlation, process mining looks at groups of actions and decisions. We’ve applied this to our local emergency room. I’m hoping we can find the most efficient processes and hardwire them in order sets. If we can eventually apply process mining to the health-care system as a whole, we might start to see gains in efficiencies.”
 

Gamification

Gamification is the term used to describe any tool or platform that applies game mechanics to nongame initiatives in order to encourage and increase engagement. Elements of gamification often include the use of badges, reward points, prizes, social interaction, and leaderboards. Gamification is frequently used by sales teams, marketers, employee training and performance management, onboarding, learning management, and health and wellness.¹¹

The rise in smartphone ownership and wearable technology will likely increase the adoption of gamification technologies to manage health-related concerns and issues. Patient education via gamification is a potentially powerful tool to enhance engagement around disease management. Maintenance of certification and CME are also growth areas for gamification.
 

Cybersecurity and data breaches

The rapid development of mobile devices and the Internet of Things, in addition to the transmission of health data on a massive scale, will mean more health data will be stolen for a variety of illegal purposes. Hacking and unauthorized access are now common occurrences. Privacy breaches, potential HIPAA violations, and financial damage to patients and institutions are all areas of concern that accompany technological changes.¹²

Dr. Lesnick stressed that all health-care professionals must be accountable for safeguarding patient information and using the latest security software. “Physicians can be advocates for their patients by cautioning them about the risks of placing their private medical information into public spaces, such as social media. Patients should also know that they may be waiving their privacy rights when they utilize commercial entities that collect and store DNA analyses for purposes of ancestry tracking or medical screening,” he concluded.
 

References

1. Dhillon V et al. “Blockchain in healthcare: Innovations that empower patients, connect professionals and improve care.” (New York: CRC Press, 2019).

2. Das R. Top 8 healthcare predictions for 2019. Forbes. 2018 Nov 13.

3. 2019 Predictions. Teladoc Health. 2019. http://go.teladochealth.com/predictions/3/.

4. Director-General. “mHealth: Use of appropriate digital technologies for public health.” World Health Organization. 2018 Mar 26.

5. Physicians Practice Staff. 2018 Mobile Health Survey Results. Physicians Practice. 2018 Feb 20.

6. Trend 1: Citizen AI. Accenture. 2018 May 24.

7. Siwicki B. Zocdoc appointment booking app now verifies insurance with AI. Healthcare IT News. 2017 Oct 25

8. Schepke J. What’s your healthcare gamification strategy? Becker’s Healthcare. 2018 May 31.

9. November 2018 healthcare data breach report. HIPAA Journal. 2018 Dec 20.

10. Siwicki, B. Zocdoc appointment booking app now verifies insurance with AI. HeathcareITNews. 2017 Oct 25.

11. Schepke, J. What’s your healthcare gamification strategy? Becker’s Health IT & CIO Report. 2018. May 31.

12. November 2018 healthcare data breach report. HIPAA Journal. 2018 Dec 20.
Note: Background research performed by Avenue M Group.

By now, most of you know that the CHEST family lost one of our dearest members and leaders in early July, Past President Mark Rosen. This loss has been felt deeply by many, not only because he was taken so suddenly, but because of who Mark was and what he meant to us. We did not get the chance to say goodbye. We shared Mark’s official obituary last month in CHEST Physician. This month, we thought it important to share something more personal.

When I think of Mark, so many words come to mind: master educator, astute and caring clinician, researcher, mentor, leader. So many qualities come to mind: generous, kind, honest, brilliant, and funny. Mark loved CHEST. He gave so much to the organization and was happy to do so. He was one of the Past Presidents who contributed even more after his presidency than during or before. Mark left an enormous footprint on our educational programs, including the annual meeting, Pulmonary Board Review, and SEEK. He was instrumental in building our international educational programs and a key player in assisting our Chinese colleagues in establishing pulmonary fellowships in their country.

When I think of my own journey with Mark, I think back to the first time I saw him. I was a senior fellow taking the Pulmonary Board Review course in Chicago. I don’t remember much from that course – except for Mark’s presentations. They included everything you needed to know, in a very logical outline. More importantly, he had a presence on stage that was larger than life. He made you laugh throughout the entire talk! Mark’s humor was self-deprecating, and he made you feel like you had been best friends forever---even if he’d never met you. From that first encounter, he became a giant in chest medicine to me. It wasn’t too many years later that, as a junior volunteer leader in the organization, I was able to finally meet Mark. He could not have been more welcoming or humble, and he instantly took on the role of mentor. I was so lucky; not only did that mentorship grow, but so did our friendship. I quickly got to the point that I looked forward to the times I would travel for CHEST events, because I knew I would see Mark. I did establish one rule, however, when we started teaching together. I refused to follow Mark in the agenda, as there was no way I could ever live up to his presentation style and humor. I didn’t want to be a let down to the crowd!

Much of what I and others have accomplished with CHEST and in pulmonary medicine is directly related to the wonderful mentors we have had in the organization, and Mark was certainly one of the most prominent. He introduced me to so many additional friends and mentors. And, Mark did this for hundreds of trainees and junior faculty throughout his career. If I were to guess, I would say that this is the thing that made him most proud. Yes, he was an established international expert in several areas of pulmonary medicine; he held several prominent positions in academic medicine and at CHEST. But, what made him most happy was seeing his trainees and mentees succeed – you would have thought we were one of his kids (whom he was also very proud of and loved dearly). Mark was THE example of an outstanding mentor.

The memory I will carry forever of Mark, however, is when he got on stage and was the Master of Ceremonies for the CHEST Challenge Championship. He was in his element as an educator, interacting with the next generation of chest medicine physicians. He spent the entire time making the contestants, and the audience, laugh. People came to the final round to see Mark, even if they had no dog in the fight. I will always fondly recall that way he would look over at me and the other judges if he wasn’t sure about a team’s answer and then have an immediate witty comeback. Many of my CHEST friends have said that Mark was the Jerry Seinfeld of CHEST. I’ve never watched a single episode of Seinfeld, but if this description is true, I plan to!

Mark kept his sense of humor until the very end, telling me in his final days that he chose to focus on “humor markers,” rather than “tumor markers” – he said that always worked out better for him! Mark, we all miss you friend. We can’t wait to share a Chopin Martini with a twist of lemon when we see you on the other side. Thank you for all you did for your family, your patients, your trainees, your colleagues, and CHEST.

By now, most of you know that the CHEST family lost one of our dearest members and leaders in early July, Past President Mark Rosen. This loss has been felt deeply by many, not only because he was taken so suddenly, but because of who Mark was and what he meant to us. We did not get the chance to say goodbye. We shared Mark’s official obituary last month in CHEST Physician. This month, we thought it important to share something more personal.

When I think of Mark, so many words come to mind: master educator, astute and caring clinician, researcher, mentor, leader. So many qualities come to mind: generous, kind, honest, brilliant, and funny. Mark loved CHEST. He gave so much to the organization and was happy to do so. He was one of the Past Presidents who contributed even more after his presidency than during or before. Mark left an enormous footprint on our educational programs, including the annual meeting, Pulmonary Board Review, and SEEK. He was instrumental in building our international educational programs and a key player in assisting our Chinese colleagues in establishing pulmonary fellowships in their country.

When I think of my own journey with Mark, I think back to the first time I saw him. I was a senior fellow taking the Pulmonary Board Review course in Chicago. I don’t remember much from that course – except for Mark’s presentations. They included everything you needed to know, in a very logical outline. More importantly, he had a presence on stage that was larger than life. He made you laugh throughout the entire talk! Mark’s humor was self-deprecating, and he made you feel like you had been best friends forever---even if he’d never met you. From that first encounter, he became a giant in chest medicine to me. It wasn’t too many years later that, as a junior volunteer leader in the organization, I was able to finally meet Mark. He could not have been more welcoming or humble, and he instantly took on the role of mentor. I was so lucky; not only did that mentorship grow, but so did our friendship. I quickly got to the point that I looked forward to the times I would travel for CHEST events, because I knew I would see Mark. I did establish one rule, however, when we started teaching together. I refused to follow Mark in the agenda, as there was no way I could ever live up to his presentation style and humor. I didn’t want to be a let down to the crowd!

Much of what I and others have accomplished with CHEST and in pulmonary medicine is directly related to the wonderful mentors we have had in the organization, and Mark was certainly one of the most prominent. He introduced me to so many additional friends and mentors. And, Mark did this for hundreds of trainees and junior faculty throughout his career. If I were to guess, I would say that this is the thing that made him most proud. Yes, he was an established international expert in several areas of pulmonary medicine; he held several prominent positions in academic medicine and at CHEST. But, what made him most happy was seeing his trainees and mentees succeed – you would have thought we were one of his kids (whom he was also very proud of and loved dearly). Mark was THE example of an outstanding mentor.

The memory I will carry forever of Mark, however, is when he got on stage and was the Master of Ceremonies for the CHEST Challenge Championship. He was in his element as an educator, interacting with the next generation of chest medicine physicians. He spent the entire time making the contestants, and the audience, laugh. People came to the final round to see Mark, even if they had no dog in the fight. I will always fondly recall that way he would look over at me and the other judges if he wasn’t sure about a team’s answer and then have an immediate witty comeback. Many of my CHEST friends have said that Mark was the Jerry Seinfeld of CHEST. I’ve never watched a single episode of Seinfeld, but if this description is true, I plan to!

Mark kept his sense of humor until the very end, telling me in his final days that he chose to focus on “humor markers,” rather than “tumor markers” – he said that always worked out better for him! Mark, we all miss you friend. We can’t wait to share a Chopin Martini with a twist of lemon when we see you on the other side. Thank you for all you did for your family, your patients, your trainees, your colleagues, and CHEST.

By now, most of you know that the CHEST family lost one of our dearest members and leaders in early July, Past President Mark Rosen. This loss has been felt deeply by many, not only because he was taken so suddenly, but because of who Mark was and what he meant to us. We did not get the chance to say goodbye. We shared Mark’s official obituary last month in CHEST Physician. This month, we thought it important to share something more personal.

When I think of Mark, so many words come to mind: master educator, astute and caring clinician, researcher, mentor, leader. So many qualities come to mind: generous, kind, honest, brilliant, and funny. Mark loved CHEST. He gave so much to the organization and was happy to do so. He was one of the Past Presidents who contributed even more after his presidency than during or before. Mark left an enormous footprint on our educational programs, including the annual meeting, Pulmonary Board Review, and SEEK. He was instrumental in building our international educational programs and a key player in assisting our Chinese colleagues in establishing pulmonary fellowships in their country.

When I think of my own journey with Mark, I think back to the first time I saw him. I was a senior fellow taking the Pulmonary Board Review course in Chicago. I don’t remember much from that course – except for Mark’s presentations. They included everything you needed to know, in a very logical outline. More importantly, he had a presence on stage that was larger than life. He made you laugh throughout the entire talk! Mark’s humor was self-deprecating, and he made you feel like you had been best friends forever---even if he’d never met you. From that first encounter, he became a giant in chest medicine to me. It wasn’t too many years later that, as a junior volunteer leader in the organization, I was able to finally meet Mark. He could not have been more welcoming or humble, and he instantly took on the role of mentor. I was so lucky; not only did that mentorship grow, but so did our friendship. I quickly got to the point that I looked forward to the times I would travel for CHEST events, because I knew I would see Mark. I did establish one rule, however, when we started teaching together. I refused to follow Mark in the agenda, as there was no way I could ever live up to his presentation style and humor. I didn’t want to be a let down to the crowd!

Much of what I and others have accomplished with CHEST and in pulmonary medicine is directly related to the wonderful mentors we have had in the organization, and Mark was certainly one of the most prominent. He introduced me to so many additional friends and mentors. And, Mark did this for hundreds of trainees and junior faculty throughout his career. If I were to guess, I would say that this is the thing that made him most proud. Yes, he was an established international expert in several areas of pulmonary medicine; he held several prominent positions in academic medicine and at CHEST. But, what made him most happy was seeing his trainees and mentees succeed – you would have thought we were one of his kids (whom he was also very proud of and loved dearly). Mark was THE example of an outstanding mentor.

The memory I will carry forever of Mark, however, is when he got on stage and was the Master of Ceremonies for the CHEST Challenge Championship. He was in his element as an educator, interacting with the next generation of chest medicine physicians. He spent the entire time making the contestants, and the audience, laugh. People came to the final round to see Mark, even if they had no dog in the fight. I will always fondly recall that way he would look over at me and the other judges if he wasn’t sure about a team’s answer and then have an immediate witty comeback. Many of my CHEST friends have said that Mark was the Jerry Seinfeld of CHEST. I’ve never watched a single episode of Seinfeld, but if this description is true, I plan to!

Mark kept his sense of humor until the very end, telling me in his final days that he chose to focus on “humor markers,” rather than “tumor markers” – he said that always worked out better for him! Mark, we all miss you friend. We can’t wait to share a Chopin Martini with a twist of lemon when we see you on the other side. Thank you for all you did for your family, your patients, your trainees, your colleagues, and CHEST.

As we put summer in our rear-view mirror and look ahead to the switch of seasons and the vivid colors of fall and prepare to indulge and learn at CHEST 2019, it is evident change is in the air. Fall is a time of change and learning about the many opportunities the CHEST 2019 meeting offers our members, and it is also the launch of all that is changing and new for you to be a part of the CHEST Foundation.

At CHEST 2019 this year, the CHEST Foundation will be holding their 3rd Annual Women & Pulmonary Luncheon on Monday, October 21. This annual luncheon has brought over 350 attendees together to not only collaborate on patient care while focusing on gender differences but also to discuss better ways to advocate for career advancements for women pulmonologists. A new change for this year is the addition of a networking hour following the luncheon, creating an open environment to discuss empowerment, education, and resources.

The CHEST Foundation continues to help young clinicians come to the CHEST Annual Meeting. As of today, more than $250,000 has been awarded by the Foundation in travel grants and complimentary registrations to more than 125 early career clinicians. YOU can have an impact and make a change for an individual by supporting travel grants this year.

The Foundation’s most noteworthy change, and one we hope all of our membership and donors will be a part of, is the launch of our new endowment in 2019/2020. The Erin Popovich Endowment will enable access to resources for patients and families, empower patients to take charge, find support groups, seek second opinions, and more, and will support research to advance patient care and improve treatment options and outcomes. This endowment will change and improve quality of life for patients and families affected by interstitial lung disease, and we encourage you to join us at the Donor Lounge to learn more.

As you embrace the changing of the season and prepare your highlights for CHEST 2019 in NOLA, we invite you to come and discover all the changes and impact the CHEST Foundation is making and why you are so important in all we do!

As we put summer in our rear-view mirror and look ahead to the switch of seasons and the vivid colors of fall and prepare to indulge and learn at CHEST 2019, it is evident change is in the air. Fall is a time of change and learning about the many opportunities the CHEST 2019 meeting offers our members, and it is also the launch of all that is changing and new for you to be a part of the CHEST Foundation.

At CHEST 2019 this year, the CHEST Foundation will be holding their 3rd Annual Women & Pulmonary Luncheon on Monday, October 21. This annual luncheon has brought over 350 attendees together to not only collaborate on patient care while focusing on gender differences but also to discuss better ways to advocate for career advancements for women pulmonologists. A new change for this year is the addition of a networking hour following the luncheon, creating an open environment to discuss empowerment, education, and resources.

The CHEST Foundation continues to help young clinicians come to the CHEST Annual Meeting. As of today, more than $250,000 has been awarded by the Foundation in travel grants and complimentary registrations to more than 125 early career clinicians. YOU can have an impact and make a change for an individual by supporting travel grants this year.

The Foundation’s most noteworthy change, and one we hope all of our membership and donors will be a part of, is the launch of our new endowment in 2019/2020. The Erin Popovich Endowment will enable access to resources for patients and families, empower patients to take charge, find support groups, seek second opinions, and more, and will support research to advance patient care and improve treatment options and outcomes. This endowment will change and improve quality of life for patients and families affected by interstitial lung disease, and we encourage you to join us at the Donor Lounge to learn more.

As you embrace the changing of the season and prepare your highlights for CHEST 2019 in NOLA, we invite you to come and discover all the changes and impact the CHEST Foundation is making and why you are so important in all we do!

As we put summer in our rear-view mirror and look ahead to the switch of seasons and the vivid colors of fall and prepare to indulge and learn at CHEST 2019, it is evident change is in the air. Fall is a time of change and learning about the many opportunities the CHEST 2019 meeting offers our members, and it is also the launch of all that is changing and new for you to be a part of the CHEST Foundation.

At CHEST 2019 this year, the CHEST Foundation will be holding their 3rd Annual Women & Pulmonary Luncheon on Monday, October 21. This annual luncheon has brought over 350 attendees together to not only collaborate on patient care while focusing on gender differences but also to discuss better ways to advocate for career advancements for women pulmonologists. A new change for this year is the addition of a networking hour following the luncheon, creating an open environment to discuss empowerment, education, and resources.

The CHEST Foundation continues to help young clinicians come to the CHEST Annual Meeting. As of today, more than $250,000 has been awarded by the Foundation in travel grants and complimentary registrations to more than 125 early career clinicians. YOU can have an impact and make a change for an individual by supporting travel grants this year.

The Foundation’s most noteworthy change, and one we hope all of our membership and donors will be a part of, is the launch of our new endowment in 2019/2020. The Erin Popovich Endowment will enable access to resources for patients and families, empower patients to take charge, find support groups, seek second opinions, and more, and will support research to advance patient care and improve treatment options and outcomes. This endowment will change and improve quality of life for patients and families affected by interstitial lung disease, and we encourage you to join us at the Donor Lounge to learn more.

As you embrace the changing of the season and prepare your highlights for CHEST 2019 in NOLA, we invite you to come and discover all the changes and impact the CHEST Foundation is making and why you are so important in all we do!