Monday, 7 August 2017

Order Sets: A POKA-YOKE for Clinical Decisions by Dr. Ujjwal Rao, @DrUjjwalRao - Part 2/2

The full potential of a CDSS can be realised when it is seamlessly integrated into the clinical workflow and is evidence-adaptive

In continuation to the the part one of the article, in the part 2 of the "Order Sets: A POKA-YOKE for clinical decisions" Dr. Rao is

ADDRESSING THE KNOWLEDGE GAP THROUGH CDSS:

THE POWER OF ORDER SETS

A “Physician Order” is a communication directing a particular service or action to be taken in the care of a specific patient. Medications, diet, physical activities, laboratory tests, radiologic studies, therapies, treatments...all are among the literally dozens of orders written to guide the care of each and every patient by the physician throughout an ordinary day. 

Thus the physician ordering process is complex and time-consuming. In addition, the continuous explosion of new evidence-based information results in the reality that providers often make mistakes, at best failing to provide the highest value care, and at worst causing preventable injuries and deaths. And while computers can address avoidable mistakes from the most mundane sources (such as illegible hand-writing), the greatest threat to patient safety and cost waste is the knowledge gap.

Fortunately, when a physician realises that he or she needs information, CDSS reference solutions provide access to current, credible, evidence-based knowledge (either integrated into an EHR, available over the internet, or in print). Thus by their very nature, reference solutions require that the physician knows he or she doesn’t know something.

But medical knowledge is doubling every two months. Clearly many times the physician doesn’t know what he or she doesn’t know... Thus patients are placed at risk because physicians are unaware that new information and knowledge is available.

Order sets are the best solution to this dangerous problem. Order sets automatically push current, credible, evidence-based information specific to the patient’s clinical history and current clinical status directly to the physician at the point of care. Take for example:


A 52 year old man is admitted for surgical treatment of a right-sided colon cancer. His surgeon regularly operates on such patients, removing that segment of large intestine harboring the malignant tumor. But like many, this surgeon is unaware that this patient’s young age and tumor location suggest an inherited syndrome requiring a much more extensive operation to prevent a second cancer over the next decade. 
If the surgeon “doesn’t know what he doesn’t know,” how can he look up “inherited colon cancer” in his CDSS reference solution? He can’t. But when the patient is admitted to the hospital, order sets specific for colon cancer patients are automatically pushed to the physician. These order sets can be commercially available or can be created by the hospital, healthcare system, regional, or international experts (physicians, nurses, pharmacists, etc.) and represent the evidence-based guidelines and information on colon cancer. Thus the order sets educate the surgeon and recommend that he order a simple blood test to check for the inherited cancer syndrome. If integrated within an EHR, the physician can actually click on embedded hyperlinks to view the EBM sources of the recommended orders. 
The surgeon will likely accept the recommended order and confirm that the patient suffers from the syndrome. Then the surgeon can search the CDSS reference solution and rapidly learn the appropriate surgical procedure for the patient, as well as how to test and screen family members for the inherited syndrome.

Thus order sets address the knowledge gap, including providing the physician with what he “doesn’t know he doesn’t know.”

But there is a risk with evidence-based order sets because clinical knowledge is advancing exponentially. When order sets are implemented but inadequately maintained, they drive providers to practice outdated medicine on a widespread basis [14]. Thus it is critical for evidence-based order sets to include a knowledge-base that continually reflects current evidence. In the near future, evidence-adaptive order sets will be empowered through advancements in machine learning and artificial intelligence. 

Today, much evidence adaption is performed manually, with professionals (using computer systems) to rapidly review new EBM for updating order sets. CDSS which incorporate order sets can reduce medication errors up to 81% [15], and today, order sets represent the most impactful CDSS solution to empower physicians in delivering the highest quality, most cost-efficient evidence-based patient care.

THE ECONOMIC ARGUMENT FOR ORDER SETS

One of the greatest challenges of healthcare reform worldwide is the reluctance of those paying for technology to invest in EBM and CDSS. The question, of course, is return on investment (ROI). However, the potential ROI of order sets through reduction in adverse drug events (ADE) and unnecessary diagnostic tests alone is projected to be enormous (in one academic hospital estimated at up to $10 million [16]). Although there remains a dearth of high-quality evidence on the cost impact of order sets, many operational benefits which intuitively link to cost reduction have been demonstrated. Including: reductions in overall length of stay; postoperative length of stay; and the total cost for multiple surgical procedures, including total knee arthroplasty, appendectomy, total laryngectomy, cholecystectomy, carotid endarterectomy, gastrectomy, inguinal hernia repair, and colon surgery [17].

University of Kentucky Healthcare (UKHC) adopted a well-known commercial order sets solution in 2013 [18], demonstrating improvements in compliance to standard practices and elimination of unnecessary tests. At the University Hospital Frankfurt in Germany, implementation of order sets focused on gastroenterologic care reduced average length of stay and overall physician ordering time while elevating physician satisfaction scores for computerised ordering [19].

ORDERING BETTER CARE: CONCLUSION

The multi-factorial healthcare dilemma including preventable medical errors, the information explosion, slow knowledge diffusion, a growing regulatory environment, and increasing litigation has rendered Clinical Decision Support Systems indispensable. 

Order sets are designed not only to answer questions that the physician is asking, but also to answer critical questions that the physician doesn’t know he or she should be asking. Founded in current, credible, evidence-based information, order sets are the most impactful of physician CDSS solutions. 

Combined with reference and other CDSS solutions, order sets have the potential to empower physicians in providing the safest, highest quality, most cost-efficient healthcare; that is, a truly reliable Poka-Yoke.

Suggested Reading

Dr. Ujjwal was also asked in a recent interview with BioSpectrum India, to share more about the challenges, and most urgent needs in today’s healthcare systems. 

Some might argue that technology is the way forward but Dr. Ujjwal is of the view that technology is only the vehicle through which information and knowledge is delivered. High-quality and consistent care needs to be driven by both tech and evidence-based medicine. The full article can be read online here: 

http://www.biospectrumindia.com/interviews/71/9023/evidence-based-healthcare-is-the-need-of-the-hour.html

References
[13]: Sackett, David L., et al. "Evidence based medicine: what it is and what it isn't." Bmj 312.7023 (1996): 71-72.

[14]: Bobb, Anne M., Thomas H. Payne, and Peter A. Gross. "View point:
controversies surrounding use of order sets for clinical decision support in
computerised provider order entry." Journal of the American Medical
Informatics Association 14.1 (2007): 41-47.

[15]: Bates, David W., et al. "The impact of computerised physician order entry on medication error prevention." Journal of the American Medical Informatics
Association 6.4 (1999): 313-321.

[16]: Glaser, J., J. M. Teich, and G. Kuperman. "Impact of information events on
medical care. "Proceedings and abstracts of the 1996 Healthcare Information
and Management Systems Society Annual Conference. 1996.

[17]: Ballard, David J., et al. “The Impact of Standardised Order Sets on Quality and Financial Outcomes.” Advances in Patient Safety: New Directions and
Alternative Approaches (Vol. 2: Culture and Redesign). Rockville (MD): Agency
for Healthcare Research and Quality (US); 2008

[18]: Elsevier Clinical Solutions. How Elsevier Helped University of Kentucky Health-Care® Bring Order to Their Order Sets. N.p.: Elsevier Clinical Solutions, 2016. Print.

[19]: Zwack, Laura. Electronic Order Entry with Order Sets at University Hospital Frankfurt.Munich:Elsevier, 2016. Print.

Author
Dr. Ujjwal Rao
Dr. Ujjwal Rao is Senior Clinical Specialist in Integrated Decision Support Solutions, and is based in New Delhi, India. He provides strategic counsel to health providers on designing world-class clinical decision support systems with Elsevier’s comprehensive suite of current and evidence-based information solutions that can improve the quality and efficient delivery of healthcare.

An experienced emergency physician, executive, clinical informaticist and technology evangelist, Dr. Rao has a decade of experience serving in trust and corporate hospitals in various roles ranging from clinical administration, hospital operations to quality & accreditation. In his former positions, Dr. Rao led EHR implementations for large hospital groups and designed bespoke healthcare analytic solutions to raise profitability.

His passion to see transformation through technology led him to volunteer as a quality consultant with the United Nations. He also currently serves as an Assessor on the Panel of the Quality Council of India for the National Healthcare Accreditation Standards body, NABH.

Dr. Rao obtained his degree in Medicine and then specialized in Hospital and Health Systems Management, Medical Law and Ethics before completing his PhD in Quality and Medical Informatics.

Tuesday, 1 August 2017

Order Sets: A POKA-YOKE for Clinical Decisions by Dr. Ujjwal Rao, @DrUjjwalRao - Part 1/2

Poka (unintended mistake) Yoke (avoid) is the Japanese equivalent for “error proofing”.  
This Lean Manufacturing strategy is more relevant than ever in healthcare today. Why?

FIRST, DO NO HARM
The Supreme Court of India recently ordered one of the largest compensations so far in the country to a girl who lost her vision at birth in a case of medical negligence. The girl, who is now 18 years old, was born prematurely at a government hospital but was discharged from the hospital without a retinopathy test, a must for prematurely born babies. By the time the family discovered the lapse, the girl had lost her vision [1].

Fentanyl is a potent opioid medication used as part of anesthesia. A hospital pharmacist received an order for a ‘fentanyl drip 5,200 mcg per hour,’ which a nurse had just transcribed after accepting a telephone order. The pharmacist called the nurse to clarify the dose. The nurse confirmed that, although the dose was large, she had “read back” the order to the anesthesiologist several times to make sure she had heard the dose correctly. The pharmacist called the anesthesiologist himself, only to find that the intended order was for a fentanyl drip 50 to 100 mcg per hour [2].

The frequency of preventable medical errors resulting in patient injury and death is staggering. It is estimated that for every 100 hospitalisations, approximately 14 adverse events occur, translating to roughly 43 million avoidable patient injuries worldwide each year. In terms of quality of life for those inadvertently hurt: the loss of nearly 23 million years of healthy life [3]. And avoidable medical errors don’t just injure patients. Between 200,000 and 400,000 patients die every year in the United States as a result of preventable medical errors, [4] making avoidable hospital deaths the number three killer of American adults. 

These stunning figures clearly directly oppose the fundamental principle of medicine: First, Do No Harm.

THE MEDICAL INFORMATION EXPLOSION

Based on an extrapolation of a 2011 study [5] the stacking of CD-ROMs holding all of medical information available by 2020 would reach from earth to the moon and a half of the same distance beyond. And the rate of our medical knowledge growth is hard to fathom: by 2020, all that humanity understands about the body, health, and healthcare is projected to double every 73 days [6].

Just to keep up with the Primary Care literature would require a General Practitioner to read for 21 hours every single day [7]!

DIFFUSION OF KNOWLEDGE TAKES (A LONG) TIME

“Diffusion of medical knowledge” is the acceptance of new scientific discoveries into clinical practice. And such diffusion takes an extraordinarily long time... 

Back in the early 19th century, the idea of hand washing prior to examining pregnant women was considered revolutionary, and it was only after decades that hand washing to prevent puerperal fever was universally accepted in clinical practice. But you don’t have to look so far back. Take the case of β-blockers, a class of drugs whose beneficial effect in heart attack patients was established almost 30 years ago. Yet today, β-blockers are still widely under-prescribed [8]. 

The tragic reality is that even today, it takes an average of 17 years for only 14% of new scientific discoveries to find their way into daily clinical practice [9]. Thus our patients routinely wait to be prescribed drugs or undergo procedures or interventions proven effective decades earlier.

In the end, we have a disastrous collision of realities: all medical knowledge will soon be doubling every 73 days, while it will likely take decades for any new knowledge to routinely be incorporated into patient care.

GOOD CARE PAYS - POOR CARE COSTS

Healthcare is being reformed globally. In particular, the payment models are increasingly moving away from Fee-for-Service (FFS) to Pay-for-Performance (P4P). Full-fledged or partial P4P models are now increasingly being adopted by most of the developed nations, including the USA, UK, and Australia, among others. P4P models aim to encourage care providers (individuals and institutions) to provide better quality care by linking reimbursement (provider payments) to clinical and performance outcomes. The models also penalise medical errors, adverse outcomes, and excessive diagnostic and treatment costs. Thus in the P4P model, providers and healthcare systems risk significant financial penalties if they are unable to avoid adverse clinical outcomes and unnecessary tests and procedures.

To summarise, healthcare is now faced with a new dilemma: a significant burden of preventable medical errors, an explosion in the rate of medical information growth, and the historically slow adoption of new discoveries. Add to this an expanding regulatory environment demanding high-quality care plus the rapid rise of medical malpractice litigation and providers must ask themselves, “Is the practice of medicine no longer humanly possible?”

A SOLUTION TO THE MULTI-FACTORIAL

HEALTHCARE DILEMMA


So how do we reduce (and eventually eliminate) preventable medical errors? Providing current, credible, evidence-based information and guidance at all points of care is a cornerstone in the answer to this question. In the area of medication errors (a common form of preventable patient injury and death), a system analysis of a large sample of serious mistakes [10] identified 16 major types of causative system failures. All of the top eight were deemed preventable through the provision of better medical information.

Today, Clinical Decision Support Systems (CDSS) are being hailed as a major
weapon in the battle against preventable medical errors [11]. And at the heart of the most impactful CDSS lies evidence-based medicine (EBM). Advocated as a method to improve clinical outcomes [12], the incorporation of EBM into powerful CDSS has the potential to transform healthcare safety and quality, a true healthcare Poka-Yoke! As such, EBM is the foundation of evidence-based care, broadly defined as patient management through the conscientious and judicious use of current best evidence from clinical care research integrated with individual clinical expertise [13]. And to complete the picture, evidence-based care should also include patient preferences, input, and active participation. 

Clearly based on the foundations of the healthcare dilemma, in order to be safe, effective, and efficient, today’s physicians, nurses, pharmacists, therapists, patients, and other healthcare stakeholders must have real-time, mobile access to current, credible, evidence-based information. While many have been disappointed that Electronic Health Records (EHRs) have not on their own solved the dilemma, it is critical to appreciate that technology is the vehicle through which EBM and other information is delivered, not the primary source of information itself. In the absence of technology (in fact, long prior to the development of computers and the internet), current, credible, evidence-based information allowed the world’s leading healthcare providers to deliver high quality, evidence-based care.

Today’s technology represents a great leap forward in accessing high value care information at points across the globe, with the knowledge provided by EBM integrated into EHRs and available via “the cloud,” all as part of CDSS.

Evidence-based care is most impactful when current, credible, evidence-based knowledge is incorporated into the provider workflow; thus, the most advanced CDSS are “workflow-integrated.” More importantly, these systems are evidence-adaptive [12]; that is, the clinical knowledge within the CDSS continually reflects current EBM from the research literature plus sources of practice expertise. 


The full potential of a CDSS can be realised when it is seamlessly integrated into the clinical workflow and is evidence-adaptive [12].
Stay tuned for the Part TWO of the Blog from Dr. Ujjwal Rao.

Suggested Reading
Dr. Ujjwal was also asked in a recent interview with BioSpectrum India, to share more about the challenges, and most urgent needs in today’s healthcare systems. 

Some might argue that technology is the way forward but Dr. Ujjwal is of the view that technology is only the vehicle through which information and knowledge is delivered. High-quality and consistent care needs to be driven by both tech and evidence-based medicine. The full article can be read online here: 
http://www.biospectrumindia.com/interviews/71/9023/evidence-based-healthcare-is-the-need-of-the-hour.html

References
[1]: Vaidyanathan, A. “Supreme Court Orders Compensation of Rs. 1.8 Crore to
Chennai Girl in Medical Negligence Case.” NDTV, July-Aug. 2015. Web.
http://www.ndtv.com/india-news/supreme-court-orders-compensation-of-rs-1-8-crore-to-chennai-girl-in-medical-negligence-case-777238

[2]: Institute for Safe Medication Practices. “Safety Briefs: Single Digits.”
Medication Safety Alert! 9 (July 2004): 1.

[3]: Jha, Ashish K., et al. "The global burden of unsafe medical care: analytic
modelling of observational studies." BMJ quality & safety 22.10 (2013):
3809-815

[4]: James, John T. "A new, evidence-based estimate of patient harms associated with hospital care." Journal of patient safety 9.3 (2013): 122-128.

[5]: Hilbert, Martin, and Priscila López. "The world’s technological capacity to
store, communicate, and compute information." Science 332.6025 (2011):
60-65.

[6]: Densen, Peter. "Challenges and opportunities facing medical education."
Transactions of the American Clinical and Climatological Association 122
(2011): 48.

[7]: Alper, Brian S., et al. "How much effort is needed to keep up with the
literature relevant for primary care?." Journal of the Medical Library Association 92.4 (2004): 429.

[8]: Bradley, Elizabeth H., et al. "Quality improvement efforts and hospital
performance: rates of beta-blocker prescription after acute myocardial
infarction." Medical care 43.3 (2005): 282-292.

[9]: Balas, E. Andrew, and Suzanne A. Boren. "Managing clinical knowledge for
health care improvement." Yearbook of medical informatics 2000.2000 (2000):
65-70.

[10]: Leape, LucianL., et al. "Systems analysis of adverse drug events." Jama 274.1(1995): 35-43.

[11]: Bates, David W., et al. "Reducing the frequency of errors in medicine using information technology." Journal of the American Medical Informatics
Association 8.4 (2001): 299-308.

[12]: Sim, Ida, et al. "Clinical decision support systems for the practice of
evidence-based medicine." Journal of the American Medical Informatics
Association 8.6 (2001): 527-534.

Author
Dr. Ujjwal Rao
Dr. Ujjwal Rao is Senior Clinical Specialist in Integrated Decision Support Solutions, and is based in New Delhi, India. He provides strategic counsel to health providers on designing world-class clinical decision support systems with Elsevier’s comprehensive suite of current and evidence-based information solutions that can improve the quality and efficient delivery of healthcare.

An experienced emergency physician, executive, clinical informaticist and technology evangelist, Dr. Rao has a decade of experience serving in trust and corporate hospitals in various roles ranging from clinical administration, hospital operations to quality & accreditation. In his former positions, Dr. Rao led EHR implementations for large hospital groups and designed bespoke healthcare analytic solutions to raise profitability.

His passion to see transformation through technology led him to volunteer as a quality consultant with the United Nations. He also currently serves as an Assessor on the Panel of the Quality Council of India for the National Healthcare Accreditation Standards body, NABH.

Dr. Rao obtained his degree in Medicine and then specialized in Hospital and Health Systems Management, Medical Law and Ethics before completing his PhD in Quality and Medical Informatics.

Thursday, 27 July 2017

#IoHT is already delivering tangible cost savings, but continuous investment is essential - Accenture

Image Source: https://www.accenture.com/us-en/insight-accenture-2017-internet-health-things-survey
The Internet of Health Things (IoHT) is already delivering tangible cost savings, but continuous investment is essential

In a recently published report by Accenture [2], based on a survey of 77 Healthcare payers and 77 Healthcare providers in the US, the reports findings indicate that healthcare leaders are at risk of missing out on substantial cost savings, if they don't take the full advantage of Internet of Health Things (IoHT).

The report indicated that by introducing more connectivity, remote monitoring, and information gathering IoHT can encourage more informed decisions, better use of resources and empowering healthcare users.


According to estimates, the value of IoHT will top US$163 billion by 2020, with a Compound Annual Growth Rate (CAGR) of 38.1 percent between 2015 and 2020.[1] Within the next five years the healthcare sector is projected to be #1 in the top 10 industries for Internet of Things app development.[2]

What is Internet of Health Things?


Internet of Health Things (IoHT) is the integration of the physical and digital worlds through objects with network connectivity in the healthcare industry. IoHT transforms raw data in simple, actionable information and communicates with other objects, machines or people. IoHT can be leveraged to improve access to health, quality of care, consumer experience and operational efficiency 


Source: Accenture Report
Source: Accenture Report









The report lists four major takeaways for the payors and providers

The Time is Now

Despite challenges with security and privacy, inaction is not an option. There are players outside of traditional healthcare organizations looking at these same industry challenges and considering ways to capture the opportunity. If providers and payers do not invest in demonstrating IoHT value now, they risk losing out to non-traditional players. Going forward, providers and payers must identify parts of the business where IoHT solutions may be applied to do things differently—and do different things to grow in the long-term.

Measure and Build on Successes

Providers and payers have already demonstrated value through IoHT—but they need to continue investments to better understand where programs are successful to prepare for future scaling. They need to measure effectiveness beyond the technology and then build on those areas of effectiveness quickly to offer value across the business. By demonstrating the benefits and best practices, providers and payers can strengthen business cases, encourage adoption and drive interoperability.

Put consumers First

Providers and payers must continue to incorporate IoHT solutions that drive better experiences and healthier patient outcomes, along with key medical and administrative cost savings initiatives. IoHT solutions offer the seamless collection of patient-generated health data, enabling providers and payers to provide more convenient, personalized and effective care. They must train their workforces to make IoHT a part of the “new normal.”

Form Nimble Partnerships

Technology and innovation partners can help payers and providers quickly test and learn how IoHT can drive business value to inform future scaling requirements. Strategy and change management partners can help to integrate these new technologies into their workflow, culture and training. 

Key Findings of the Survey

  • 73% consider IoHT to be a major change, and consider IoHT to be a major disruptor in three years. 
  • however, 49% say the leadership at these organisations are yet to understand the potential of IoHT. 
  • As IT investments are going up so are the IoHT investments seeing to become a major budget line item.
  • Healthcare providers and payors are investing in IoHT in three areas of their businesses - RPM, wellness and operations. And these organisations are reporting real benefits from the initial programs.
  • While 57 percent of healthcare organizations surveyed say that their IT departments lead the IoHT charge, 26 percent say their research and development (R&D) divisions are leading their IoHT efforts and one in ten organizations even have dedicated IoHT subsidiaries or business units.
  • RPM Based IoHT: 33% of PROVIDERS report extensive operational cost savings from their RPM IoHT programs. 42% of PAYERS report extensive medical cost savings from their RPM IoHT programs. 
  • The majority of both providers’ (76%) and payers’(75%) RPM IoHT investments are focused on cardiac conditions. Interestingly, in the past, behavioral health has not received investment at similar levels to traditional high-cost areas such as cardiac, but the spotlight appears to now be shining on this area. Mental health, including behavioral health, is a relatively high priority for both providers (48 percent) and payers (55 percent)
Source: Accenture Report, [2]


References

[1] “The Internet Of Medical Things–What Healthcare Marketers Need to Know Now,” January 2016, Victoria Petrock: Contributors: Annalise Clayton, Maria Minsker, Jennifer Pearson, eMarketer.

[2] Accenture 2017 Internet of Health Things Survey 
https://www.accenture.com/us-en/insight-accenture-2017-internet-health-things-survey


And there you go, its fairly simple and we look forward to you sharing your experiences with our community of readers. We appreciate you considering sharing your knowledge via The HCITExpert Blog
Team @HCITExperts
Author
Team HCITExperts
Your partner in Digital Health Transformation using innovative and insightful ideas

Wednesday, 26 July 2017

What is #ConnectedCare? Is the Healthcare Industry ready to embrace it in India?



During the recently held #PhilipsChat the from Philips Healthcare set the agenda to discuss various aspects of what is Connected Care? 
(http://blog.hcitexpert.com/p/connected-medical-devices.html
Whenever a TweetChat is held, the moderator puts out an agenda for the discussion. Once its time, the participants share their point of view by Tweeting out their responses to the questions, tweeted by the moderator. 

The Connected Care #PhilipsChat questions follow and I Look forward to You sharing your thoughts and point of view on the role of Connected Care in Healthcare: 

1. How would you explain connected care in one line? 
2. Is the healthcare industry ready to embrace connected care?
3. How are your organization using connected care? Since when?
4. Based on your experience, what are the elements to enable connected care further?
5. How are you involving policy makers to embrace connected care?

If we take these questions with an india context, how connected care can enable the affordability and accessibility to healthcare in India. These are the most often mentioned aspects of Healthcare, that needs to be addressed by not only the government, but also the Startup community willing to disrupt the Health Tech / Digital Health industry. 

I have attempted to share my thoughts on Connected Care questions put forward during the tweetchat and I hope you will consider sharing your insights by filling in the form below

1. How would you explain connected care in one tweet?

An always connected channel of communication of care between the patient and provider, from “touch time” to “face time”  

2. Is the healthcare industry ready to embrace connected care?

In India, with the major push for digital services by the govt and private healthcare facilities, and with 350+MN internet users connected care is the only way to solve the accessibility to healthcare problem (1:3200 doctor to patient ratio)

4. Based on your experience, what are the elements to enable connected care further?

The connected care needs to bring about change in thought of how to use a connected care framework for the patient as well as the doctor. 

For the patient, connected care is about 
- experience that enables an ease of access to care
- Ability to build their own healthcare record’s completeness 
- Have a better set of processes and #workflows to manage their health and care 
- Have the ability to find "patients like me" and be part of the community 

For the Doctor, I believe it will be about 
- how to glean new insights from the data stream
- How to collaborate with a patient via an always connected model? What signifies the end of a consultation? 
- To build constantly evolving care plans for their patients, based on realtime, near-realtime, time-delay, or frequency per day/week month updates
- To evolve more treatment plans based on the insights that can be drawn from the raw patient data feed (an e.g.)
- How to build a community and be part of a community of specialists to keep themselves up-to-date on the current research and practices.


I am including the Questions as a Google Form, do consider sharing your insights into what is Connected Care? And how do you see it being enabled for the benefit of the patients and clinicians.




Author
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Manish Sharma
Founder HCITExpert.com, Digital Health Entrepreneur

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