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Yasmine Mustafa, Co-Founder and CEO of ROAR, looks at how technology can improve healthcare for patients and staff safely, including the role of wearable technology in healthcare safety. Technology is in every facet of healthcare today. From operating rooms that monitor air temperature to a very specific degree, to remote patient monitoring at home, technology is making it possible to save lives. Implementing comprehensive safety protocols in healthcare settings Stepping back, consider the importance of putting safety protocols into healthcare settings. On a global scale, technology can provide more data, better information and faster response times. In many ways, then, it can save lives and help fill in gaps in problem areas like nursing shortages. Yet, for this to happen, organisations must put in place safety protocols. Safety systems in any type of healthcare setting must meet some specific goals: They must meet all regulatory requirements put in place by governing bodies. They must also involve all levels of the organisation, from senior leadership to frontline staff caring for patients. They must meet all compliance requirements for privacy protection. Team training programmes, including those using simulation, are necessary to help support employee use and understanding of such technology. Solutions need to be scalable and grow with technology. As new technology becomes available, these systems must be able to 'keep up.' A senior leadership team should assemble solutions and compare product options. Ultimately, the goal is to ensure a streamlined transition when incorporating any of these tools. Advanced security measures for patient and staff protection The goal of any security measure should be twofold: It should increase patient safety without creating any added risk of injury. It should keep nurses and doctors, as well as other healthcare professionals, free from injury. Any tools used need to address both of these aspects together. For example, many organisations are putting access control systems in place. These systems minimise the risk of people entering into areas where equipment, medications or other sensitive systems are located. At the same time, they are easily accessed using a badge system. That way, there’s no delay to the patient waiting on medication nor any slowdown for staff trying to get that care. Rapid response teams are also essential for improving healthcare facility safety. This incorporates a careful level of protection that needs to blend privacy with surveillance. With a rapid response team in place, both patients and caregivers are receiving fast, immediate and very targeted help sooner. This can help with situations related to violence, mental health complications, health emergencies, or other safety risks on the premises, like fire or power outages. Using technology to improve healthcare safety Technology allows organisations to handle safety challenges in a more effective manner. Consider how healthcare safety can be improved and ways that technology can support that process: Technology helps to create a culture of safety. Everything is done with specific, very well-defined strategies and following specific steps. Creating a culture of safety allows both patients and healthcare workers to understand what is expected. Technology works to improve communication at all levels. Problems can be dealt with more effectively. Patient needs are communicated in a more streamlined manner through digital communication tools. There’s more insight into emergency response needs as well. Technology can also help with ensuring basic care procedures and checklists are completed properly. For example, digital devices can be used to help nurses work through a checklist of questions to ask a person before allowing them to be admitted into an ER area, reducing security risks and ensuring protocol is followed. Another way technology enhances safety in the healthcare setting is by providing a way to find out what went wrong when an incident occurs. It allows management to look back to see where the breach occurred or the mistake was made, creating a teachable opportunity. Depending on the specific targeted areas of safety, there is technology that can streamline and improve safety. Future trends: The evolving role of wearable tech in healthcare safety Perhaps one of the most exciting ways technology is being integrated into healthcare facilities is with the use of wearable technology. The use of wearable technology is growing by leaps and bounds. Deloitte reports that in 2022, the market itself grew 41% to a value of over $60 billion in the USA. That includes everything from smart glasses to exoskeletons, wearables and smart devices. We already know the value of wearable devices. You may have a smartphone that monitors your steps or a watch that performs a basic ECG after a workout to check your heart rate and rhythm. Wearable technology can do much more though, including making healthcare facilities safer for both patients and staff. Wearable technology puts tech tools within reach of patients and caregivers without actually needing to use their hands to do the work. Consider a few ways this enhances safety: Panic buttons and devices allow for immediate summoning of help when there’s an emergency. It’s immediately available with a code word or by pressing a button on a device. Wearable technology allows for patient monitoring in all situations, no matter where they go. For example, a patient who falls in the restroom can be detected by a change in their heart monitor from the nurse's station. Technology can be used to allow voice recognition to allow healthcare workers to call for help without having to free their hands to do so. Regular safety audits and compliance in healthcare facilities Technology also enhances safety by ensuring that facilities meet all safety audits and compliance requirements. With these types of routine checks, organisations have an efficient way of ensuring employees and patients receive a safe, secure place to be while also minimising the risk of breaches in security, safety and other risks. With routine safety audits, supported by access to data from technology tools, it’s possible to find ways to consistently improve. Healthcare facilities are safer. Employees and caregivers feel protected. Patients receive the life-saving care they need in a secure environment.

Digital solutions have already transformed how health services are offered, accessed and used, and will continue to do so in the years to come. With the adoption of new technologies, new ways of working are emerging that seek to combine the best of digital approaches with the benefits of face-to-face contact. In this online event, the panel of experts will explore how wearables have created better health outcomes for people living with long-term conditions, such as diabetes. They will look to the future and discuss how we can make sure that digital approaches are prioritised in the long term to continue empowering patients and supporting clinicians to create patient-centred care, leading to improved health outcomes. They will also explore the lessons from diabetes and wearables that offer wider learning across the NHS on harnessing the benefits of technology for a digital future. Register

In this blog, patient Becky Tatum reflects on two articles in Forbes magazine describing how technology is enabling patient's with multiple chronic conditions who may have been discharged from hospital, to now be provided with aftercare in their own home. Becky looks at the pros and cons of receiving hospital treatment at home from a patient's perspective.   Hospital-level care at home, in the form of remote monitoring and daily visits from medical professionals, is being touted as the potential future of healthcare, saving money and freeing up hospital beds. But as well as the financial considerations, it is important to reflect upon how this approach would feel to you as a potential patient in receipt of this novel treatment approach. As a patient, the upsides to being treated in your home instead of in hospital are obvious. It saves time and money to not have to travel to the hospital regularly for treatment. You are in the familiar setting and comfort of your own home, which is likely to leave you happier and more relaxed. It’s comforting and gives you peace of mind knowing that family members are nearby. Moreover, you are not restricted to seeing loved ones at set visiting times, which (as we know too well) during the height of the COVID-19 pandemic were (and still are) extremely limited, or in many cases not allowed at all. Also, it would be less noisy at home compared to being in hospital, with none of the unwelcome sounds from other patients, the nursing station, etc. Another upside is that you don’t have to go to an area where you would mix with others who may have communicable infections, which is always a real risk for immunocompromised patients. From the point of view of the care you receive, the attention of the medical staff is focused fully on you with no distractions, rather than having to see many patients in quick succession, so care is likely to be of higher quality and more personalised. But, the downsides to such a treatment approach are aplenty. Firstly, being treated in your home is an invasion of personal privacy and removes the boundaried distinction between home and hospital – some patients might want to keep the two domains very separate. Secondly feelings of uncertainty and unsafety may result from not being in a purpose-built medical environment with staff at your call 24/7, promoting worries such as, ‘will medical concerns be picked up soon enough?’ and ‘will staff turn up when they are supposed to?’, to name but two. There could potentially be a delay in medical intervention in the time it takes for staff to attend the home once an alarm has been raised, especially in rural areas or if weather conditions are bad; this could be dangerous if the patient goes into crisis and rather than call for an ambulance they wait for their community-based carer. There may also be the tendency for more mobile patients to over-do things and be too active in their home environment; simple things like letting the dog out or just making a cup of tea might be too much physical effort compared to the limited self-sustaining activity necessary for people in a hospital bed. There are practical and social considerations, too. If living independently or in a household where family members aren’t always available, the lack of regular physical support to wash, prepare food, etc, may be an issue – so for some people, medical care would need to be augmented with social care. Even the act of letting staff into the home may be problematic if you have reduced mobility and there is no-one else at home. And, with knowing that (essentially) strangers are continually entering your home, you may feel the need to keep your house tidy at all times, too, which adds extra pressure. It would also be very disruptive for other family members that are present to have staff constantly arrive and depart, invading their personal or work space as well as the patient’s. Then there is the impact on the environment from the various medical professionals driving around to patients’ homes multiple times each day, something the eco-conscious cannot overlook. Overall, there are pros and cons in being treated in your own home instead of in hospital. Receiving high-acuity care and monitoring in the home environment is promoted by hospitals and insurers as the potential way forward for hospital treatment. But whether this is the future of hospital care or not, crucially needs to take into account the views of the patient, which will always be unique. Forbes articles Moving More Medical And Long-Term Care To Seniors’ Homes Home Health Care Is A Bright Light During Covid-19 With An Even Brighter Future

In his newsletter today (The Top 10 Dangers of Digital Health), the medical futurist, Bertalan Meskó, raises some very topical questions about the dangers of digital health. As a huge advocate of the benefits of digital health, I am aware of most of these but tend to downplay the negative aspects as I generally believe that in this domain the good outweighs the bad. However, as I was reading his article, I realised that it was written very much from the perspective of a clinician and, to some extent, a healthcare organisation too. The patient perspective was included but not from a patient safety angle. Many of the issues that he raises do have significant patient safety issues associated with them which I’d like to share in this blog. 1. Regulating adaptive AI algorithms Where an AI tool quickly adapts to reflect its environment and the context in which it operates, the AI may “reinforce those harmful biases such as discriminating based on one’s ethnicity and/or gender”. These will further exacerbate existing health inequalities and place certain patients at a disadvantage. It is important that the ground rules for these AI tools include firm parameters that seek to prioritise patient safety. A bit like Asimov’s Zeroth Law, ”a robot may not harm humanity, or, by inaction, allow humanity to come to harm”. 2. Hacking medical devices remotely The idea that hackers might target people's implantable cardiac devices was popularised in a 2012 episode of the US television drama ‘Homeland’, in which terrorists hacked a fictional vice president's pacemaker and killed him. It is not just VIPs (or VPs) who need to worry about this. Potentially anyone with an implanted device could have it hacked and be held to ransom. Medical device manufacturers should take far more care in the security that they build into their devices to protect patients from unwarranted attacks on them. Frankly, when large healthcare organisations are procuring these types of devices, this is one of the key areas that they should be interrogating their potential suppliers about. 3. Privacy breaches by and on direct-to-consumer devices and services This is a difficult one because if we want digital systems to really understand us and provide advice or treatment personalised to us, then those digital tools must have access to our confidential medical data. However, privacy is still very much a high priority for most patients and they (rightly) want to know what is happening to their data – who is using it, how long is it being held, is it being passed on to third parties without the patient’s explicit consent? People often forget who they have given access to their data, for what purpose and sometimes stop using a digital tool without realising that all of their data is still being held (and possibly collected via an active API) by the digital tool’s supplier. It would be helpful if our mobile phones and PCs could highlight: a. When we shared sensitive data, who with, and what data was shared. b. A list of active APIs that are still sharing our data, etc. Data that is used for purposes other than those intended by the patient are potentially a safety risk to that patient and should be treated as such. 4. Ransomware attacks on hospitals Yes, this is awful for the hospital, and yes, it may cost them money; however, let’s not forget whose data has been stolen, the patients’! Are they sufficiently alerted to this, told what is happening, given ways to mitigate any issues to them personally? In an ideal world they are, but in reality the hospital is probably in panic mode and communicating transparently with patients is low down on its priority list. As the Medical Futurist says: “The average patient should demand more security over their data” – but how do they do this? What can a single patient do to ensure that the hospitals who have stewardship over their data (not ownership in my opinion) make it as secure as possible. This brings me back to an idea that my sadly departed friend, Michael Seres, had many years ago. On each hospital exec team (not Board) there should be a Chief Patient Officer, whose job it is to push for patient interests in operational matters (which is why they shouldn’t be a non-exec member of the Board). That is the person whose job it should be to hold their organisation to account over the security of their patients’ data. 5. Technologies supporting self-diagnosis Dr Google has been an issue for some years, and people’s off-the-shelf devices that monitor their vital signs are not necessarily medical grade, nor do their users generally have the skill to interpret the outputs from them. However, doctors should embrace patients who are keen to manage their own chronic conditions and support them in doing so. This ‘shared accountability’ has to be the model for improved population health and doctors not willing to work with their patients shouldn’t have any. 6. Bioterrorism through digital health technologies A bit exotic this one and certainly not a near-term risk when looking at the sorts of things described in the newsletter. However, in a world that is still dealing with a pandemic, and reliant on vaccines to gain some normality back into our everyday lives, the security of (for example) that supply chain is critical. What if a batch was intentionally sabotaged or in some way its efficacy reduced? In exactly the same way that medical products (especially implants) should be made as safe and secure as possible, the same is true for the medicines that we rely on. 7. AI not tested in a real-life clinical setting The newsletter makes the case for issues related to how staff use the AI, but PLEASE… test this with patients first! Safety in use is critical and only feedback involving patients will help developers to optimise these digital tools to be as safe as possible. 8. Electronic medical records not being able to accommodate patient-obtained digital health data This is a very personal issue for me. Why should my doctor have to send me for tests when I can give him/her perfectly reasonable data that I have gathered myself from a device that has been CE marked and approved by the FDA/MHRA etc.? Electronic Medical Record vendors are incredibly reticent to allow anyone other than the authorised doctor to enter anything into a patient’s record. There are some good reasons for this. However, I’ve long thought that there could be an annexe to the record that is patient-controlled where they can enter a new address, add data from their own blood pressure device and over-the-counter drugs or remedies that they are taking. That way, doctors would have an up to date, (hopefully) reliable set of data to have a more informed discussion with their patient and it could accelerate the time between consultation and referral/treatment. 9. Face recognition cameras in hospitals I’m less worried by this in principle; however, I am interested to know how the data generated will be used and the security around it. If it is only used by the hospital to optimise patient flow, or remotely detect symptoms that are then used to help patients either directly or indirectly, then fine. If it is shared with others for more sinister purposes, then I would be concerned. 10. Health insurance: Dr Big Brother This is less relevant to the UK – only 11% of us have private health insurance. Again, this boils down to who collects data on patients, for what purposes, is explicit consent gained from the patient to share their data and how may those third parties use it? There are both negative and positive connotations to the gathering of a person’s health data by their health insurance company, but given that they already ask for access to all GP and secondary care records, having access to health wearable data (as Vitality Health already does) is not a big step. Conclusion I still believe that the benefits of digital health outweigh the risks, but the risks outlined above are not inconsequential. Many of the negative aspects are predicated on poor management and control of patient data. One of the ways that this should be mitigated is to have one or more patient representatives at an exec (not non-exec) level who hold healthcare organisations to account over this important aspect of care provision.

This webinar will explore virtual care and the use of patient health data through remote patient monitoring. In the UK and US alike, COVID-19 has accelerated the dramatic shift towards utilising digital health services and tools to virtually connect with and care for patients. Remote patient monitoring (RPM) offers providers the opportunity to remotely collect and utilise patients’ personal health data, such as data from their home-use medical devices and wearables, within care delivery efforts. These personal health data are providing deeper insight into patients’ physiologic health metrics, lifestyle decisions and behavioural trends while replacing the clinical data previously collected in-person. As health care organisations need to quickly scale virtual care to thousands of patients, clear best practices and lessons learned have emerged. This episode will deep-dive into the successful operations of the largest, centralised RPM programme, supporting over 3000 clinicians and more than 50,000 enrolled patients. We’ll delve into the most basic and complex challenges around patient-generated health data, patient consent, enrollment workflows, device logistics, patient and provider engagement, and more. This webinar will explore: Core operations and technologies to a holistic virtual care strategy The clinical outcomes, patient and provider satisfaction, and efficiencies created with RPM Best practices in digital health operations, data integration, analytics, and engagement A model and framework for scaling virtual care and RPM to thousands of patients quickly A CPD certificate with 1 CPD credit will be issued to those joining the webinar live as well as those who watch the recording afterwards. Certificates will be issued 7 days after the webinar to those who watch it live and after 30 days for those that watch the recording. Join in the conversation online using #RSMDigiHealthBook hereFollow us on Twitter: @RoySocMed Book here

In this extended episode, our panel will describe the Care Information Exchange, a patient portal that facilitates the sharing of healthcare records across NW London. This system currently holds the records for over 1.6 million patients and allows patients, hospitals, GP practices and social care organisations to effectively share records for a population of 2.4 million. They will also describe how the frailty team in the Trust have used the portal with remote patient monitoring technology to redesign a care pathway for lung conditions, post-COVID. They will discuss the resulting improvements in patient care, especially in detecting deterioration during hospital stays and afterwards in the community, and the economic benefits that have accrued through the use of patient-generated data. A CPD certificate with 1 CPD credit will be issued to those joining the webinar live as well as those who watch the recording afterwards. Certificates will be issued 7 days after the webinar to those who watch it live and after 30 days for those that watch the recording. Book here Join in the conversation online using #RSMDigiHealthFollow us on Twitter: @RoySocMed