Jean Ross, RN

@healthapiguy The question will be who will the the trusted source of reconciling. Right now, we make patients jump through hoops to get their med list right in their patient portal, hence the continuation of self-made lists on sticky notes.

I do think there's a distinction between "auto-reconciliation" and "showing outside data contextually in the chart". Reconciliation is an act of deduplication, acceptance, and ownership of the reconciled data as "correct". Reconciling medications creates a new active medication list. When queried, I sent my reconciled list back out into the world. As mentioned before, a lab test that was ordered somewhere else and performed at a lab somewhere else is never mine. Same with clinical notes authored elsewhere. So I wouldn't expect to echo that back when queried.

They propose to use SMART App Launch 2.2 in a phased approach, moving from 1/2/2.2 when finalized to 2/2.2 by 2026 with all certified tech supporting 2.2 and above by 2028.

@healthapiguy nurse dream: Not having to select and enter 15 medications on a new patient who decided to pop into my ER for the 1st time and is well seen in another ER and health system. Can't a patient just bring me a QR code I scan and they load sourced into my team's EHR?

this presumes organizations don't constantly echo external organizations' data as their own! if they do, they things get messy.

@healthapiguy 100% agree. there is data that we need patients and caregivers to reconcile and others that are truly "owned" by the system. You can prescribe all the things you want in your EHR, but if I ain't picked up my Rx and put it into my piehole, then it's not on my med list at home.

i.e. i show up at sutter and say my active meds. I show up at ucsf, say my active meds. now reconcile and deduplicate the aggregate list to create my up-to-date medications list

It was a nurse that led @rachelsuzhunt to a group of young cancer patients to make her journey less alone. Keep using your voice, Rachel! A few mentors for you: @TheLizArmy and Adam Hayden’s TikTok and blog glioblastology.com to see how “normal scary” your journey is.

@rachelsuzhunt @washingtonpost Your story matters. Get as personal as you need to & are comfortable doing. Never apologize for being honest & real. Never apologize for refusing to accept “bad luck” as you see the data and on the front lines with your “Still alive” posse. And be the owner of your health story!

I try not to get too personal on this app for fear of being perceived™️, but I wanted to share a piece I wrote for The @washingtonpost Cancer took my life by storm, and only now is it calming. I’m grateful I can shine some light on this growing issue washingtonpost.com/wellness/2024/…

2/ the waitlist of Hoosiers needing critical services 3/ reimbursement for services provided to children with complex health conditions. I will tirelessly advocate for adequate healthcare coverage for the 2 million Hoosiers who rely on Medicaid to receive life saving services.

@sunshine4378 Would love to talk!

@StuartBlitz As a rare disease patient- I regularly complain about the lack of a single integrated medical record. I always love going to new providers & bring my partial hardcopy records & trying to explain why what they are saying will work- will not work as a treatment. 😂

One of the biggest healthcare issues is patients don’t have all their health data in one place. So many siloed systems. What if someone built a super app that pulled in all their data? They’d pay a monthly fee. Payors would push to their members. Is anyone building this?

@moira_here Would love to talk!

primaryrecord.com/the-importance… Hot off the presses! Jean Ross, MHA, BSN, RN, critical care nurse, former VP of the Indiana Nurses Foundation, Dementia Friends Champion, and long-time CARE supporter, shares lessons learned volunteering with CARE in her latest article.

@HITeaWithGrace @theviveevent @savvy_coop @hitlikeagirlpod @askjoyrios @GraceCordovano @amariedauwer @zajctjasa @HeatherLandi @VNeilley @MakeMyDana @ShereeseMayMba I’m excited about @TheLizArmy panel on Tuesday about making data work for patients!

Top 3 trends at #ViVE2024? Health system/pharma partnerships via smart #healthtech companies, Generative AI/NLP, specialty care innovations. Mostly can’t wait to see the patient voice amplified through @savvy_coop’s Genius Bar! Thoughts? Additions? #digitalhealth #healthtech

💯

@joshuapliu Just to educate, AI matching for nurse staffing would be huge. It’s way more than language. Nurses often are as specialized as doctors so there is a need to know years of experience, equipment checked off on, patient population trained in, certifications, age, etc.

UCSF Health is in the early stages of testing various AI tools to tackle workforce burnout and staff shortages - with mixed feedback from nursing staff. Use cases they are testing: 🔮 Predictive analytics to flag patients deteriorating in-hospital The challenge with predictive analytics is always the “so what?” Unless there is a clear protocol on how to respond to the outputs of a predictive analytics engine, it’s just an academic exercise. We have clear protocols for when a patient suddenly develops a fever. But what do we do if predictive analytics “warn” me that a patient has a 20% risk of mortality in the next 30 days but no other symptoms? Until someone creates a protocol for these situations, it’s an insight with no action. 👩‍⚕️ AI matching engine to pair nurses with patients based on the nurse’s background, education and experience I guess perhaps language is the obvious matching parameter. Maybe clinical areas of interest…? But do we create a risk of frontline staff developing too narrow an experience of patient care if they end up treating a homogenous set of patients? Is increased specialization of this type net beneficial for patient care? I guess someone’s going to test it… 🏥 Predictive analytics for patient flow - recommending which patients should flow to which beds in the hospital OK this I like and is probably universally accepted (and I’m pretty sure already exists as 3rd party solutions) 📚 Custom GPTs for staff to query training materials E.g. asking the GPT “how to change a dressing” instead of needing to be taught live. This I like and we will likely see an internal FAQ chatbot for every organization - even outside of healthcare. While beneficial, this can’t be the killer use case… I mean, how much time does this actually save? Meanwhile a local nursing union has raised concerns that AI will reduce the clinical workforce, de-personalize patient care, and increase risks of error (e.g. AI bias). I think most of those concerns are largely addressable, especially with time and experience. And actually, the workforce shortage is so bad, I doubt AI will reduce the clinical workforce anytime soon. One could also ask: if AI could reduce the required clinical workforce while improving access/quality of car, why is that bad? That said I think this is a good example for getting the right initial use case - one that is high ROI and shows the potential of AI while being seen as universally beneficial by most parties - is so important for educating the healthcare system on the potential good for AI. Help everyone experience the potential good for AI and then people will be more open-minded to new use cases. What do you think? What use cases would get the most nursing buy-in while driving a high ROI?

@mickytripathi1 Thank goodness you only saw one doctor that day! Just imagine if you walked down the hall to a 2nd appointment with a different doctor in “the same health system”, and you were handed this packet again. That experience may have led to federal changes for all of us.

I love my primary care provider. I really do. But.....there's gotta be a better way to express that than a 64-question paper survey or a Dwight Schrute hack.

@rikrenard I am! Nurses are coming together to make sure y’all know the real problems and products needed.

Who’s going to the ViVe conference in LA next month? 😎

@mickytripathi1 I don’t know @mickytripathi1, I am pretty ecstatic you are among the near 40% who knows the general ingredients to egg salad AND what kind of store to find them. But, now that you realize your mistake, how do we make sure you can file a claim so grocery stores know to do better?

Transparency won't cure user inattention. Case in point: While at grocery store decided to make some egg salad for my mom for lunch so grabbed a few ingredients at the last minute. And now *I'm* to blame for not knowing that Miracle Whip is not mayonnaise!? 🤢 #ResponsibleAI

Always check on each other even if it seems out of place for you to do.

@joshuapliu I think about all the Googling families do when faced with a scary diagnosis. I know, as a wife & mom, I would want my hands on what that doctor is seeing, but not saying to us in the decisions they’re weighing about my family members care. These tools feel so one-sided.

Will Epic enable the holy grail of intelligent patient care: the transformation of patient data into intelligent, personalized care delivery? If you know Judy Faulkner, Epic’s CEO, she doesn’t like the spotlight. So her taking the stage at the Forbes Healthcare Summit is meaningful. At the event, she lifted the hood on Epic’s plans for Cosmos, Epic’s research database of 226M patient records, to evolve from a research database to an intelligent clinical decision support (CDS) tool. For example, automatically identifying similar patients and seeing what treatments worked / didn’t work for that condition. As Judy explained: “As a physician, I may have a patient in front of me. Right now, about 10% of the decisions doctors make come to evidence-based medicine, the other 90% is anecdotal or what you tried last time. Now we can look and say 'OK, there are 28,572 patients just like this one and here's what has worked for them, in different ways. That for some treatments, you may get better results quicker. For other medications, it may be it take longer, but it's a better result. Maybe a patient has a risk of stroke. Maybe some medications are more expensive. That information is going to be shown to the clinician who can then make the best choices for the patient.” I gotta say it was smart for Epic to focus on Cosmos as a voluntary research database for many years before figuring out ways to drive further point of care value. This worked for Epic because they have won the academic medical center market - not sure how well this strategy would have worked for other EHRs. On the surface this seems like the panacea for transforming big data in healthcare into actual useful clinical insights on an individual patient basis. In reality, given the complexity of healthcare, I suspect providers will initially focus on uncovering low hanging fruit use cases where the CDS will be most effective (e.g. where there’s high confidence and low risk) and utilization of the CDS will gravitate to those. There will also be many use cases where there just won’t be enough confidence to leverage the CDS to make decisions. Physicians will still seek guidelines, directives or training on how to use what will be additional yet still imperfect insights - which of course Epic itself wouldn’t and shouldn’t provide. The smart thing to do will be to make the tools available to providers, and let them “discover” what those use cases are and build guidelines on how to apply the CDS effectively. In addition, providers will expect as much access as possible to the underlying reasoning behind any insights that get surfaced - which will influence their confidence in the insight. And what about the UI/UX for this - e.g. chat-based inquiries initiated by the clinician? Automatically surfaced insights? Perhaps both, as high ROI use cases get determined? We’re still far from a panacea, but it’s exciting nonetheless to see what this leads to.

Excellent piece. I cringe when I see new tech laser focused on wellness & health as if it’s all in our control. Sometimes it’s just bad luck and our words matter to ensure we do not isolate others: How to navigate a chronic illness vox.com/even-better/20… via @voxdotcom

Most importantly…patients and family caregiver win!