Dignity Health’s chief digital officer explains why he thinks Apple can succeed for population health and precision medicine efforts where other PHR launches have not.

By Mike Miliard     April 18, 2018     09:46 AM

As a longtime collaborator with Apple – since before it even beta-tested its Health Records project, live now at 39 hospitals – San Francisco-based Dignity Health is in sync with the iPhone developer’s vision, said Shez Partovi, MD.

screensnap of Apple's personal health record feature with iOS 11.3.
A screensnap of Apple’s personal health record feature with iOS 11.3.

“We had been working with Apple prior to their initial announcement for some time,” said Partovi, chief digital officer and senior vice president of digital transformation at Dignity Health. “We’d been working with them for a while because we’re aligned in our philosophies of empowering patients by giving them their data.”

As part of the Health Records launch, Dignity will leverage HL7’s FHIR standard to securely move patients’ health data from own electronic health record system to the iPhones of patients using iOS 11.3 – enabling them manage meds, labs, allergies, conditions and more, and notifying them when the health system makes changes to their health information.

[Also: Apple reveals 39 hospitals to launch Apple Health Records]

“When you think of personalized medicine, you can think about caring for yourself in two dimensions,” said Partovi. “There’s care management, where a health system or physician or team is managing your care, and there’s self-management.”

For those patients managing an illness or a chronic condition, “a big part of your life is self-managing that condition,” he said.

Luckily, nowadays there are “more and more tools out there that will be enhanced if they have your data.” A tool like Apple’s Health Records, that puts valuable EHR data right onto a person’s smartphone, can only be a boon.

“That, for us, has always been the philosophy,” said Partovi. “We recognize that a lot of care happens outside the four walls of a health system. And we believe that for healthy populations we need to give patients their data.”

Picking up where Google left off

The idea of personal health record is nothing new, of course. Most providers offer at least a basic patient portal that can be accessed via computer or smartphone, although utilization of them remains underwhelming.


Operation Safety: A Case Study in Preventable Workplace Falls

Falls from heights and elevated surfaces continue to be a driver in signage graphic for article, Operation Safety: A Case Study in Preventable Workplace Fallsworkers’ compensation costs across the United States.  Now is the time for employers and other interested stakeholders to take a stand against falls.  It will not only reduce workers’ compensation program costs but increase morale within the workplace.

A Case Study in Preventable Workplace Falls

Falls within the workplace continue to be the leading cause of workplace deaths despite improvements and availability of cost-effective safety equipment.  This is mainly prevalent in the construction industry where workers engage in daily activities in a variety of settings and conditions.  This includes smaller residential construction projects, which account for a disproportionally high number of catastrophic workers’ compensation claims.  Preventing these incidents all starts with a proactive contractor dedicated to improving the safety on their job site.

Preventing falls from heights and elevated surfaces can be prevented by simple strategies:

  • Advance planning that includes understanding the job site and unique conditions employees might face when performing their work activities;
  • Making sure all employees and others on a construction site have the necessary safety equipment. This includes making sure the equipment is properly working and free from defect; and
  • Providing the necessary training on how to correctly use the safety equipment used in the workplace. A surprising number of work injuries and deaths occur when this equipment is not correctly used by employees. 

Communication is Key!

The first step in preventing falls in the workplace is communication.  When it comes to workplace safety and a known safety risk, interested stakeholders can never communicate to its workforce enough.  This communication must also be effective.  Steps contractors can take should include:


Violence against teachers: 1 in 5 educators say they don’t report incidents

Columbus, OH — One out of five teachers who experiences physical or verbal violence on the job does not report it to school administrators, according to a study led by researchers at Ohio State University.

teacher in classroom for article, Violence against teachers: 1 in 5 educators say they don’t report incidentsThe researchers surveyed 3,403 kindergarten through 12th-grade teachers. Of the 2,505 who said they had been a victim of some form of violence:

  • 25 percent reported actual physical abuse or assault.
  • 20 percent reported threats of physical violence.
  • 37 percent described verbal insults, disrespectful language or inappropriate sexual advances.

However, 20 percent never informed an administrator about the incident, approximately 14 percent did not tell a co-worker and nearly 24 percent kept the news from family.

“You would think that the first thing a teacher would do after a violent encounter or threat would be to tell the school’s administrators, but 20 percent aren’t even doing that. That’s disturbing,” Eric Anderman, lead author and professor of educational psychology at Ohio State University, said in March 7 press release. “Too many teachers aren’t talking to anyone about what happened.”

The researchers also found that teachers were more likely to talk with co-workers about violence than with administrators – 8 percent described a lack of support when they reported violence.

“Some schools may need to re-evaluate how they can support and help teachers who are victims of violence,” Anderman said.


If You Have a Workplace Policy Against Drunk Driving, Then Pay Attention…

If you knew a certain behavior put your employees at a four-times greater risk of injury would you encourage it? Probably not. Yet many employers allow and even encourage workers to use cell phones while driving, despite the evidence showing the danger.

texting driver accident poster for article, If You Have a Workplace Policy Against Drunk Driving, Then Pay Attention…

In addition to putting workers at risk, employers have been held liable for up to $25 million for employee crashes — even when they were using hands-free devices. Companies can protect their workers, greatly reduce their workers’ compensation costs, and steer clear of liability by implementing and enforcing distracted driving policies.

The Problem

Motor vehicle crashes are the #1 cause of work-related deaths each year, and distractions are one of the main reasons for accidents. Cell phone use while driving results in 1.6 million auto accidents annually.

Studies show people who drive while talking on the phone are 4 times more likely to have a crash, and those who text are 8 times more likely. Distracted driving also presents risks for workers in the area. In fact, distraction is the top cause of accidents in work zones.

The problem is our brains are not equipped to fully concentrate on both driving and cell phone use simultaneously. Driving and communicating via cell phone both require significant brain power. But the brain cannot focus it’s complete attention on more than one task, so it must choose where to focus attention, or split attention between two or more mental activities.

The effect is the area of our brain that processes moving images decreases by one-third when we are talking on the phone — whether it is a hand-held or hands-free device, since both are more cognitively demanding than having a conversation with someone in the car.

Drivers who use cell phones can miss seeing up to 50 percent of their driving environment. Several studies have shown talking on a cell phone (hands-free or not) while driving is comparable to driving while drunk.

One 2006 study showed “when drivers were conversing on either a handheld or hands-free cell phone, their braking reactions were delayed and they were involved in more traffic accidents than when they were not conversing on a cell phone. By contrast, when drivers were intoxicated from ethanol they exhibited a more aggressive driving style, following closer to the vehicle immediately in front of them and applying more force while braking.” This resulted in the conclusion “when driving conditions and time on task were controlled for, the impairments associated with using a cell phone while driving can be as profound as those associated with driving while drunk.”

The Liability

There are numerous cases showing the extent of employers’ liability for accidents caused by cell phone usage. Examples are:

  • A jury found that a driver and the company that owned the vehicle were liable for $21.6 million because testimony revealed that the driver may have been talking with her husband on a cell phone at the time of the fatal crash.

Medical Marijuana Education Lagging Behind Clinical Needs

With only 9% of medical schools teaching students about medical marijuana, new graduates are ill-equipped to prescribe the substance and field questions on the topic, a new study suggests.Medical Marijuana logo for article, Medical Marijuana Education Lagging Behind Clinical Needs

Researchers surveyed deans at over 100 medical schools and residents and fellows at one large academic center; scoured a national medical curriculum database; and found a paucity of education on an increasingly used treatment for pain and other conditions.

“I’m not surprised by the findings,” said Mark Steven Wallace, MD, chair of the Division of Pain Medicine at UC San Diego Health. “How do you develop a curriculum when you don’t have high-quality data?”

The federal government prohibits marijuana prescribing, but the substance is legal in 29 states as well as the District of Columbia. More states are in the process of legislating in favor of recreational or medical marijuana legalization.

Despite the increased legal availability of the substance, as co-investigator Carolyn Dufault, PhD, assistant dean of education at Washington University School of Medicine in St. Louis, and her colleagues found, medical schools are not keeping up with recognition of the medical value of marijuana.

They surveyed 101 deans at 82 allopathic and 19 osteopathic medical schools in the United States, 258 residents and fellows at Washington University, and analyzed curricula from 2015 to 2016 as listed in the Association of American Medical Colleges (AAMC) Curriculum Inventory.

The results of the survey (Drug Alcohol Depend 2017;180:151-155) showed that two-thirds of deans believed their graduates were not prepared to prescribe medical marijuana, and 25% said their students were not ready to answer questions about it.


Can An mHealth Kit Improve Outcomes in Workers Comp Treatment?

Cedars-Sinai will be testing a digital pain reduction kit, which includes VR glasses and mHealth wearables, to see if mobile health technology can replace opioids for people recovering from workplace injuries.

 By Eric Wicklund

 – Cedars-Sinai Medical Center is participating in a study to determine whether an mHealth kit containing wearables and a pair of virtual reality glasses can help people suffering from work-related injuries recover more quickly and without the use of opioids.

patient in hospital wearing VR glasses for article, Can An mHealth Kit Improve Outcomes in Workers Comp Treatment?

Researchers at the Los Angeles hospital are partnering with Samsung Electronics America, Bayer, appliedVR and The Travelers Companies for the 16-mointh study, which will put the “digital pain-reduction kit” in the hands of between 90 and 140 participants.

“Workplace injuries that lead to chronic pain can cause ongoing issues, as an injured employee may mask pain with opioids or other drugs,” Dr. Melissa Burke, Travelers’ National Pharmacy Director, said in a press release. “

Identifying new, non-pharmacologic alternatives for pain reduction  can help an injured employee avoid chronic pain, lower the chances that they will develop a dangerous opioid addiction and reduce medical costs.”

Led by Brennan Spiegel, MD, MSHS, Director of Health Services Research for Cedars-Sinai and a professor of medicine and public health at UCLA, Cedars-Sinai has been one of the leadersin studying the application of virtual reality tools and other mHealth devices in healthcare, focusing particularly on digital therapeutics.

Continue reading Can An mHealth Kit Improve Outcomes in Workers Comp Treatment?

More Inclusive Workplaces Recruiting Autistic Employees

Mar 8, 2018

With autism rates growing nationally, and even more dramatically in New Jersey, where one in 41 children receive an autism diagnosis today, it is no surprise that the jobless rate is higher for young adults that are living on the spectrum. While this statistic underscores a challenge, it also reveals a meaningful opportunity for New Jersey’s autism awareness month logo for article, More Inclusive Workplaces Recruiting Autistic Employeesemployers who seek to create a more inclusive workplace.

Like all young adults, young people on the spectrum want to live independently and work. However, the prospect of a job interview can be challenging for many, especially for those who might engage in repetitive behaviors that can seem unusual to people who have had limited exposure to people with autism. “These idiosyncrasies may preclude an employer from clearly seeing their hidden talents or skills such as an intense focus or the ability to work intently with numbers and patterns and process data, which neurotypical populations may lack,” explained Julie Mower, executive director of The Phoenix Center, a school for students with significant developmental disabilities and those on the autism spectrum ages five through 21 based in Nutley. “These employees also enjoy performing repetitive tasks for extended periods with near perfect accuracy, helping to increase productivity on group projects and initiatives.”

However, with top talent increasingly in demand, companies such as Microsoft, Walgreens, Zinburger, Capital One, and Procter & Gamble, are actively recruiting people with autism, especially in technical jobs. Consider SAP which has a formal program to recruit those with autism spectrum disorder; the Silicon Valley giant already has 130 such employees, as shown recently on CBS News.

At The Phoenix Center, young adults with autism are also meaningfully contributing to workplace; through its Transition and Community-Based Instruction programs, the school facilitates employment opportunities for students with autism, with positive results for employer and student alike. “Our students and graduates are placed in jobs throughout NJ in companies such as Walgreens, Shop Rite, a Kia automotive dealership, and Liberty Science Center, for example, and have shown real aptitude for computer programming, computer design and math problem solving, for example,” Mower said.


Do Online Medical Results Do More Harm Than Good?

Sandra G. Boodman
March 29, 2018

As she herded her two young sons into bed one evening late last Google logo with stethoscope for article, Do Online Medical Results Do More Harm Than Good?December, Laura Devitt flipped through her phone to check on the routine blood tests that had been performed as part of her annual physical. She logged onto the patient portal link on her electronic medical record, scanned the results and felt her stomach clench with fear.

Devitt’s white blood cell count and several other tests were flagged as abnormal. Beyond the raw numbers, there was no explanation.

“I got really tense and concerned,” said Devitt, 39, a manager of data analysis who lives in New Orleans. She immediately began searching online and discovered that possible causes ranged from a trivial infection to cancer.

“I was able to calm myself down,” said Devitt, who waited anxiously for her doctor to call. Two days later, after hearing nothing, she called the office. Her doctor telephoned the next day. She reassured Devitt that the probable cause was her 5-year-old’s recent case of pinkeye and advised her to get tested again. She did, and the results were normal.

“I think getting [test results] online is great,” said Devitt, who says she wishes she had been spared days of needless worry waiting for her doctor’s explanation. “But if it’s concerning, there should be some sort of note from a doctor.”

Devitt’s experience illustrates both the promise and the perils of a largely unexamined transformation in the way growing numbers of Americans receive sensitive — sometimes life-changing — medical information. A decade ago, most patients were informed over the phone or in person by the doctor who had ordered testing and could explain the results.

But in the past few years, hospitals and medical practices have urged patients to sign up for portals, which allow them rapid, round-the-clock access to their records. Lab tests (with few exceptions) are now released directly to patients. Studies estimate that between 15 and 30 percent of patients use portals.Bottom of Form.


Diversity Training: How to Handle LGBTQ Issues with Cultural Sensitivity

Cultural competency has gained a stronger foothold in health care over the past decade. Still, while strategies to provide care without bias have helped reduce disparities among minority populations, the same can’t be said for those in the LGBTQ (lesbian, gay, bisexual, transgender, queer) community.

graphic for article, Diversity Training: How to Handle LGBTQ Issues with Cultural SensitivityLack of trust between patient and provider can have a significant impact in workers’ comp. Statistics from the Institute of Medicine and the Kaiser Family Foundation show that LGBTQ individuals are more likely to delay or not seek the medical treatment they need because of the discrimination they’ve experienced in the past.

To compound matters, some states offer little legal confidentiality protection for this population. While patient confidentiality is universally governed by HIPAA, this isn’t the case in workers’ comp which is exempt from this privacy law. This may cause gay or transgender individuals to not disclose their sexual orientation to a medical professional because for fear it could get back to their employer and open them up to more discrimination.

If they’re already facing some discrimination from coworkers or their peers, it’s going to decrease their productivity, job satisfaction, motivation to go back to work. What can we do to give these individuals the support they need and help them return-to-work safely and efficiently?

GenexYou can find some solutions from this recent interview, Treating LGBTQ Injured Workers: Gaining Cultural Competence, Building Trust.

Continue reading Diversity Training: How to Handle LGBTQ Issues with Cultural Sensitivity

A ‘sweet spot’ BMI to reduce heart disease risk?

Joy Victory is Deputy Managing Editor of HealthNewsReview.org. She tweets at @thejoyvictory.

An extremely brief New York Times “Well” post published last week — “A ‘Sweet Spot’ for Heart Health” — suggests that people must be within a very narrow weight range–a body-mass index (BMI) of 21 to 23–if they want to reduce their risk of heart disease as much as possible.

infographic for article, A ‘sweet spot’ BMI to reduce heart disease risk? What you need to knowThe Times’ article reports on a prospective study of nearly 300,000 middle-aged British men and women, followed for about five years, who had their relative body fat measured by five methods: body-mass index (BMI), waist circumference, waist-to-hip ratio, waist-to-height ratio, and body fat percentage.

The British study adds to a growing body of research that shows that the so-called “obesity paradox” — the notion that a slightly higher than “normal” BMI may reduce mortality — may not really exist. Such was the case with this study: Increasing BMI was associated with an increased risk for heart disease, as well as with the other measurements for measuring body fat.

And there was no BMI “sweet spot,” so to speak. Overall–after researchers controlled for things like smoking and coexisting health conditions–the less people weighed, the less likely they were to develop heart disease.

But the Times’ article doesn’t provide this context and instead implies that people must be within a narrow BMI range–not too low, and not too high. It also doesn’t explain that the BMI is an imperfect tool and shouldn’t be used in isolation: Very fit athletes, for example, can have a high BMI that places them in the “overweight” category.

Nor is it mentioned that this kind of research, known as a prospective cohort study, is not designed to prove that obesity — or even fat itself — causes cardiovascular disease. All the variables that likely contribute to heart disease cannot be fully accounted for in this kind of study design.