Patient safety is an age-old concern in the healthcare industry. However, as the latest tech-enabled tools begin to emerge in medicine, new questions around patient safety begin to arise as well.
“When we think about the use of these tools in healthcare, we think about what is the same and what is different [from traditional care],” Jennifer Goldsack, executive director of the Digital Medicine Society, said at the Patient Safety in a Digital World symposium held at the Dana-Farber Cancer Institute in Boston on Tuesday. “Trying to reduce avoidable patient harm is still that definition of patient safety, whether we are using traditional modalities or whether we are [using] digital approaches. I think that we need to pause and think about what is different.”
These differences are plentiful, according to panelists at the symposium yesterday, and include concerns over cybersecurity, passive data collection, and patient education or miseducxation.
New questions on the table
As more data becomes available, the stakes are higher to use that data responsibly and ensure security. Goldsack brought up the example of big tech companies, such as Google, which upon the acquisition of Fitbit will not only have web search and maps data but also wearable data.
These tools could give the tech company a fuller picture of what is happening in a person’s life; the wearable’s accelerometer can detect when someone is agitated, for instance, and GPS tracking could show a trip to the liquor store.
“I’m not accusing anyone of anything … but it just goes to show there is risk for patient harm there. There is a risk you could sell them a flight to Vegas instead of trying to put them in touch with an online counselor,” Goldsack said. “There is also a risk that [they] just sell that profile data, and it is now harder for you to get a job and it affects your life insurance or health insurance. All of these, to me, [make it hard for] patients out in the world.”
Knowledge is power
Patient and provider education is key when safely implementing new technologies.
“When we are talking about patient safety, what do we mean by actually having something for the patient?” Luba Greenwood, a lecturer at Harvard, said at the symposium. “What does it mean to educate and empower patients? Are we educating and empowering patients with the right type of companies, with the right type of products? Or do we have a bunch of nonsense where we are confusing patients? And most importantly, are we confusing physicians?”
Bringing new technologies into the workforce before nurses and doctors have had a chance to fully familiarize and understand them could lead to major issues, according to the panelists.
“When I went out and started working in critical care, I had six months of orientation and had the orange [ECG] book I had to memorize so I knew all of the different arrhythmias,” Kathleen McGrow, chief nursing information officer at Microsoft, said on the panel. “Now we are going to [tell] nurses that have never been exposed to [ECG that] we’re going to put a two-lead on the patient, we’re going to put it in the cloud and run AI on it, and we’re going to send an alert."
But exposure to the tech being employed in real-world practice can begin even before clinicians get into the hospitals.
“I was approached by one of our universities recently saying we are missing a trick not being in at the universities and medical schools, and saying 'Look, this is the landscape you will actually have to work in and these are the technologies you are going to have to deal with,' and starting to educate them a little bit,” Jenni West, associate director of digital change at the Innovation Agency NHS, said.
Challenges for startups
While the tech world has long operated under the "move fast and break things" mantra, medicine instead takes the "do no harm" approach. Startups and tech still have a few lessons to learn when it comes to developing tools that address patient safety, according to panelists.
“Startups, in our experience, think they know everything. They are convinced that the old way of doing things — or the healthcare way of doing things — just exists to be changed or disrupted. Their attitude can be refreshing, but it also can be naivete,” Laurance Stuntz, director of the Massachusetts eHealth Institute, said. “One of the projects we are working on is trying to get to a happy medium in what does a health system need in terms of risk management around cybersecurity for the startup, versus what is the startup prepared to do and answer in terms of what assurance they can give an institution that they’ve actually validated."
When it comes to innovating for healthcare, the reality is that big tech has an upper hand over startups, Greenwood said.
“When you are thinking about a large tech company, at least they have a good understanding of what kind of data they need to train the model and make sure they get that data," she said. "Startups do not necessarily have access to that."
Big tech has also been able to hire insiders from the healthcare world that understand the challenges of patient safety, she said.
“I do want to differentiate tech companies versus startups. I would say that tech companies, including Verily and Google and Microsoft and Amazon, actually do have the resources. So, the companies I’m talking about aren’t actually tech companies,” Greenwood said. "Tech companies have a lot of resources to think through these issues. They have former FDA people, they have nurses, they have physicians that are educating them. I’m more worried about the startups.”
The medical world is still very much working out the kinks of tech tools. However, the rise of data and digital leaves the industry no choice but to consider these in relation to patient safety.
“The promise of integrating all this information to detect devastating conditions like Alzheimer’s disease early so we can develop a treatment is so exciting. But the idea of harm is really important, and we do need to redefine the boundaries,” Goldsack said.
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