Nurses identify 10 needs health startup should focus on

The following list was compiled from interviews with Sheila Antrum (president and senior vice-president, health adult services, UCSF Medical Center), Daphne Stannard (director and chief nurse researcher, Institute for Nursing Excellence, UCSF Medical Center), and Alberto Garcia (patient care director, health adult services,UCSF Medical Center).

Why are we sharing this? UCSF’s Center for Digital Health Innovation was formed three years ago to help improve patient care using technology, and we’d like to see more collaboration between health systems and entrepreneurs in health care. Please reach out to us if you’re working on any of these issues!

1. Patient and family navigation technology. Health systems employ many people as “navigators” to guide patients and their families from one location in a hospital or clinic to another. We like the idea of such technology that in addition to guiding patients through the hospital, helps patients and family members stay abreast of clinical updates. For example, for a patient getting surgery, the app would help guide the patient from the waiting area to the preoperative area and then would later alert the patient’s family members when the surgery has been completed. This solution relies on deep integration with existing hospital technologies, including the electronic health record (EHR) and hospital scheduling software.

2. Virtual hospital sitters. UCSF and other health systems spend millions of dollars each year hiring people to sit at the patient bedside to monitor for falls, self-harm, or other deleterious behaviors. If sitters could be partially replaced with robots or other virtual technology, UCSF could keep patients safe while saving huge amounts of money on workforce costs.

3. Artificial intelligence for the hospital. Advances in machine learning and artificial intelligence (AI) have opened the door for predictive modeling to enhance patient care. From ICU monitoring systems that model patients’ vital signs and produce patient-specific care recommendations, to identifying patterns in care that can have significant impacts on patient outcomes, the future potential for AI in health systems is substantial. Beyond the use of patient data, Sheila and her colleagues expressed interest in AI for the hospital environment – a system in which the environment adapts to patient needs. Such technology could be used for better managing inpatients with pain, delirium, or for promoting mobility for hospitalized patients.

4. Automated documentation within the electronic health record. It’s well accepted that both nurses and physicians spend too much time documenting in electronic health records (EHRs). Nurses, in particular, spend large amounts of time transcribing information from pumps and other patient devices to the EHR. Automated documentation between connected devices and the EHR would improve workforce efficiency and also allow hospitals to more quickly and accurately assess risky states for the institution and the patient, and optimize accordingly. Why hasn’t this happened already? EHR integration between devices is notoriously cumbersome, leaving nurses to take on this effort manually.

5. Virtual home-health communities. Telehealth is rightly a huge area of interest for healthcare innovation. But most telehealth companies are focused on 1:1 patient and provider visits. We see a future in which one provider is able to hold virtual group visits, for example for patients discharged from the hospital with similar conditions. Using population health management tools and the hospital discharge team, these patients could also be matched with a community of patients in their neighborhood, or connect with each other through a virtual platform with relevant resources and communication functions.

6. Price transparency tools for the inpatient setting. There needs to be a better way to track the costs patients face on an ongoing basis. In addition, price transparency tools need to interface with EHRs. Differing reimbursement offered by different plans to each health system have made this issue an ongoing challenge for patients and providers.

7. Pain management dashboard. Current stand-alone technologies exist for chronic disease management, but a pain management dashboard embedded within the EHR could lead to a better and safer tracking of patients with chronic pain issues. With the growing pain medicine epidemic, better and safer pain management is hugely important. Right now, pain management is a fragmented process, requiring patient, pharmacy, nursing, and provider input. An integrated dashboard that allows for cross checking with outpatient pharmacies and the CURES database, pain scoring, and ordering would help ease this currently manual process.

8. Technology to enable safe patient handling. Care teams constantly have to move, position, and lift patients —  even when they shouldn’t. And these tasks can be taxing to staff and result in significant hospital liabilities. Similarly, the safe handling of hospital waste is still a very manual process. Robotic technologies that automate these tasks are appealing from a time, cost, and safety perspective.

9. Research management application. For providers and care teams, it is difficult to know if a patient is enrolled in a clinical trial, which can create significant safety issues. For example, if a patient enrolled in a clinical study is admitted to the hospital and is administered a medication that interacts with a study drug, the patient could be at significant risk for a drug interaction. At present, there is no automated way of managing and flagging patients enrolled in trials. With a better research management application that connects to the EHR, an automated research interface would flag patients who are part of a trial and provide additional supporting materials regarding safety measures that must be followed.

10. Apps for frontline staff. Frontline nurses attend to almost all of a patient’s basic needs. In doing so, they often juggle up to 25 pieces of paper with critical information. Ideally, nurses could use charting software that would help manage and streamline all this information.

Motherhealth is looking for investing partners, doctors and developers for a Health Mobile Outpatient application that will match, monitor and report patient generated health data, including video chats with care providers, cancer care coordination analytics, genetic and lab tests health data sharing and more. Email Connie Dello Buono at ; 1708 Hallmark Lane San Jose CA 95124

Competition in Health Exchanges is for the greater good

Government officials have said that the exchanges will keep insurers’ prices down by making them compete with each other. Prices on the exchanges have been lower than government forecasts, partially a sign of “healthy competition,” Cohen says, and are generally lower in more competitive markets. So far, though, the marketplaces seem to be having another effect on major insurance companies, too: Scaring them away.

Large insurers like Cigna and UnitedHealth have abstained from many states’ exchanges this year; Aetna has backed out of seven exchanges it originally applied to, instead “focusing on the markets where we can be most competitive and deliver the greatest value to our customers,” a spokesperson says. In Mississippi, 36 counties would not have had any plan options if Humana had not joined at the 11th hour, Melville says. “There were concerns there would be coverage deserts, there would be places that you wouldn’t be able to get a policy.” This hasn’t happened, but some states have so few carriers offering plans in the marketplaces that the lack of competition has kept rates high.

West Virginia and New Hampshire, for example, currently have only one carrier for their entire states, respectively. Wyoming only has two, after most of the state’s insurers skipped the exchange, and has the highest rates in the country. Analysts, however, say that there is likely to be more competition in future years: Insurers will wait and see how 2014 plays out and re-evaluate their strategies. Aetna, for one, says it is “taking a measured, multiyear approach to exchanges.”