Risk Insider: Jeff Driver

Hooba-Dooba! Digital Health Care Reality: Part II

By: | August 15, 2017 • 4 min read
Jeff Driver is the Chief Risk Officer- Stanford University Medical Center and the Chief Executive Officer - The Risk Authority, LLC. He can be reached at [email protected]

As discussed in Part I, digital health care use is on the rise, and while in many ways rewarding, is not without risk. At TRA Stanford, we identified cyber security, misdiagnosis, and informed consent as three pressing issues risk managers will face.

Cyber security: As medical devices are increasingly connected to the internet, hospital systems, and other medical devices, there is a higher risk of hackers collecting sensitive information, or worse, interrupting “life critical systems” that protect human life.

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In 2015, the FDA and Department of Homeland Security provided a warning that medical devices could be tampered with by hackers.  Devices, such as IV pumps, could be accessed remotely through a hospital’s network which would allow an unauthorized person to control the device and change the dosage of medication delivered to the patient.  The vulnerability is the same for digital health apps and wearables.

A variety of clinical risks may arise through the use of digital health apps.  One such concern is informed consent and the question regarding what consent means when care is supplemented through the use of digital health apps.

The risk mitigation strategies between medical devices and the devices used to transmit or receive data through digital health apps and wearables are very similar. Due diligence efforts should ensure that digital health apps are provided through HIPPA compliant platforms and appropriate security measures are in place. Some measures include, for example, a technology backbone and infrastructure to support the function, remote device integration with real-time data sharing, reporting and cross data correlation; interoperability, data analytics and big data management, and privacy and security. A thorough risk analysis of all potential vulnerabilities is indispensable.

Misdiagnosis: While rife with potential for preventative health care, many apps have been developed without being validated for diagnostic accuracy or utility using established research methods. The use of digital health apps and any technology requires an overhaul of existing processes and procedures, as well as a process to evaluate and revise workflows. The following due diligence may help mitigate operational risk related to validity and ethicality:

  1. Research whether the app does what it says its going to do. Developers should be able to provide information about testing and provide disclaimers that their apps are not medical devices and are not approved by the FDA, when applicable.
  2. Prepare the patient, practitioners and organization to utilize the digital health app.
  3. Carry out a mock trial run of a patient encounter utilizing the technology before it is actually incorporated into patient care.

Informed consent: A variety of clinical risks may arise through the use of digital health apps.  One such concern is informed consent and the question regarding what consent means when care is supplemented through the use of digital health apps.  For example, patients may be given a code to download a specific app.  When the patient downloads the app, does that mean the patient consented to the use of the app?  Of course the clinician should complete the risk and benefit conversation with the patient, but when is consent complete?

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Clinicians should follow existing guidelines for informed consent and revise the process as necessary to conform with the unique nature of incorporating technology into patient care.  There are multiple criteria for informed consent that are applicable to this process, such as:

  1. Evaluating and documenting the patient’s competence to understand and to decide.
  2. Voluntary decision-making.  This is important because the patient should not be coerced into using this technology if he/she does not want to.
  3. Disclosure of material information is a key component of the consent process. It should be clear to the patient how the information gathered will be used in their treatment plan.
  4. The patient should expressly, in writing, authorize the plan.  The plan should include when and how the patient should access the digital health app, and a process should be in place to follow-up with the patient to determine whether the patient has accessed the app at the designated time and whether the patient has been able to utilize the app as intended.

Digital health apps will quickly become a regularly used tool to complement existing patient care practices.  There are many upsides to the risk, including more expeditious care through transmitting information in real-time, greater patient satisfaction, greater practitioner satisfaction, chronic disease management, and opportunity for competitive advantage. There are potential risks, too, but these risks can be effectively managed when proactively identified.

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]