A look into clinical pathology and medical publishing

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Clinical pathology covers a broad range of responsibilities and functions in medicine. As a discipline, it includes clinical (bio)chemistry, medical microbiology, hematology, coagulation, clinical immunology, and increasingly molecular diagnostics. We recently sat down with the Editor of the American Journal of Clinical Pathology, Dr. Michael L. Wilson, to learn the vital importance of this field. Dr. Wilson also shares with us his insights on his journal’s readers, authors, and publishing a medical journal…

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SCIO Health Analytics®

Based in West Hartford, Connecticut, SCIO Health Analytics® is a leading health analytics solutions company, leveraging the power of healthcare data, predictive analytics, and healthcare business experts to provide clients the solutions to decrease costs, improve health outcomes, increase revenues, and drive ROI and sustainability.

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Innovation Insight for Healthcare Provider Digital Twins

Article | September 4, 2020

A digital twin is a digital representation of a real-world entity or system. The implementation of a digital twin is a model that mirrors a unique physical object, process, organization, person or other abstraction. For healthcare providers, digital twins provide an abstraction of the healthcare ecosystem’s component characteristics and behaviors. These are used in combination with other real-time health system (RTHS) capabilities to provide real-time monitoring, process simulation for efficiency improvements, population health and long-term, cross-functional statistical analyses. Digital twins have the potential to transform and accelerate decision making, reduce clinical risk, improve operational efficiencies and lower cost of care, resulting in better competitive advantage for HDOs. However, digital twins will only be as valuable as the quality of the data utilized to create them. The digital twin of a real-world entity is a method to create relevance for descriptive data about its modeled entity. How that digital twin is built and used can lead to better-informed care pathways and organizational decisions, but it can also lead clinicians and executives down a path of frustration if they get the source data wrong. The underlying systems that gather and process data are key to the success for digital twin creation. Get those systems right and digital twins can accelerate care delivery and operational efficiencies. Twins in Healthcare Delivery The fact is that HDOs have been using digital twins for years. Although rudimentary in function, digital representations of patients, workflow processes and hospital operations have already been applied by caregivers and administrators across the HDO. For example, a physician uses a digital medical record to develop a treatment plan for a patient. The information in the medical record (a rudimentary digital twin) along with the physician’s experience, training and education combine to provide a diagnostic or treatment plan. Any gaps in information must be compensated through additional data gathering, trial-and-error treatments, intuitive leaps informed through experience or simply guessing. The CIO’s task now is to remove as many of those gaps as possible using available technology to give the physician the greatest opportunity to return their patients to wellness in the most efficient possible manner. Today, one way to close those gaps is to create the technology-based mechanisms to collect accurate data for the various decision contexts within the HDO. These contexts are numerous and include decisioning perspectives for every functional unit within the enterprise. The more accurate the data collected on a specific topic, the higher the value of the downstream digital twin to each decision maker (see Figure 1). Figure 1: Digital Twins Are Only as Good as Their Data Source HDO CIOs and other leaders that base decisions on poor-quality digital twins increase organizational risk and potential patient care risk. Alternatively, high-quality digital twins will accelerate digital business and patient care effectiveness by providing decision makers the best information in the correct context, in the right moment and at the right place — hallmarks of the RTHS. Benefits and Uses Digital Twin Types in Healthcare Delivery Current practices for digital twins take two basic forms: discrete digital twins and composite digital twins. Discrete digital twins are the type that most people think about when approaching the topic. These digital twins are one-dimensional, created from a single set or source of data. An MRI study of a lung, for example, is used to create a digital representation of a patient that can be used by trained analytics processes to detect the subtle image variations that indicate a cancerous tumor. The model of the patient’s lung is a discrete digital twin. There are numerous other examples of discrete digital twins across healthcare delivery, each example tied to data collection technologies for specific clinical diagnostic purposes. Some of these data sources include vitals monitors, imaging technologies for specific conditions, sensors for electroencephalography (EEG) and electrocardiogram (ECG). All these technologies deliver discrete data describing one (or very few) aspects of a patient’s condition. Situational awareness is at the heart of HDO digital twins. They are the culmination of information gathered from IoT and other sources to create an informed, accurate digital model of the real-world healthcare organization. Situational awareness is the engine behind various “hospital of the future,” “digital hospital” and “smart patient room” initiatives. It is at the core of the RTHS. Digital twins, when applied through the RTHS, positively impact these organizational areas (with associated technology examples — the technologies all use one or more types of digital twins to fulfill their capability): Care delivery: Clinical communication and collaboration Next-generation nurse call Alarms and notifications Crisis/emergency management Patient engagement: Experiential wayfinding Integrated patient room Risks Digital Twin Usability Digital twin risk is tied directly to usability. Digital twin usability is another way of looking at the issue created by poor data quality or low data point counts used to create the twins. Decision making is a process that is reliant on inputs from relevant information sources combined with education, experience, risk assessment, defined requirements, criteria and opportunities to reach a plausible conclusion. There is a boundary or threshold that must be reached for each of these inputs before a person or system can derive a decision. When digital twins are used for one or many of these sources, the ability to cross these decision thresholds to create reasonable and actionable conclusions is tied to the accuracy of the twins (see Figure 2). Figure 2: Digital Twin Usability Thresholds For example, the amount of information about a patient room required to decide if the space is too hot or cold is low (due to a single temperature reading from a wall-mounted thermostat). In addition, the accuracy or quality of that data can be low (that is, a few degrees off) and still be effective for deciding to raise or lower the room temperature. To decide if the chiller on the roof of that patient wing needs to be replaced, the decision maker needs much more information. That data may represent all thermostat readings in the wing over a long period of time with some level of verification on temperature accuracy. The data may also include energy load information over the same period consumed by the associated chiller. If viewed in terms of a digital twin, the complexity level and accuracy level of the source data must pass an accuracy threshold that allows users to form accurate decisions. There are multiple thresholds for each digital twin — based on twin quality — whether that twin is a patient, a revenue cycle workflow or hospital wing. These thresholds create a limit of decision impact; the lower the twin quality the less important the available decision for the real-world entity the twin represents. Trusting Digital Twins for HDOs The concept of a limit of detail required to make certain decisions raises certain questions. First, “how does a decision maker know they have enough detail in their digital twin to take action based on what the model is describing about its real-world counterpart?” The answer lies in measurement and monitoring of specific aspects of a digital twin, whether it be a discrete twin, composite twin or organization twin. Users must understand the inputs required for decisions and where twins will provide one or more of the components of that input. They need to examine the required decision criteria in order to reach the appropriate level of expected outcome from the decision itself. These feed into the measurements that users will have to monitor for each twin. These criteria will be unique to each twin. Composite twins will have unique measurements that may be independent from the underlying discrete twin measurement. The monitoring of these key twin characteristics must be as current as the target twin’s data flow or update process. Digital twins that are updated once can have a single measurement to gauge its appropriateness for decisioning. A twin that is updated every second based on event stream data must be measured continuously. This trap is the same for all digital twins regardless of context. The difference is in the potential impact. A facilities decision that leads to cooler-than-desired temperatures in the hallways pales in comparison to a faulty clinical diagnosis that leads to unnecessary testing or negative patient outcomes. All it takes is a single instance of a digital twin used beyond its means with negative results for trust to disappear — erasing the significant investments in time and effort it took to create the twin. That is why it is imperative that twins be considered a technology product that requires constant process improvement. From the IoT edge where data is collected to the data ingestion and analytics processes that consume and mold the data to the digital twin creation routines, all must be under continuous pressure for improvement. Recommendations Include a Concise Digital Twin Vision Within the HDO Digital Transformation Strategy Digital twins are one of the foundational constructs supporting digital transformation efforts by HDO CIOs. They are digital representations of the real-world entities targeted by organizations that benefit from the advances and efficiencies technologies bring to healthcare delivery. Those technology advances and efficiencies will only be delivered successfully if the underlying data and associated digital twins have the appropriate level of precision to sustain the transformation initiatives. To ensure this attention to digital twin worthiness, it is imperative that HDO CIOs include a digital twin vision as part of their organization’s digital transformation strategy. Binding the two within the strategy will reinforce the important role digital twins play in achieving the desired outcomes with all participating stakeholders. Building new capabilities — APIs, artificial intelligence (AI) and other new technologies enable the connections and automation that the platform provides. Leveraging existing systems — Legacy systems that an HDO already owns can be adapted and connected to form part of its digital platform. Applying the platform to the industry — Digital platforms must support specific use cases, and those use cases will reflect the needs of patients, employees and other consumers. Create a Digital Twin Pilot Program Like other advanced technology ideas, a digital twin program is best started as a simple project that can act as a starting point for maturity over time. Begin this by selecting a simple model of a patient, a department or other entity tied to a specific desired business or clinical outcome. The goal is to understand the challenges your organization will face when implementing digital twins. The target for the digital twin should be discrete and easily managed. For example, a digital twin of a blood bank storage facility is a contained entity with a limited number of measurement points, such as temperature, humidity and door activity. The digital twin could be used to simulate the impact of door open time on temperature and humidity within the storage facility. The idea is to pick a project that allows your team to concentrate on data collection and twin creation processes rather than get tied up in specific details of the modeled object. Begin by analyzing the underlying source data required to compose the digital twin, with the understanding that the usability of the twins is directly correlated to its data’s quality. Understand the full data pathway from the IoT devices through to where that data is stored. Think through the data collection type needed for the twin, is discrete data or real-time data required? How much data is needed to form the twin accurately? How accurate is the data generated by the IoT devices? Create a simulation environment to exercise the digital twin through its paces against known operational variables. The twin’s value is tied to how the underlying data represents the response of the modeled entity against external input. Keep this simple to start with — concentrate on the IT mechanisms that create and execute the twin and the simulation environment. Monitor and measure the performance of the digital twin. Use the virtuous cycle to create a constant improvement process for the sample twin. Experience gained through this simple project will create many lessons learned and best practices to follow for complex digital twins that will follow.

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Trends, challenges and opportunities in UK’s healthcare sector in 2021

Article | September 4, 2020

COVID-19 has practically given a metaphorical high-voltage jolt to the whole world. It fell like a plague and affected humans in a way that nothing else has since the last global war. In short, it has reminded us of our mortality. As a result, improvement has become the new goal for the wise. According to Jana Abelovska, Head Pharmacist atClick Pharmacy, “COVID-19 has put the world on notice, especially the healthcare sector. Everything and everyone has seen its effects. But in this turmoil also come opportunities – an opportunity to grow and be better. It is a time of progress to help create a better and healthier tomorrow.”

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Reimagining healthcare with Azure IoT

Article | September 4, 2020

Providers, payors, pharmaceuticals, and life sciences companies are leading the next wave of healthcare innovation by utilizing connected devices. From continuous patient monitoring, to optimizing operations for manufacturers and cold-chain supply tracking for the pharmaceutical industry, the healthcare industry has embraced IoT technology to improve patient outcomes and operations. In our latest IoT Signals for Healthcare research, we spoke with over 150 health organizations about the role that IoT will play in helping them deliver better health outcomes in the years to come. Across the ecosystem, 85 percent see IoT as “critical” to their success, with 78 percent planning to increase their investment in IoT technologies over the next few years. Real-time data from connected devices and sensors provides benefits across the health ecosystem, from manufacturers and pharmaceuticals to health providers and patients. For health providers, IoT unlocks efficiencies for clinical staff and equipment:

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9 Ways UVC Light Tech Can Safeguard Staff & Patron Health

Article | September 4, 2020

As COVID-19 rages on, warning sirens have sounded of late amid a flurry of headlines surrounding Ultraviolet-C (UVC) light device safety issues. Rightfully so, as the current pandemic has ushered in a veritable “wild west” of UVC gadget deployments with subpar consumer safeguards, instructions or guidance. So important are the concerns amid this rapidly proliferating product sphere, the FDA recently issued a consumer advisory regarding UVC light technology that’s applicable for industrial, business, travel and residential use. Once largely a germicidal method leveraged in hospital, industrial and other commercial settings for its extreme efficacy, today’s breed of UVC technologies are small, portable and inexpensive enough to be making their way into businesses of every type across the globe—and even traverse with individuals while they’re out and about. This, as generalist retailers like Amazon and Walmart have joined the fray in their attempts to divert market share from the more specialized, expert-driven, safety-focused UVC purveyors. While germ-killing UVC technologies do proffer tremendous advantages and results for users—serving as a potent tool for easily and effectively eradicating harmful viruses, bacteria, pathogens and microorganisms—there are a number of considerations a business (or employee) should heed before procuring and using such a powerful device. This includes, but is certainly not limited to, why; when; where; and how it will be used—variables that impact safety and risk concerns related to UVC wavelength, dose and duration of radiation exposure. Shopping in this category can be equally overwhelming. One need only Google “UVC lamps,” which delivers nearly 100,000 results, to realize how bloated this category has become. Amid the chaos, I did happen upon a highly targeted, category-dedicated source wholly dedicated to UVC technologies: CureUV.com. This company draws on over 20-years of expertise in the design, development and provision of technologically advanced UV products and solutions. Today, they are a premier provider of germicidal UVC light solutions for commercial, industrial, portable, residential and even water applications. While its form factor catalog is copious, below are a few of CureUV’s more popular UVC devices starting under $90 that proffer chemical-free disinfection, which can help ensure your spaces remain free of illness-causing microbial contaminants like viruses, bacteria, mold and other fungi: Rechargeable Handheld UV Sanitizer Wand With Digital Timer Here's a highly portable way to eliminate germs and have a cleaner environment no matter where you may be. This powerful UVC illumination system, which retails around $89, eradicates up to 99.9 percent of viruses, bacteria, germs, mold, dust mite eggs and flea eggs on surfaces. This non-chemical option adds an extra layer of safety to you with no hazardous residue. It contains a 6-inch UVC lightbulb allowing for a wider coverage of area as well as accelerating sanitation in the process. A built in timer inside the device allows you to keep track of desired dosage creating precise sanitation sessions-- anywhere from 5 to 60 minutes to indefinite. Its silent operation allows for a noise free solution for sanitation, and sleek and cordless and lightweight design is perfect for travel however near or far--daily around town or those hotel visits. Sanitize how you want in your desired target area or on your personal items keeping them germ free. An internal rechargeable battery saves money on replaceable battery purchases as compared to various other handheld wands on the market. GermAwayUV 18-Watt Handheld UVC Surface Sanitizer This device offers reliable and highly portable sanitizing performance at an entry-level price. Indeed, at under $120, this is an affordable, dual-bulb, handheld UV sanitizer that still maintains power levels similar to more industrial UV surface sanitizers. This lightweight and ergonomically designed 18-watt UVC sanitizer will give you much peace of mind. It has a 6-foot cord adequate for most applications, but the sanitizer will run easily with virtually any simple power extension. Its two 9-watt UVC sanitizer bulbs are guaranteed to produce UV light in the 253.7 nanometer (nm) wavelength, which has been consistently proven to eliminate all illness-causing microorganisms. It's the perfect tool to disinfect high use and traffic areas, as well as locations where bacteria and viruses congregate like bathrooms, door handles, seating areas and cooking/dining spaces. It'll prevent the spread of harmful bacteria and microorganisms, or simply add an extra layer of cleanliness and protection to your cleaning procedures. It comes bundled with protective amber UV safety glasses. Deluxe GermAwayUV 95-Watt UVC Surface Sanitizer with Cage With a 95-watt bulb, this chemical-free, tabletop UV room and surface sanitizer is the strongest of its kind. It will result in effective room sanitation by killing up to 99.9 percent of bacteria, viruses, mold spores, yeasts, C. diff, odors and other harmful microorganisms. With a simple touch of a button you'll be able to leave the room while the entire space is cleaned and disinfected in a matter of minutes. The device has five time settings: 10, 20, 30 and 60 minutes; and hold for indefinite run time. After the selected dosage time has elapsed, the device will automatically shut off. You can use it regularly to ensure a consistently clean room. Heavy Duty Dual Bulb 72-Watt HVAC UV Air Purifier Suitable for use anywhere, including schools, offices, work-floors and medical rooms to sanitize air and environmental surfaces, this device is effective in small and large rooms/buildings alike, up to 2,400 square feet. With a powerful 72-watt bulb and a standard electrical unit, you can insert this premium UVC bulb into any HVAC system as an easy add on to sanitize the air in the system. Typical air purifier units and HVAC systems are definitely useful, designed to filter and ventilate air well. But even the finest filters can’t stop atomic sized bacteria and viruses. This device is therefore a great extra add on because it really does target and stop bacteria and viruses from circulating. It sanitizes and disinfects air passing through the HVAC system. Its 72-watt bulb emits UVC light of 254nm and is the most powerful bulb. Most devices are typically only effective in small rooms, but with this level of wattage you can use this device in large rooms and building types. At its wavelength, the emitted light is able to penetrate and kill the DNA of atomic sized organisms that create problems for humans. UVC emission also acts to eliminate mold spores, yeast and fungi. So, inserting this unit device into your existing HVAC system ensures that not only will the air that moves through your building be ventilated, it will also be irradiated and disinfected as it passes over the bulb. Instead of just filtered air in your system, you’ll end up with sanitized, healthy air. Add on (retrofit) features like this one are great because you can just insert them into an already installed and operating HVAC system with minimal additional running costs. This device is easy to install and is capable of DIY application. Other available HVAC retrofit air sanitation and purification solutions include a coil scrubber or 36-watt HVAC UVC air purifier. GermAwayUV High Occupancy Wall Mountable 150-Watt Air Purifier and Sanitizer This is a safe and efficient way to sanitize and disinfect the air in high traffic occupied areas. Simply mount the sanitizer on the wall as you would hang a TV or mount a standalone AC system and let the system do its magic. The air purifier will use its powerful, yet quiet, fan to continually cycle all of the air in the room through the system. Once the air does so, it will be met by a quintuple filtration and sanitation system that culminates in a full 150-watt UVC germicidal irradiation. Put this system in a busy hallway, a crowded restaurant, a veterinary clinic with high traffic, a busy office, etc… and it will eliminate bacteria, viruses and harmful pollutants as quickly as possible without exposing anybody to any UVC rays. It proffers optimum perf

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Spotlight

SCIO Health Analytics®

Based in West Hartford, Connecticut, SCIO Health Analytics® is a leading health analytics solutions company, leveraging the power of healthcare data, predictive analytics, and healthcare business experts to provide clients the solutions to decrease costs, improve health outcomes, increase revenues, and drive ROI and sustainability.

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