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Medtronic, Inc. (“Medtronic”) offers RemoteView, which permits a user (“Programmer User”) of the Medtronic CareLink® 2090 Programmer (“Programmer”) to allow the viewing of information presently displayed on the Programmer screen with one or more individuals in remote locations anywhere in the world (“Remote Viewer”), including remote health care professionals or Medtronic representatives.
Limited License Grant. You are hereby granted a nonexclusive, nontransferable, terminable, nonassignable, nonsublicensable, limited license to install and use a copy of the Licensed Software solely for authorized and legitimate purposes. You may not otherwise copy, use, modify, reverse engineer, decompile, disassemble, create derivative works based on, or integrate with other systems or programs the Licensed Software without the prior written consent of Medtronic. You shall have sole responsibility for any fees or charges, including service or data charges, incurred by you in connection with your use of the Licensed Software. You shall not remove any proprietary or other legend or restrictive notice contained or included in the Licensed Software or other documentation associated with such Licensed Software. You agree to maintain any and all copyright, trademark, and other notices on the Licensed Software and any associated documentation.
Licensed Software Functionality and Data Use, Collection, Viewing, and Transfer.
“Active Remote Viewer” as referred to herein shall mean a Remote Viewer that has installed the Licensed Software and has at the relevant point in time an active network connection to a Medtronic server via the Licensed Software.
By installing or using the Licensed Software or clicking any acceptance button in connection with this Agreement, you acknowledge, understand, agree to, and consent to all of the following, including when you are an Active Remoter User:
) Registration. To obtain access to the Licensed Software, you must register at the Medtronic RemoteView website and establish a user name and password. All information that you provide in connection with such registration must be complete, accurate, and truthful. The user name and password are personal to you and must not be shared with anyone else. You will also not attempt, directly or indirectly, to disable, bypass, or defeat any password protection associated with the Licensed Software. Medtronic reserves the right to deny or disable any user name or password or request for any user name or password.
) Your Personal Information. Medtronic will collect information in connection with your registration and installation and use of the Licensed Software, including your first and last name, your email address, a selected security question(s) and your corresponding answer(s), your address, and your telephone number. You agree that Medtronic may store this personal information about you on a Medtronic server, including a server located in the United States of America.
) Session Key. To view the information on the Programmer, the Remote Viewer must generate a Session Key that must be shared with and entered by the Programmer User. “Session Key” as used herein means a unique token active for a limited period of time generated by the Remote Viewer. You agree not to share this Session Key with anyone other than the Programmer User who has initiated the specific session.
) Logging of Session Activity. Each time you log in to the Licensed Software, Medtronic will collect information about your activity, including in an aggregated log or database, regarding you and your session, including your name, username, computer name, IP address, operating system details, and session details (including transferring and sharing activity, start and end times, view only or control activity, and any chat messages between or among any Active Remote Viewers. You agree that Medtronic may store any personal information about you on a Medtronic server, including a server located in the United States of America.
) Active Remote Users. When you are an Active Remote Viewer: (1) you will be able to view the name and/or user name of any other Active Remote Viewer who is logged into the same Medtronic server; and (2) any other Active Remote Viewer who is actively logged into the same Medtronic server will be able to view your name and/or user name. The Licensed Software also permits one Active Remote Viewer to share the information being viewed to any other Active Remote Viewer. You must not share any information from the Medtronic programmer, including with any other Active Remote Viewer, absent the express permission from the Programmer User that is allowing you to view the information.
) Availability. Medtronic has limitations on the number of users that can concurrently log in to the Licensed Software at any given time. Thus, installation of or accessing the Licensed Software does not guarantee that it will be available to you for use at any time.
Permissions. By installing and using the Licensed Software, you represent that you have permission to do so from any associated clinic, hospital, or medical practice and that your use of the Licensed Software complies with any policies or requirements of such associated clinic, hospital, or medical practice. You are also responsible for confirming that the Programmer User has obtained any necessary patient consent before allowing you to view any patient information via the Licensed Software.
Your Acknowledgements. You acknowledge that the Licensed Software is not the exclusive method of viewing information from the Programmer and that the Licensed Software is not the exclusive method by which to obtain a patient’s implanted cardiac device data, including any data on the Programmer. You also acknowledge that the Licensed Software is not intended to be used as a life-sustaining or interventional tool during medical emergencies. You further acknowledge that Medtronic is not, and shall not be deemed to be, a provider of patient health care services by virtue of its provision of access to the Programmer screen information via the Licensed Software. You also acknowledge that information from the Licensed Software is not an electronic medical record and use of the Licensed Software does not in any way relieve you from using your best medical judgment to determine a proper course of treatment for patients.
Security/Privacy of Patient Data. Your use of the Licensed Software and any Session Keys shall be solely for legitimate and lawful purposes and not for any malicious purpose. You are solely responsible for and will use your best efforts in maintaining the confidentiality and security of any copies of the Licensed Software as well as any user name, password credentials, and any Session Keys that can be used in accessing the Licensed Software, a Medtronic server, or any information from a Programmer. You are solely responsible for and will use your best efforts in keeping any patient information you may receive or view in connection with the Licensed Software confidential and secure, and you will not attempt to capture or copy any patient information you view in any electronic or hard copy format without the express permission of the Programmer User. You will be responsible for any obligations or liabilities associated with any lost, stolen, or otherwise compromised patient information.
Reporting Issues and Feedback. You agree that you will report any issues or questions, technical or otherwise, regarding the Licensed Software promptly and directly to Medtronic. If you submit any comments or ideas to Medtronic, in the absence of a separate agreement regarding such submissions, you grant to Medtronic an unrestricted, royalty-free, irrevocable license to use, reproduce, display, perform, modify, transmit, and distribute such ideas in any medium and agree that Medtronic is free to use them for any purpose. In addition, Medtronic has no obligation to provide continued maintenance and support to you in connection with the Licensed Software. Any maintenance and support services provided by Medtronic shall be at Medtronic’s sole discretion.
Limitations of Liability.
THE LICENSED SOFTWARE IS PROVIDED TO YOU “AS IS,” AND MEDTRONIC EXPRESSLY DISCLAIMS ANY AND ALL WARRANTIES WITH RESPECT TO THE LICENSED SOFTWARE AND YOUR USE THEREOF, INCLUDING WITHOUT LIMITATION ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, AND NONINFRINGEMENT. MEDTRONIC DOES NOT WARRANT THAT THE USE OF THE LICENSED SOFTWARE WILL BE UNINTERRUPTED OR ERROR-FREE.
Legal Compliance. You shall at all times use the Licensed Software in compliance with all applicable laws. You shall ensure that your installation and use of the Licensed Software complies with all applicable export and import laws, regulations, orders, and policies of the United States of America and any other applicable jurisdiction. You represent and warrant that (i) you are not located in a country that is subject to a U.S. Government embargo, or that has been designated by the U.S. Government as a “terrorist supporting” country, and (ii) you are not listed on any U.S. Government list of prohibited or restricted parties.
Term, Termination, Modifications, and Support. This Agreement shall be in effect from the date when you first install or use the Licensed Software. Medtronic may modify, amend, or terminate this Agreement at any time, including by providing notices or an updated version of this Agreement on a Medtronic website. Medtronic may modify, disable, or terminate your use or Medtronic’s support of the Licensed Software at any time, including by providing notices on a Medtronic website. All obligations which are ongoing in nature shall survive termination or expiration of this Agreement. At any time upon Medtronic’s request (including via a notice on a Medtronic website), you agree to promptly delete and terminate use of any and all copies of the Licensed Software. In addition, upon Medtronic’s request, you agree to provide written verification that you have destroyed all copies of the Licensed Software together with the manner, date, and time of such destruction.
NayaMed International Sárl Customers: Whether the RemoteView feature shall be used in connection with NayaMed customers or devices shall be solely within the discretion of NayaMed International Sárl. If the Licensed Software is used connection with NayaMed customers or devices, this Agreement shall be directly between you and NayaMed with respect to those uses.
It can cut down on paperwork and give doctors more time with patients.
by Michael Ash, Joe Petro and Shafiq Rab
November 12, 2019
A surge of new healthcare products from wearable consumer health trackers to diagnostic algorithms promising to improve medical outcomes and costs with artificial intelligence (AI) is prompting physicians and hospital executives to ask a fundamental question: “Are these technologies solving the right problems?”
Two ongoing developments add scale and urgency to this important question. The first is a virtual gold rush of technology vendors looking to stake a claim in the healthcare IT market, which is projected to top $390 billion by 2024 according to research firm MarketsandMarkets. The second is what the World Medical Association is calling a “pandemic of physician burnout,” caused by a staggering workload of electronic paperwork to document patient care and which is required for insurance coverage, financial reimbursement, and medicolegal liability protection. More than half of clinicians report feeling burned out from the hamster wheel of documentation and reporting tasks that often require spending two hours at a computer for every hour spent in patient care. A 2019 study published in the Annals of Internal Medicine conservatively estimated the resulting annual costs of higher physician turnover and lower revenue from reduced clinical hours at $4.6 billion.
It is essential to develop technology that empowers doctors so that they can get back to doing what they trained for and love. It is equally important that we return to patients their doctors’ undivided attention.
Accordingly, healthcare IT development should begin with a deep understanding of how clinicians need and want to work, then implement AI capabilities with the explicit goal of adapting to and supporting how they deliver care. Ambient clinical intelligence (ACI) is one promising approach.
As the name indicates, ACI is less a device than a set of capabilities as unobtrusively present and available as the light and sound in the exam room. The best way to picture ACI is to think of a typical exam room with a flat-screen display on the wall showing requested information. An inconspicuous array of microphones captures the patient interaction accurately regardless of speakers’ movements or positions. A computer isn’t needed in the exam room, because the computing and data entry takes place behind the scenes in back-end and cloud-based systems.
ACI builds on the familiar speech recognition technology that doctors have used for the past 20 years. It also uses voice biometrics — in short, a way to identify individuals by voice — to authenticate clinical users, and other technologies to distinguish between the clinician, patient, and anyone else in the exam room. It also integrates conversational AI, machine learning, speech synthesis, natural language understanding, and cloud computing to provide diagnostic guidance and clinical intelligence. That includes highlighting potentially overlooked diagnoses based on patient history and symptoms, as well as possible drug interactions and recommended alternative medications. The system responds in real-time when the doctor asks to view patient histories or test results, prescribes medications, orders tests, and schedules follow-up appointments. Once the patient visit is over, the system creates a summary for the patient, updates the patient’s record, and enters appropriate billing codes for the physician to review, edit, and submit in the electronic health record (EHR).
Patient privacy is necessarily integral to ACI for HIPAA compliance, system functionality, and user acceptance. The patient data collected in ACI must be closely guarded, stored with the patient’s consent, and only repurposed in anonymized form for clearly defined clinical purposes.
Today, an array of providers, including Nuance (where co-author Petro is CTO), Microsoft (which has partnered with Nuance to accelerate ACI development and deployment), Google, Amazon, and Apple are developing versions of the technology.
Two of us (Drs. Ash and Rab) began pilots of Nuance systems at our institutions earlier this year. We started by providing ACI to a minimum of five physicians each in specialties that tend to have structured visits and predictable issues, including: orthopedics; ear, nose and throat; surgery; gastroenterology; and cardiology. This measured approach allows us and our clinicians to refine the technology and to adapt to a workflow that is at once different — in how we have used technology — and familiar, in how we naturally deliver patient care.
To measure ACI performance we are capturing metrics related to the quadruple aim of enhancing patient experiences, improving population health, reducing costs, and improving the work lives of healthcare providers. Those include independent patient satisfaction surveys, EHR data indicating documentation of time per visit and after-hours documentation, average visit counts per provider, and qualitative assessments from physicians comparing ACI to the use of remote virtual and in-person scribes, and when no scribe is used.
It’s too early to report definitive quantitative conclusions about clinical or financial outcomes. However early data and personal reports from physicians using ACI have been encouraging. For example, 95 percent of patients whose doctors used ACI during a visit have consented to being recorded, and turnaround time for ACI to complete reports in the EHR is 50 percent lower than what we had anticipated.
The clearest results to date are qualitative, especially in physician satisfaction reported directly to us and spread by word of mouth from physicians using ACI to others who have not experienced it. One physician reported that, “I would probably spend six to eight hours a week documenting. I bet that my time has been cut in half, if not by two-thirds. Spending an extra five minutes on every patient, if you’ve got 30, 35 patients, that’s a lot of time, and you can find a lot of things to do with an extra two hours every day.”
More generally, one commented that ACI “allows the patient visit to work the way it should.” One of the most striking comments came from a physician initially skeptical of ACI, because past technologies failed to deliver on promises of reduced administrative burdens. He is now an ACI supporter “because it allows me to go back to being a physician versus a data-entry clerk and allows us to do what we wanted to do in a way that doesn’t fracture the patient-physician relationship.”
ACI and other new AI technologies can transform healthcare. But technical advancements alone cannot achieve the improvements we need in costs, quality, and outcomes. That can only happen by designing technology in support of clinicians who make the healthcare system work and care for us and our families.
Michael Ash, MD, is EVP-Chief Transformation Officer of Nebraska Medicine and vice chancellor of Information and Technology for the University of Nebraska Medical Center (UNMC). He previously held positions at Cerner Corporation, including Chief Medical Officer and VP for physician strategy and innovation. Before Cerner, Dr. Ash practiced as an internal medicine physician.
Joe Petro is the Executive Vice President and Chief Technology Officer of Nuance Communications. Before joining Nuance in 2008, he served as Senior Vice President of Product Development at Eclipsys Corporation and as an executive in startups and large‑scale enterprises.
Shafiq Rab, MD, MPH, is Senior Vice President & CIO, Rush System for Health and Rush University Medical Center, and Board Chair, at the College of Healthcare Information Management Executives (CHIME). He previously served as Co-CIO and senior VP at Hackensack Meridian Health, Greater Hudson Valley Health System, Catskill Regional Medical Center, St. Mary’s Hospital, and Carrier Clinic/East Mountain Hospital.
This article originally appeared on HBR.org and is being brought to you by Medtronic.
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