John Sharp is an IT Manager for a major medical center in Northeast Ohio. Areas of expertise include: ehealth, personal health records, Web 2.0 technologies, social media and project management. He is active in the Healthcare Information Management and Systems Society and the American Medical Informatics Association. The opinions expressed on this blog are those of the author.
Leveraging EMR Data to Develop Disease-Based Registries
March 6, 2010
This is my other presentation at HIMSS 2010. One of the real values of EMRs is the secondary use of the data for research. While respecting patient privacy, this kind of research can be rapidly developed from EMR data. We recommend the following steps:
- define the cohort of patients you want to study/monitor
- define the data elements you want included
- review and verify data elements with subject matter experts
- set up a regular interval to extract the data
- generate some test queries to verify the process
- monitor to use of the data (ongoing governance)
Our initial experience with a Chronic Kidney Disease registry has been a success. We recommend that research issues be considered in any purchase and implementation of an EMR.
Social Media at HIMSS 2010
March 5, 2010
Social Media at the Annual Conference of the Healthcare Information Management and Systems Society has come a long way. A few years ago, the bloggers meetup was a dozen or so of us meeting in a bar near the conference site. This year, for the second time, there was a social media center and three panels of Meet the Bloggers. I was glad to be a part of it. Participatory Medicine was represented by ePatientDave discussing his new involvement with Kaiser. A busy twitter stream kept many informed of the concurrent activities. My round table with Deborah Kohn on Social Networking: Are You Listening, was well received. Another version of the slides are below. Some of the recommendations out of the session include:
- be prepared for dealing with complaints via social media by monitoring and having a plan on how to respond
- listen – monitor what people are saying about you
- consider social media in job recruitment
- support for launching social media in health care organizations must be endorsed from the top
- educating employees about social media can prevent abuse of the tools at work
Social Media Use Cases for Health Care
View more presentations from John Sharp.
Book Review: Googled-The End of the World as We Know It
February 27, 2010
I recently completed this book by Ken Auletta who promotes his unique access to the search engine giant. The books follow the history of Google from the earliest days of the founders at Stanford, to rocketing to fame, going public and then being labeled as the evil empire. More recently, he chronicles conflicts with the government, traditional media, traditional advertising, publishers and China. He leaves with Google at a crossroads of maturing founders which he suggests may be losing focus, competitors in social media, and ongoing challenges from Microsoft and others.
The book describes each new major app and the process and culture of building new tools and keeping them free. Only two pages are devoted to Google Health, however. Generally, the books focuses much more on the advertising business which has made lead to Google’s financial success sometimes overshadows description of apps and the engineering culture. Too many pages are devoted to the failing of traditional media and, of course, Google and the competition continue to evolve since the publication of the book.
The closing question in the book is: has Google become so big and entangled in conflict that it has lost its innovative edge? Recently the excitement over Google Wave and Buzz have met there match with Apple’s iPad. Yet the dominance of cloud computing and Google’s dominance in the cloud may continue to have more of a long term impact than the devices that connect to the cloud.
Review of Chasing Medical Miracles
February 21, 2010
The subtitle of this 2009 book by Alex O’Meara is “The Promise and Perils of Clinical Trials.” O’Meara combines this personal experience of a clinical trial using stem cells for Type I Diabetes. He reviews the risky world of clinical trials beginning with large for-profit research centers who recruit healthy volunteers and stories of the volunteers who participate for a living or to supplement their income. Some questionable situations are noted including the recruitment of low income and alcoholic men in Indianapolis and elsewhere. He details some famous cases of unethical trials which landed in the courts including those involving genetics and conflicts of interest. Fortunately, some of these potential abuses are more carefully scrutinized. He spends two chapters on international clinical trials which have shifted much of the work to developing countries with a real focus on the issues in Uganda as case study. The fact that drug companies provide medical care in addition to clinical trials creates a dilemma for developing countries with small healthcare budgets.
One outstanding story related to a patient’s right to their own data is from a Hepatitis C trial in which the subjects were not allowed to receive information on their viral load during the study as a way of discouraging drop outs. However, this in itself seems unethical in that the patient would not know whether the treatment was effective or ineffective and whether their disease was progressing. I hope that Institutional Review Boards would not approve such a procedure for trials involving serious illness. Much of the book looks at the issues with placebo controlled studies and blinding – it raises many questions which are yet to be resolved by medical scientist and bioethicists.
I would recommend this book for anyone involved in clinical research, whether in Pharma, medicine or as a patient.
Decision Tree and the Quantified Self
February 15, 2010
The article in Wired on Decision Trees and the new book also by Thomas Goetz has generated a greater interest in participatory medicine and quantifying one’s life and health.
The title of the first chapter says it all: Living by the Numbers – How alot of science and a little self awareness can give you control of your health.
Brian Ahier addresses these issues as well in his post on “Data Not Drugs: Taking Control of Your Health in the Age of Genetics.” While pointing out the host of tools available to manage your health, everything from WolframAlpha to GetUpAndMove, he discusses earlier adopters who will lead the way, knowing not only their genetic risk but also quantifiy their daily health status. He notes that with few blockbuster drugs in the pipeline, perhaps this is the future of healthcare. Can the quantified self, enabled by health promotional tools which get easier to use each day, have a larger impact on health than the next lipitor?
Medpedia adds Clinical Trials
February 3, 2010
Medpedia continues to add vetted health information. In addition to health topics in a Wikipedia style, they had added news and RSS feed from blogs (including this one). Now they have developed integration with ClinicalTrials.gov. The unique approach they are promoting is linking from articles to related clinical trials. I tried this for myself and was able to find that it worked particularly well for some terms like “diabetes.” Also, the search function has good features and the advanced search, called “Clinical” includes Study Type (Interventional,
Medpedia, despite its growth, has some gaps. For instance, if you look for articles by the alpha index, like leukemia, you find none, but do a search and dozens of very specific articles appear (hairy cell leukemia). Overall the number of articles, organization and layout of Medpedia continues to improve. Try out the Clinical Trials search for yourself and see what you think.
PHRs, EHRs and Social Media – Where are We Headed?
February 2, 2010
Two coincidental articles were published today. First, in iHealthBeat, John Moore and Matthew Holt talk about why ”Consumers Not Ready for Do-It-Yourself PHRs.” In response to the decision by Revolution Health to discontinue their PHR, the experts comment that “the direct-to-consumer market for PHRs just doesn’t work.” But they say that populated records are the future, those tethered to EHRs, like Kaiser’s and how Google Health and Microsoft HealthVault enable this kind of population of data from other sources. In the future, as it is now for some, the PHR will not be separate from the EHR, just the interface on the front of patient data. But this will mean patient entered data, like diaries of their conditions, and from home monitoring devices.
The second article appeared in JAMA, from the Centre for eHealth Innovation in Toronto, titled, “Electronic Health Records in the Age of Social Networks and Global Telecommunications.” Here the authors talk about the intersection of social media and EHRs. Specifically, the authors envision the future with open standards which can enhance interoperability and “natural language enrich by audio or video…Rich media has the potential to reduce ambiguity and enhance performance in complex tasks.”
So while the concept of PHRs may be on the decline, the future of patient empowerment through information has only begun. The convergence of personal health information, provider-based information and social and rich media will provide a basis for future health decisions on a very individual, personal level.
Models of Care: Can They be Copied?
January 28, 2010
Can good models of efficient care be emulated in other hospitals. Much has be touted about the Mayo Clinic, Cleveland Clinic and others. The lower costs of these models has been documented. See the Dartmouth Health Atlas report on chronic care (see table on page 9).
In a video on Huffington Post Video last month, the interview at the Cleveland Clinic about the successful EMR still questions whether this success can occur elsewhere. Yes, the implementation was expensive and expensive to maintain but the benefits over paper are quantifiable in terms of quality of care and improved outcomes. Maybe the lessons of successful EMRs have paved the way for others.
Finally, Dr. Cosgrove, CEO at the Cleveland Clinic is interviewed by Fox Business News at the Davos World Economic Forum. He again repeats his contention about the need to address obesity and health care costs. Again, a model or approach to care and costs which others can emulate.
Medicine: Cottage Industry or Post-Industrial Care Process?
January 21, 2010
In the New England Journal of Medicine this week there is a health care reform piece titled, “Cottage Industry to Postindustrial Care — The Revolution in Health Care Delivery.” The article, by leaders in health care quality, raises significant questions about the problems in health care delivery and a path to a solution through “standardization of value-generating processes, performance measurement, and transparent reporting of quality.”
The authors address concerns about “cookbook medicine” but rightly describe medicine as a cottage industry: “Services are often highly variable, performance is largely unmeasured, care is customized to individual patients, and standardized processes are regarded skeptically. Autonomy is hardwired into the system, because most physicians practice in small groups with limited oversight or coordination.”
How do we move to post-industrial care or even better, 21st century, technology-enabled, patient-focused care. Does that mean that small practices should join large practices, academic medical centers? The authors don’t propose that solution, but do propose following clinical practice guidelines which are flexible enough to manage individual differences in presentation. If medicine is trending toward broad implementation of clinical practice guidelines and a stronger focus on outcomes (value-based medicine), technology-centered particularly around the electronic medical record and a focus on efficiency, can small practices survive? Are will moving toward industry consolidation much like what has been experienced in banking?
The cottage industry of medicine with fee-for-service as a funding model, continues to drive up cost without adding value. While I am no economist, I believe medicine is changing and models of practice which focus on efficiency, technology and patient experience are taking the lead.
One final quote from the article: the authors characterize this cottage industry as chaos – “Chaos confounds constructive action, whereas wise standardization is a foundation for effective variation, efficiency, reliability, and rapid innovation.” Let’s hope that wise standardization through guidelines can promote the kind of rapid innovation needed to transform healthcare and that policy and funding decisions follow this direction.
Major Robert Wood Johnson Foundation Report on PHRs
January 19, 2010
The Robert Wood Johnson Foundation has published an 7 chapter online book about Personal Health Records. The book is a great summary of the current state of PHRs as well as initiatives promoted by Project Health Design. Chapters are:
Chapter 1: Personal Health Records 101
Chapter 2: Project HealthDesign and the Next Generation of Personal Health Records
Chapter 3: Observations of Daily Living
Chapter 4: The Health Information Technology Landscape
Chapter 5: Personal Health Records and Health Information Technology—Costs, Policies and the Incentives Driving Adoption
Chapter 6: Privacy and Personal Health Records
Chapter 7: Personal Health Records—Business Models, Open Platforms and the Challenges Ahead
Worthy of note is chapter 3 on Observations of Daily Living (ODL), the importance of having patients enter their own daily activities and disease experience into a PHR. While the chapter does not specifically mention social networking sites like Organized Wisdom or PatientsLikeMe, the implication is that these type of tools provide value, often unrealized, by most provider organizations. ODLs could also include direct input into a tethered PHR or via home monitoring devices.
Also presented well is the discussion of the Health IT landscape and the emphasis on open platforms. Microsoft HealthVault and Google Health are described as revolutionary innovations. They provide PHRs with open connections to EHRs and devices as well as a portable, web-based record empowering patients to bring their records to any provider.
They conclude with addressing business models and incentives to make PHRs successful. “Open platforms create a wide avenue for innovation in health care” and the need to move past proprietary models is promoted. I might add that existing proprietary EMRs must be able to talk to the open platforms through web services or the CCR standard. There is no excuse for not adapting to these standards to enable the transfer of data into patients’ control.
Looking toward future and the new grant recipients for Project Health Design, the authors conclude: “They will face a number of challenges, including how to capture observations of daily living (ODLs); how to aggregate and analyze those data in a PHR; how to use the findings to inform the clinical encounter; and, ultimately, how to empower patients to understand, influence and improve their health. ”
