Archive for 2009
The Quantified Self, ePatients and Participatory Medicine
December 29, 2009
Kevin Kelly has posted “The Quantified Self, Tools for knowing yourself and your body” which links to a more extensive paper entitled, “A Billion Little Experiments,” The concept of the Quantified Self points to patient empowerment and specifically ePatient activism which takes control of one’s health or illness by understanding one’s body and its processes. It seems that communities, such as, PatientsLikeMe and OrganizedWisdom, provide a real opportunity for quantifying life and sharing that life in real time. Quantifying the self opens the door to participatory medicine – by knowing yourself, you can engage your physician in a dialog on what you know about your body. We are a billion little experiments.
I hope that the concept of the Quantified Self becomes part of the medical lexicon along with ePatients and participatory medicine.
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Updated Blog with Updated Thoughts
December 27, 2009
Thanks to my daughter, I have moved my blog to WordPress and have an updated skin. This will certainly encourage me to post more frequently in the new year. The focus of my posts in the coming year will include:
- e-Patients, participatory medicine and particularly the lethal lag time in research
- Health 2.0 specifically research related tools both for patients and providers
- eHealth and its convergence with Health 2.0, mHealth and telemedicine
- health policy issues including comparative effectiveness research and medical home, two key directions in research and policy
What for changes to the blog as I get used to WordPress and add widgets which are helpful to my readers.
Thanks for reading and share your thoughts about the new year in ehealth and Health 2.0.
Share this:Why Michael Porter Makes So Much Sense
December 17, 2009
Last night I heard Michael Porter speak at the Cleveland Clinic. Author of Redefining Healthcare, among other books, he drove home his approach to value-based competition in health care. He has many quotable, provocative statements on health care:
- fee for service model is toxic to improving health outcomes
- Competition must be based on results.
- Competition should center on medical conditions over the full cycle of care.
- Results information to support value-based competition must be widely available. (aka, disease registries)
- increasing value actual reduces cost.
He also reemphasizes some basic principles that are strongly backed by evidence – high volume regional medical centers typically have better outcomes that low volume centers. But he acknowledged that consumers must realize that local care may not be the best care for especially for complex conditions. Do you want to get your total knee replacement at a hospital which does one a week or 1400 per year? Not that volume is everything but consumers need to have the data available to make wise choices, outcomes data in particular.
He admitted some disappointment in the current health care reform because it does not change the incentives toward value-based competition. See How Reform Went Wrong.
Share this:Convergence of PHRs and Social Networking
December 3, 2009
In an article titled “Socialize Medicine:How Personal Health Records and Social Networks Are Changing Healthcare“, Darin Stewart traces the parallel growth of social networking for health conditions and personal health records. He notes the important role of family health manager (aka, mom) in healthcare being transformed through PHRs. Yet I see also a family internet health manager who may search for health content for a newly diagnosed condition in the family and also search online health communities for support. But can Google Health and Microsoft Health Vault and other full-feature PHRs including provider supported PHRs integrate social networks like PatientsLikeMe.com and 23andMe.com. The article proposes that signs like the 20,000 downloads of downloads of the HealthVault software development kit. With the amount of innovation in the Health 2.0 space, he may be right.
Share this:Lethal Lag Time: Concerns, Possible Solutions
November 24, 2009
In a follow up from yesterday’s post, I came across an article in the Journal of the National Cancer Institute on a drug funding issue force one of the major cooperative oncology groups to modify how they approach clinical trials. The article, titled,
“Costly Cancer Drugs Trigger Proposals To Modify Clinical Trial Design” notes a new drug costing up to $9000 per month per patient. In doing the economic analysis using formulas like Quality Adjust Life Years (QALYs), the real value of these treatments is being questioned.
On the brighter side, two potential solutions to long lag times for research are a search tool and a predictive modeling tool.
- explorys is a new spin off from the Cleveland Clinic which “enables users to collaborate, search, and tag meaningful correlations from treatments and outcomes within patient populations while maintaining security and privacy.” Hoping to get a demo soon.
- Archimedes Model which is reviewed recently in Business Week
and in Wired Magazine this month. which is a predictive modeling tool which is a full-scale simulation model of human physiology, diseases, behaviors, interventions, and healthcare systems.
Lethal Lag Time: Defining and Advocating
November 24, 2009
Lethal Lag Time is described in the in the e-Patient While Paper (page 87) in the context of bypassing the lag time by using patient-initiated research. But are there other ways to accelerate traditional clinical trials or provide other alternatives to answer research questions. A search of the term “clinical trial failures” yields only 7 results on Pubmed. Clinical trial recruitment yields on 29 results. Don’t we need more study of research to understand some of the problems in clinical trials, such as, failures and recruitment problems? Are there ways to examine each phase – protocol development, funding, recruitment, even publication etc.? The Obama administration is providing some DOD grants which are simple application processes and rapid decision cycles. Why can’t a similar program be applied to medical research grants?
Finally, is there a way to inject the urgency of a term like Lethal Lag Time into the medical research discussion including the professional literature? Not sure how we can do this but Participatory Medicine and e-Patient involvement are key. Watch for more blog posts on this topic.
Enterprise 2.0 – Limits of Social Media in the Organization
November 13, 2009
Earlier this week I presented on a social media panel at the NEOSA CIO Symposium in Cleveland. Slides below and bookmarks here. I was surprised at how many companies block social media from their employees (about 50% from an informal poll). After the panel, I think many were going to take a second look at social media as both a customer engagement tactic and/or a internal tool set for employee collaboration and communication.
Some related blog posts on this topic include:
- The Über-Connected Organization: A Mandate for 2010 from Harvard Business Review
- Let’s Move Away From Social Media and Get Down to Business – from ReadWriteWeb
which argues for a pragmatic Enterprise 2.0 which will:- Address key business concerns
- Demonstrate business value
- Acquire social computing competency
Enterprise 2.0 is a work in progress. I hope we will see more articles/blogs on ROI and general benefits of Enterprise 2.0, particularly in health care organizations.
Interview for Significant Science
November 6, 2009
Having met Hope Leman at Medicine 2.0, I was impressed with her Scan Grants website. Hope asked me for an interview for her new blog Significant Science. Who could refuse to be a part of significant science.
The interview appeared today. It made me think about how my thinking about the web has evolved from early websites in the 1990s through more interactive web applications to this age of social media. Social media in health care is evolving quickly as more join the experience and some push the envelope.
Thinking about the Future
October 29, 2009
What will the Web Look Like in 5 years? Gartner presented Eric Schmidt, CEO of Google to talk about the future. Some of his key points include:
- Five years from now the internet will be dominated by Chinese-language content.
- Today’s teenagers are the model of how the web will work in five years – they jump from app to app to app seamlessly.
- Five years is a factor of ten in Moore’s Law, meaning that computers will be capable of far more by that time than they are today.
He also talks about being trapped in a 1980s architecture. I heard a webinar demo of an app today which uses client-server technology. It seems to me that any application which does not use the web with AJAX and hosted on a virtual server is old technology and not something that should be supported.
Schmidt also talks about the Google business model and pricing. He notes that Google customers ask for more features for a price that is less that what they are paying for desktop applications. They are starting at the bottom with the largest customer for Google docs/email of 35,000 seats but 10s of thousands of companies (at $50 per seat).
“We are not trying to design the future, we are trying to invent it along the way.”
“We have migration tools and no one seems to migrate back.”
Is the implication that the majority of companies will move the cloud for desktop apps and enterprise apps? Are current vendor supported enterprise apps inflexible as he says. Are companies and health care missing out on mobile opportunities? Open source also adds to that flexibility.
Five years from now, will be all on powerful wireless devices, running open source, cloud-based apps, with books on netbook tablets and running a Wave-like instantaneously messaging. What will that mean for health care and especially collaboration in health care? How about collaboration so fast that medical treatment is communicated and executed faster than we can imagine either at home or at a local clinic thru virtual technology promoting health and treating symptoms to minimize side effects. Support of participatory medicine will be seamless through these mobile, real-time social networks.
Finally, thanks to Eric Schmidt for his humorous quips throughout. Check out the full 45 minutes also.
Share this:The Experience of being an embedded Twitterer at a conference
October 22, 2009
Two weeks ago I was at the Cleveland Clinic Innovation Summit as an embedded tweet. As an experiment to promote the conference and encourage twittering, I was asked to actively tweet at this important conference which included many CEOs from drug and device firms. Here are some of my experiences.
A hash tag was decided a few weeks in advance: #CCInnovation.
Initially, keeping up with presentations which included slides was manageable. Abbreviating key quotes from leaders in medical innovation is a challenge and including links to their companies required some quick searches. When the program shifted to an interview style with a panel, it became more difficult to keep up with what was being said and who said it, much less adding a link. Some followers asked for who was saying what. Including a hash tag, who is speaking, what they said and potentially a link is a trick in 140 characters.
Some of the important followers were from the press. It’s not clear how many conference registrants actually participated or followed the twitter stream.
Technical challenges: at times the wireless was not available. At one point I switched to Tiny Twitter on my Blackberry.
Overall, it helped to know the conference content being familiar with clinical trials and the pharma and device industries.
