Archive for 2010
Innovative Informatics for Clinical and Translational Researchers
October 18, 2010
On Friday, I attended this symposium sponsored by the National Center for Research Resources of the National Institutes of Health where the meeting was held. The symposium presented some of the latest software development for supporting research in academic medical centers. Topic areas included:
- Data Repositories for Research
- Participant Recruitment Tools and Strategies
- Clinical Information Systems and Research Study Management Systems
- Research Portal Innovations
Some highlights include
- i2b2 as a data repository (Informatics for Integrating Biology and the Bedside)
- REDCap for research study management (Research Electronic Data Capture) – used in over 160 centers
- Vivo – enabling scientific collaboration – an impressive development using semantic technology.
The scope of these technologies are impressive and on the cusp of enabling great strides in medical research. Through the NIH and CTSA grant process, this parallel development to the Health 2.0 startup process is ongoing. When will these academic tools converge with the Health 2.0 and social media explosion to transform medicine together?
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Social Media in Health Care – Latest Presentation
October 4, 2010
This is more of an introductory presentation I gave at Toledo Hospital for social workers, including information on hospital policies, prescribing social media to patients, and some of the risks of social media. At the end of the presentation, I discussed the dilemma of managing the professional and personal identities. Links to website mentioned are on Delicious.com
Social Media Season
September 28, 2010
It must be Fall because the conference season is ramping up. Two social media conferences going on at the same time:
- ePatient 2010 in Philadelphia with the likes of ePatient Dave and Susannah Fox
- Health Care Social Media Summit in Jacksonville, Fl
Notable is the announcement by Radboud University Nijmegen Medical Centre in the Netherlands and the Mayo Clinic of a Global Social Media Health Network.
All of this reflects the maturity of the healthcare social media, ePatient and Health 2.0 community. A kind of convergence is occurring bringing technology to the focus on the patient with full participation of the epatient. Greater attention by mainstream media and the scientific community is only accelerating the movement – see last week’s Scientific American Pathways article, “The Rise of the Empowered Patient“, which quotes Lucien Engelen of Radboud University among others. Can this convergence be sustained? Will the enthusiasm and energy be focused to create real change in healthcare? This level of optimism can only do good.
Share this:Impact of Accelerating Technologies
September 23, 2010
Singularity University is teaching the importance of accelerating technologies. It is teaching its students “to take advantage of exponential growth trends in order to create global change.” Salim Ismail, CEO of SU points out that many startups turn into billion dollar businesses in ever shortening time frames, sometimes as little as two years. And he says that many of the technologies we are learning today will be outdated by the time they are completed.
How will we manage this accelerated growth in technology? Is there anyway to keep abreast of it? Will only rapid development approaches be successful in the near term? What about legacy systems (like many EMRs) which take years to upgrade? Maybe events like the upcoming Health 2.o Hackathon will be the real future of healthcare technology.
What the Singularity video here:
Share this:Connected for Health: The KP HealthConnect Story
September 16, 2010
In a new book edited by Louise Liang, the story of the comprehensive implementation of the EHR at Kaiser Permanent. The story begins in 2002 when George Halvorson, the new CEO, saw the need to implement the EHR not as a cost savings initiative but as a market differentiator. He laid down the challenge to accomplish this national implementation in 3 years. What this represented was not just a software implementation but an organizational change from 9 relatively independent regions to a single practice model centered around this technology. They developed the Blue Sky Vision with consumer centric focus including these themes: home as the hub, integration and leveraging, secure and seamless transition, and customization (perhaps better stated as patient-provider partnership).
The book not only provides a history of this organizational and technology change but also lays out a project management roadmap that can be emulated for smaller hospital systems and hospitals. Regardless of size, EHR implementations must take into consideration timeline, stakeholders and technical challenges. For Kaiser, the timeline affected the implementation in several ways, most notably in delaying customization of provider templates and smart forms until after the go live. Involving stakeholders, two chapters address the building of clinical content by physicians and nurses. They state, “clinicians won’t necessarily be faster, but they should be better” referring to improvements in patient safety and other clinical decision support aspects of the EHR. The role of the patient as a significant stakeholder is addressed in a chapter about My Health Manager, the MyChart product from Epic Systems which was implemented to included eVisits and patient-provider messaging.
Part of the vision from the initiation of project is value realization beyond utilizing the EHR in routine clinical practice.This involves aligning KP HealthConnect with KP values: high quality care, personal care, convenient and affordable. The three phases of value realization are: value creation, value requiring harvesting and transformation of care. This steps included everything from reducing duplication of services, to re-engineered workflows to developing metrics around best practices and clinical guidelines. Population care has become a reality including practice innovation. While most of the care management emphasizes primary care (including a chapter on Redesigning Primary Care), there is some material on specialty practices, such as, oncology.
Adding value for KP HealthConnect also means improving patient safety and enhancing research. In the safety realm, one of the most important concepts behind the EHR which should be true of every EHR is “Making the Right Thing Easy to Do.” This is where may EHR implementations fail, actually accomplishing quite the opposite and leading to open rebellion by clinicians. If the right thing is easy to do and especially easier than paper, then this single fact makes the cost worth the investment. In research, the efforts are still at early stages but include retrospective and prospective research, comparative effectiveness research and personalize medicine/genomics. As an adjunct to research, a chapter is devoted to the Archimedes Model as a future direction for KP. Utilizing EHR data, the model takes population studies to a new level by simulating clinical trials and developing mathematical predictive models.
Has Kaiser realized its Blue Sky Vision? The implementation was certainly accomplished on time but admittedly over budget (3.2 billion vs. 4 billion). At one point, the authors admit to the technical challenges which resulted in stopping the accelerated weekly implementations. Stress on the IT core systems forced a six month hold. Overall the book presents an optimistic view of EHR implementation, successful because of systematic, team approach including all regions and all professions. Many of the themes in the book are reminiscent of the optimism of Health Care Reform and EHRs which some times seem a distant dream with very gradual adoption.
Who should read this book? First, any hospital or healthcare system planning or in the midst of an EHR implementation. Second, hospital CIOs but perhaps more importantly, project managers. Project management professionals are the boots on the ground of EHR implementation and need to learn how to involve stakeholders and move past obstacles toward successful, on schedule implementation. Also, those interested in exploiting or harvesting the value of the value of the EHR in quality improvement, patient safety and research. Finally, clinicians who are involved in EHR implementations or governance will better appreciate the need for vision and the comprehensive impact of EHR on practice and potential practice innovation.
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Google Health: New Features, Fit and Trim
September 15, 2010
Today Google Health launched a major update. Many of the features were part of the demo at HIMSS 2010 include the flexible graph feature for lab results. As with the previous version, editing information is easy and intuitive. In viewing individual lab results, a definition is in the right column along with news and articles from Google Scholar – contextual information. Usability research was an important aspect of the updates which included adding new features:
In additional, new partnerships round out the offering: Fitbit, Cardiotrainer, and WorkSmartLabs. So it appears that in lieu of making Google Health a mobile app itself, they have partnered with mobile app developers particularly around wellness and exercise. Although Google Health displays well on an iPad browser in landscape view.
Three new provider partnerships are announced as well, Lucile Packard Children’s Hospital at Stanford, University of Pittsburgh Medical Center (UPMC) and Sharp HealthCare. Look forward to hearing more about these and how they are encouraging the use of Google Health. UPMC is an Epic shop with MyChart.
The announcement has led to lots of buzz in blogs and twitter including “Google Health Unbound: Can It Overcome Indifference to Personal Health Records?” and Google Health Takes a Big Step Forward by Dr. Dean Ornish on Huffington Post.
Share this:P4 Medicine – Revolutionizing Healthcare?
September 9, 2010
I attended a presentation by Leroy Hood of the Institute for Systems Biology today on P4 Medicine. The 4 Ps are:
- Prediction
- Prevention
- Personalized
- Participatory
In the presentation, he demonstrated studies (in mice) of looking at the complete process of illness: genotype, phenotype including biological networks and molecular machines. He is even examining the organ specific blood footprints and miRNA as markers of disease progression.
He predicts that in the future there will be a virtual cloud of data points for each person, billions of data points for billions of people, and that healthcare IT must prepare to address this.
The real core of something like P4 is prediction. The complexity of achieving this level of analysis for many diseases is a challenge. One audience member questioned why the promise of P4 medicine is more likely to provide cures that the promise of decoding the human genome which came with such promise a decade ago. It is difficult to find a good critique of P4 Medicine to balance the pure optimism of Dr. Hood. At any rate, P4 Medicine and Personalized Medicine are trends to watch with tempered optimism.
Below are slides from a presentation by Leroy Hood at Ohio State University where he will speak in October.
Predicting Health IT Five Years Out
August 30, 2010
In an article in xConomy Seattle, there is a report from a meeting of the Washington Biotechnology and Biomedical Association, reporting on the future of Health IT. Some key predictions:
- “As we near 2015, many in the industry predict healthcare will see an integration of social media, cloud computing, and collaborative commons—creating resources that allow consumers to more actively engage with their health through information technology.”
- “primary care facilities and hospitals are not capitalizing on the existence of electronic resources to provide better care for patients and improve efficiency for healthcare providers”
- “Healthcare is the last bastion of mom and pop stores,” ?The first step in healthcare is to make everything digital,” “The next step is to takes what’s digital, and make sense of it—to make some intelligence out of the information you already have.”
- “Arguably healthcare is a data problem, and we’re trying “Scientists are not thinking of their data as an ingredient to the solution. They’re thinking of it as an ingredient to their next paper,”
- “researchers will have to amend not only what they do, but how they go about doing it—the emphasis will become less about research and clinical data, and more about how that data is stored, accessed, and used”
- “models could also use the power of social networks to give patients access to information and resources provided by other patients with similar conditionals—data that could help patients research and decide on a treatment plan, as well as help physicians make recommendations.”
- “One example would be using personalized data from electronic medical records, combined with data from available studies, to create individualized predictive care models.”
All great ideas held back by cottage industry attitudes and slow adoption of EHRs and PHRs. My only question is, why can’t we have this sooner than 5 years?
Share this:Open Notes Project – Right Thing or Wrong Question
August 18, 2010
The discussion of having doctors notes on one’s care readily available electronically was stimulated by a recent New York Times article titled, Should Patients Read the Doctor’s Notes? Roni Zeiger of Google Health challenges whether this is the right question. For e-Patients, it is both the wrong question or obviously the right thing to do. Transparency of medical records, now written into health care reform, is the obvious right thing to do but will take time for physicians to catch up to the idea. Granted that few patients even have access to a PHR tethered to and EMR, but at least those that do should have access to notes in the long run. If patients are to be full participants in their health care and treatment, they should know their doctors observations and treatment plans. As Roni Zeiger says this is one of “the best ways for the patient to understand and remember the doctor’s guidance.”
Share this:IBM Initiative to Improve Healthcare Quality and Costs
August 6, 2010
Recently IBM announced a major initiative to address significant data problems in healthcare. Acknowledging the fact that data is in structured and unstructured format and from various sources, the task of integrating these data points into a individual dashboard format can enable better medical decision making. One tool to enable this kind of data integration is their text analytics tools LanguageWare™ (LW) and Cognos Content Analyzer (CCA). Both of these were acquisitions by IBM in the past few years and it appears that they are now integrated enough to be used with large data sets in health care. Analyzing unstructured information can benefit insurance companies as well. The tool looks like it combines natural language search and semantic technologies. The video illustrations the typical international approach of Big Blue.
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