Archive for 2010

American Association of Medical Colleges – Group on Information Resources

July 22, 2010

Next week I am attending a leadership institute of the AAMC in La Jolla, California. This week-long institute is by nomination – a group of 33 of us will attend, many CIOs and other leaders in healthcare IT and library science at academic medical centers. The program is very participatory with small groups making up much of the time as well as some lectures from a diverse faculty. Doing preparation for the institute has provoked thinking about leadership concepts and how to influence change in academic organizations. Although the term innovation is not explicit in the program, it certainly is on my mind as I prepare. One of the readings in preparation is from the book, Medicine and Business: Bridging the Gap by Sheldon Rovin, particularly chapter 3 on Leading Change. Also recommended to me are:

I have to give credit to all those supporting my attendance and interested in the outcome. There is the potential for a major impact on my career and outlook. Looking beyond managing programmers and supporting research projects, there are opportunities to influence the future of medicine. I want to be a part of that.

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What’s New with PHRs – evidence and interoperability

July 16, 2010

A new study from Kaiser documents some clear clinical benefits for the use of PHRs.  The study, which was published in the July issue of Health Affairs, observed 35,423 patients with diabetes, hypertension, or both. Researchers found that the use of secure patient-physician messaging in any two-month period was associated with statistically significant improvements in HEDIS (Healthcare Effectiveness Data and Information Set) care measurements. Results included 2 to 6.5 percentage point improvements in glycemic, cholesterol and blood pressure screening and control.

Also, there is a good video on PHR/eHealth application interoperability which also promotes the Health 2.0 Accelerator. The future of patient centric care must be interoperable. Watch the video.

Part of the video is a demo of  SurveyorHealth for managing medications which includes an interesting tool Simulate Alternatives. Check out one of the demo patients.

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Health 2.0 – a Double Dutch Treat

June 30, 2010

Lucien Engelen of Radboud University, Nijmegen, NL, and his team  (Tom Van De Belt is the first author) have struck two goals in the world cup of Health 2.0.  In the Journal of Medical Internet Research, they have published “Definition of Health 2.0 and Medicine 2.0: A Systematic Review.”  This broad review of published literature and blogs included a post by me and many others. They note no consensus on these definitions but some recurring themes:

  • Web 2.0/technology
  • patients
  • professionals
  • social networking
  • health information/content
  • collaboration
  • health care change.

The second publication is “A Little Booklet About Health 2.0“, originally available in Dutch, now in English for the Kindle, soon to have an English paper edition.  This modest title provides a good introduction to Health 2.0 for beginners and those who may have concerns about venturing into this growing field. It is a quick read and dives right into the key topics, using the example of MyCareNet, an innovative interactive platform for IVF patients and providers and leads us to the concept of participatory healthcare and bringing in the patient’s perspective on service design.

These two publications demonstrate some of the growing Dutch leadership in Health 2.0 which will culminate in the Medicine 2.0 conference in Maastricht this November and the TEDxMaastricht program.

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Declining Marginal Returns of Complexity

June 21, 2010

Just completed the book The Collapse of Complex Societies by Joseph Tainter, an archeologist. The focus of the book is on civilizations like the Roman Empire and the Mayas but it made me wonder about the complexity of health care and whether we are at the point of declining marginal returns.  It is apparent from the health care reform experience that competing stakeholders make any attempt at reform a complex and nearly impossible process. Clay Shirky wrote a blog post in April on The Collapse of Complex Business Models. Just like societies which become too complex to respond to major stressors.  While I am not predicting the collapse of health care in the US but one must wonder whether some of the complexity could be simplified by the experience of other countries, such as, single payer systems and an emphasis on primary care (medical home).  Would be interested in other opinions, especially from those who have read the book.

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Curing Cancer Clinical Trials

June 17, 2010

The Institute of Medicine has issued another groundbreaking report, this time on cancer clinical trials. An editorial about the report in the New England Journal of Medicine titled, Cancer Clinical Trials — A Chronic but Curable Crisis, makes some bold statements, such as, “the program is bloated, cumbersome, inefficient.” Slow approval processes with multiple layers and poor recruitment levels are symptomatic.

Recommended changes include improving:

  • the speed and efficiency of the design,
  • launch, and conduct of trials;
  • innovation in science and trial design;
  • trial prioritization,selection, support, and completion; and
  • incentives for patient and physician participation

The full IOM report lays out participation of key stakeholders, particularly patients and physicians. The emphasis on patient participation is strong and reminiscent of the e-Patient White Paper. While the concept of the Lethal Lag Time is not directly mentioned, the overtones can be heard. I recommend this report as key to the future of the conduct of clinical trials including innovative approaches.

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Partnerships with Online Communities – The Long Tail

June 4, 2010

Chris Anderson in writing Long Tail: Why the Future of Business Is Selling Less of More, popularized this concept particularly in viewing markets in the wired world. How does it apply to health care? Probably in many ways. But specifically it came to mind in thinking about the relationship of provider organizations like hospitals and online communities. While many online communities may attract large numbers, for instance, in diabetes and breast cancer, many more condition specific communities are relatively small even though they may have a national or international scope. Gilles Frydman of ACOR recognized this early by encouraging the proliferation of online communities through his listserv.

Provider organizations are moving into social media but struggling to identify meaningful ways to connect with their patients through Facebook and Twitter. Perhaps the struggle has to do with a broad stroke strategy of trying to appeal to all comers. The real opportunity is in the Long Tail of small online communities who know the best hospitals, information sources, physicians for their disease or condition and talk to each other about it all the time. Certainly PatientsLikeMe.com has found this in the specialize community of ALS and others like it have found the value in the long tail. What about groups like Marfan Syndrome or others that fall under the umbrella of the National Organization of Rare Diseases (NORD).  Specialist who treat these diseases in the long tail of healthcare have a unique opportunity to become online partners potentially contributing to blogs, social networks or listservs and inviting patients to post blogs about their experiences on the hospital’s blog or Facebook page. There are many possibilities to explore – meetups, suggestions for improving care – hope to see some take up this challenge.

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Technology and the Future of Chronic Care

May 24, 2010

Accenture has published a report on “Connected How Technology Will Transform the Future of Chronic Care.” From the Accenture Innovation Center for Health, a good source for research white papers. The paper reports that “a broad range of consumer health electronics at home, a two-way, direct-to-consumer infrastructure” and smart devices which set the stage for health care connectivity. Analytics and predictive modeling provide a second layer and visualization, decision support and collaboration provide the third. Connect health examples include the HealthVault and Cleveland Clinic home monitoring pilot and a remote monitoring trial by the VA system.

There is no doubt that the convergence of technologies have the potential for revolutionizing chronic care, however, we must go past the pilot stage and initial startups to broader change. Partnerships between consumer electronics, startups, providers and insurers need to come together with government support. Perhaps after the first wave of meaningful use EHRs, this new level of innovation can flourish.

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A History of Innovation in Medicine

May 17, 2010

Health 2.0 has pushed innovation in health care from its inception. From social networks for patients and providers to vertical search and mobile health tools, innovation continues. The Quantified Self represents the latest level of innovation for healthcare. The letters to the NY Times Sunday Magazine in response to the feature on The Data Driven Live, has this choice quote by Patricia Flatley Brennet of Project HealthDesign “Doctors are experts in clinical care; patients are experts in their daily experiences and how they make them feel. Both need to share more with each other.”

But some healthcare organizations have been innovative from the beginning. See the video on the Cleveland Clinic Model of Medicine and then read their latest Annual Report with President Obama on the cover. What a great place to work.

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The Quantified Self in Healthcare – Part 2

May 10, 2010

More evidence of this movement continues to emerge. For instance, I came across the Philips DirectLife device today which can record a number of activity parameters to quantify one’s life. In an article in the Linux Journal, of all places, there is an article title, Now Data Gets. Personal. The author cites Alexandra Carmichael of CureTogether and the Quantified Self Community as a prime example. The article points back to an earlier one in the same journal called The Patient as the Platform. The author proposes that through the use of PHRs controlled by patients, such as, Google Health, the patient could be center of health information rather than the provider or payer. This article from 2008 essentially proposes a solution for health information exchange without costly state or national initiatives.

The combination of the quantified self and the patient as the platform can potentially create a future where rich information is controlled by the patient and shared with providers to enhance personal wellness and treat conditions. Adding social networking with like patients creates a powerful trio of technology for the e-patient.

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Trends in Social Media in Health Care

May 7, 2010

Yesterday I had two content successes. My article Social Media in Health Care: Barriers and Future Trends was published in the Perspectives section of this online newsletter. In it I propose 3 trends to watch for:

  • Managing a conversation;
  • Engaging e-patients;
  • Convergence with personal health records; and
  • Social media for providers

I will be interested in your comments on this blog or via Twitter (@JohnSharp).

Yesterday I also spoke at the J. Boye Conference in Philadelphia on Social Media in Health Care: Humble Beginnings to Patient Engagement. This conference is more intimate and interactive than most with specific tracks for each day. I spent the first day in the Higher Education track and found many similarities with the struggles we in health care experience. The second day had an eHealth track that included Jane Sarasohn-Kahn who had just returned from a Senate Hearing on Mobile Health.

Check out my slides below.

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