Personal Trifecta
November 4, 2010
One of the advantages of having a personal blog is not only expressing one’s opinions but also promoting accomplishments. I have been fortunate to have three in recent months:
- coauthorship on a major article on a disease registry from EMR data - Development and Validation of an Electronic Health Record–Based Chronic Kidney Disease Registry, Clinical Journal of the American Society of Nephrology, Nov. 2010. Press Release:Health Registry Could Transform Chronic Kidney Disease Care
- named in an NIH grant: Refinement and Enhancement of a Web-Based Risk Calculator Deployment System
- named a Fellow in the Health Information and Management Systems Society (HIMSS)
Also, I became a fellow in the Group for Information Resources of the American Association of Medical Colleges this summer and reviewed a grant for a Dutch organization. Great opportunities and challenges keep coming. A great year.
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Innovation Summit – Obesity, Diabetes & the Metabolic Crisis
November 2, 2010
This week I attended the Cleveland Clinic Innovation Summit and contributed to the live tweeting of the event. There was substantial discussion of devices in the pipeline and drugs for diabetes but a less optimistic outlook on drugs for obesity with some being shut down by the FDA. The most scientific yet controversial presenter was JefferyFriedman, who referred to his 2009 Newsweek article on “The Real Cause of Obesity” as a summary of his position that most of obesity is genetically determined. Many referred to the recent prediction posted by the CDC that the current incidence of diabetes being around 10% of the population with the potential of growing to 20 – 30% by 2050.
At the end of day two, the annual announcement of Top 10 Innovations. The final day will include health IT interventions for obesity and diabetes.
Share this:Health Care is Coming Home
October 28, 2010
In the New England Journal Journal of Medicine this week, a perspective article by a Cleveland Clinic physician, promotes the future of home care. Dr. Landers notes five major forces driving healthcare to the home.
1. Aging of the population
2. Epidemics of chronic disease
3. Technological advances
4. Health care consumerism
5. Escalating health care costs
In the conclusion of the article, he notes this as a long term trend perhaps taking decades. My view as a technology optimist, is that the combination of these forces will result in a faster pace of change with high tech home care being an integral part of the medical home.
Share this: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.
