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.
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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.
Share this: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.
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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.
Share this: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. “
Share this:Health Data Rights Get Broader National Attention
January 14, 2010
First, I need to applaud CNN for creating a place to focus on the Empowered Patient. And today a special article on a patient’s right to their own data and citing two prominent ePatients – Jen McCabe and Dave deBronkart. “Lack of information kills people” – the article details several anecdotal cases of how patients were injured or died as a result of lack of correct data and medical errors. The patient having their data certainly can add to patient safety – why not have more eyes looking at patient data, especially when it about one’s own body. Looking forward to more features in the Empowered Patient.
Share this:Social Media and Search in Health Care
January 12, 2010
Several new stories popped up today:
- Microsoft’s secret weapon against Google: Health search – although this reviewer sees a some temporary advantage over Google Health search, he notes that even more important is a search within a simple-to-use electronic medical records system for consumers and does not see either as doing a good job of this yet
- Oncologists Using Twitter to Advance Cancer Knowledge: about physicians using twitter for “Disseminating, correcting, and expanding information in conversation with professional colleagues”
- Boundary Erosion in Information Technology: John Glaser points out how social media and other consumer-oriented technologies as risk to Healthcare IT but also sees “Boundary erosion is an underlying, unalterable trend in information technology. It will not reverse itself.” He encourages a balance between unbridled enthusiasm and blocking these technologies.
Interview on Social Media
January 5, 2010
My interview by Hope Leman on the Significant Science blog just today was rediscovered on Twitter resulting in significant activity. The interview, titled “Maneuvering Medical Institutions Through the Wild Waters of Social Media” and covered the range of activities in social media at the Cleveland Clinic. This interview emerged from my presentation at Medicine 2.0 “Hospital Adoption of Medicine 2.0: A Culture Change.”
While social media strategy continue to evolve, new opportunities present themselves. Particularly significant shifts are toward participatory medicine and e-patients. As noted previously, I will continue to post about participatory research and the lethal lag time in research which may only change from patient-initiated advocacy.
Thanks again to all who have read the interview and follow this blog and my twitter posts.
Share this: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.
Share this: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.
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