Posts Tagged ‘eHealth’

Innovation and Social Media at HIMSS

February 11, 2011

HIMSS emphasis on social media has grown every year. From a humble meeting of bloggers at a bar several years ago, to a social media center on the exhibit floor this year. Quite a change. I have the privilege of presenting 3 times at the social media center – providers panel on Monday, a solo presentation,   Social Media in Health IT—Rapid Dissemination and Collaboration, and a meet the bloggers on Wednesday another Meet the Bloggers panel. Plan to join the tweet-up as well and tweet throughout using the #HIMSS11 hash tag.

On the innovation front, I helped plan the HIT X.O track which is new to HIMSS this year. Thinking from the future will stretch everyone’s thinking. Covering everything from futuristic mobile apps to personalize medicine in the next 10 years and military technology in healthcare, each session looks to be exciting.

See you there!

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WebMD vs. MayoClinic.com – Reliable Medical Information

February 6, 2011

In an article in the New York Times Magazine today, Virginia Heffernen discusses a Prescription of Fear. She contrasts the WebMD approach to health information with that of MayoClinic.com, opposing what she sees at a for-profit website with major funding from drug companies on the one hand with a respected non-profit medical institution on the other.  In comparing the two sites on the topic of headache, for one thing, she uses a Google search to find content on the sites rather than the sites own search engine and then claims that one has advertising and drives uses to prescription usage while the other does not.

I tested this with the term Fibromyalgia. It turns out that both sites display an add from Pfizer on the landing page, MayoClinic also has ads by Google but WebMD did not. WebMD on its chapter on treatment includes 3 brand name drugs but also recommends physical therapy and medical marijuana.  MayoClinic recommends lifestyle and home remedies, alternative medicine and coping and support but nothing about drug therapy.

MayoClinic advertising policy states that  ”we accept advertising and sponsorship under strict guidelines” but does not state whether they have any control over the Google ads appearing on their pages. WebMD’s policy is extensive and states “under no circumstances will WebMD’s acceptance of any Advertisement be considered an endorsement of the product(s) and/or service(s).” Both sites are HON Code certified and WebMD also has eTrust and URAC shields.

So there may be something to WebMD suggesting drug treatment more often that MayoClinic, but the article fails to mention that MayoClinic.com is supported by advertising and in some cases has more ads per page than WebMD.

It should be noted that other medical institutions do not use advertising but provide reliable medical information from their own sources such as, Duke and Cleveland Clinic .

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Year in Review – Books of 2010

December 31, 2010

Following Kent Bottle’s lead in influential books in 2010, I decided to compose my own list:

  1. Chasing Medical Miracles The Promise and Perils of Clinical Trials. Tells it like it is – to be a participant in a clinical trial.
  2. Googled-The End of the World as We Know It – somewhat disappointing in that it discussed the advertising side of the business and less about the history of its technical evolution.
  3. DIYU: Epunks, Edupeneurs and the Coming Transformation of Higher Education. This book was recommended by a speaker at the J. Boye conference in Philadelphia. Questions the future viability of universities as they are undermined by Web 2.0 technology.
  4. Leading Geeks – Required reading for anyone who manages geeks, especially programmers. Helpful for anyone to understand the culture of geekdom, understanding the mindset of managing ambiguity and tearing down some stereotypes.
  5. The Singularity is Near by Ray Kurzweil – mind blowing futurism and undying optimism in technology even though this is from 2005 and 650 pages. The law of accelerating returns puts us on a fast track to the future. I am now following Kurweil’s Accelerating Intelligence blog.
  6. A Little Booklet About Health 2.0 – by Lucien Engelen. Brief but advancing health 2.0 concepts with a peak to the future from a European perspective.
  7. Long Tail: Why the Future of Business Is Selling Less of More – this lead to my blog post on Partnerships with Online Communities – The Long Tail, discussing some of the implications of the long tail in healthcare.
  8. The Collapse of Complex Societies – a venture into history and anthropology which I enjoy and blogged about: Declining Marginal Returns of Complexity
  9. Laugh, Sing and Eat Like a Pig by e-Patient Dave – a personal, signed gift from Dave himself when he visited Cleveland and had dinner with us.
  10. Connected for Health: The KP HealthConnect Story – Probably the best story of successful implementation of an EMR on a large scale basis with honest, realistic discussion of struggles and successes.
  11. Program or Be Programmed – Ten Commandments of the Digital Age – read appropriately as an ebook, makes some good points without being paranoid about technology’s growing role in our lives.
  12. The Bottom Billion: Why the Poorest Countries Are Failing and What Can be Done About It. Recommended by @Ciscoiii when visiting the World Bank in Washington, DC. Excellent analysis of failed states with recommendations at the UN level for solutions.
  13. Founding Faith: Providence, Politics, and the Birth of Religious Freedom – found this in Philadelphia at the Liberty Bell bookstore.

One on my shelf is Reading in the Brain: the New Science of How We Read.

More book reviews to come next year and many more will be on my Sony Reader.

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Book Review: Program or Be Programmed – Ten Commandments of the Digital Age

December 30, 2010

This quick read by Douglas Rushkoff is less ominous than the title sounds but still thought provoking.  The author does not advocate becoming a programmer per se but understanding the greater control and influence over our decisions that apps have on our everyday lives. Particularly the chapter on Choice: You May Always Choose None of the Above; here he emphasizes the need to be aware of and not locked into choices made for us.  Whether it is Google search results/adwords or Amazon recommendations of what others have selected, were are ever so gently guided toward choices. It reminds me of the decades old book of Alvin Toffler, Overchoice. Even then he anticipated the problem of hundreds of choices of models and colors and didn’t anticipate the ability to search millions of products online. Maybe we need tools to help us in our choices to guide us to our preferences to reduce the number of choices. But understanding enough about how this tools are programmed frees us from a type of slavery to them.

In addition, there are chapters about online identity: Do Not Be Always On, Live in Person, Be Yourself, Do Not Sell Your Friends. Increasingly, the lines between our online and offline identities are becoming blurred. Some handle this better than others, but identity confusion occurs with the most distasteful evidence in cyber-bulling and  getting lost in game worlds. The advice to retain our humanity is well founded.

While the book does not address health issues on the internet and social media in depth, there are some implications for ePatients and patient-physician relationships. These need to be based in reality, not the virtual world. These identities and relationships can be extended by apps and tools but not to the exclusion of real life.

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2010 Year in Review

December 24, 2010

It has been a year full of travel and accomplishments. Here is a month-by-month review:

Looking forward to more in the coming year – conferences, presentations, publications.

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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.

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Connected for Health: The KP HealthConnect Story

September 16, 2010

Connected For HealthIn 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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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?

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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.”

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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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