July 23, 2008
Medpedia: A New Model for Health Information
Creating the worlds largest body of health information on the web is no easy feat but Internet entrepreneurs are teaming with doctors, researchers and other medical professionals to create Medpedia - a Wikipedia for health.
According to an article in today's LA Times, the website which is in its beginning stages is being written and edited only by trained professionals and will gather the kind of knowledge usually confined to academic circles and make it understandable and available to consumers.
Finding credible, understandable health information on the Net has been a challenge and source of frustration for consumers and although there are sources for disease information and treatment options such as WebMD or Healtline, medical information is described by James Currier, founder and chairman of Medpedia, as 'one of the least developed areas of the Internet' according to the LA Times article.
This concept has generated a great deal of interest from medical establishment including physicians, medical schools, hospitals, health organizations and public health professionals. Harvard Medical School, Stanford School of Medicine and the UC Berkeley School of Public Health have expressed an interest in participating in the project. The site will receive content from the National Institutes of Health and the Centers for Disease Control, and possibily provide information on current clinical trials for various diseases and conditions.
Over the next few years, Medpedia's goal is to recruit thousands of health experts to create content for more than 30,000 diseases and conditions, more than 10,000 prescription drugs, thousands of medical procedures and millions of medical facilities around the world.
Source: LA Times
July 16, 2008
Technology That Adapts
The basic premise of most technologies is that people need to adapt to the technology to make it function at an optimal level. But shouldn't it ultimately be the other way around? A paper presented at the Association for the Advancement of Artificial Intelligence in Chicago this week describes a system that for the first time offers an instantly customizable approach to user interfaces.
Krzysztof Gajos and colleagues from the University of Washington Department of Computer Science and Engineering have developed a system called Supple. It is primarly designed for the disabled who have a more difficult time adapting to traditional computer interfaces.
Supple, begins with a one-time assessment of a person's mouse pointing, dragging and clicking skills. A ring of dots appears on the screen and as each dot lights up, the user must quickly click on it. The task is repeated with different-sized dots. Other prompts ask the participant to click and drag, select from a list, and click repeatedly on one spot.
An optimization program then calculates how long it would take the person to complete various computer tasks, and in a couple of seconds it creates the interface that maximizes that person's accuracy and speed when using a particular program. Researchers tested the system last summer on six able-bodied people and 11 people with motor impairments. The resulting interfaces showed one size definitely did not fit all.
For example, "a man with severe cerebral palsy used his chin to control a trackball and could move the pointer quickly but spastically. Based on his skills test, Supple generated a user interface where all the targets were bigger than normal, and lists were expanded to minimize scrolling. By contrast, a woman with muscular dystrophy who participated in the study used both hands to move a mouse. She could make very precise movements but moved the cursor very slowly and with great effort because of weak muscles. Based on her results, Supple automatically generated an interface with small buttons and a compressed layout."
One of the researchers pointed out that "from an accessibility standpoint, it's always better to change the environment, rather than use specialized assistive technologies, Supple could be useful for many people with limitations in function, ranging from the elderly, to people with low vision, to people with hand tremors." The program could also be used to create interfaces that can adapt to different sizes of screen, for example on handheld devices.
If you think about applications for the non-diabled, some exist already. For example, if you insert your key into the ignition of a luxury car, the seat and steering wheel automatically adjust to preprogrammed body proportions or, as you walk through the rooms of Bill Gates' mansion, each room adjust its lighting, temperature and music to accommodate your personal preference.
Artificial Intelligence Research, University of Washington
Twenty-Third AAAI Conference on Artificial Intelligence
The Supple Toolkit is an open source project released under the Apache License. It contains the core SUPPLE libraries for building Supple applications and rendering.
You can download the latest toolkit release here.
July 09, 2008
Physician Information on the Web
Just how important is it for physicians to review their online profile? Have you Googled yourself to find out what information is available and how it is presented? Chances are that your patients have done this.
According to the current JAMA, authors Tristan Gorrindo, MD and James E. Groves, MD from Massachusetts General Hospital, Boston, discuss the domains of personal information available on the Internet and the scope of professional and personal information that is available about physicians and easily available on the World Wide Web. They point out that states routinely publish information about a physician's education, training, board certification, and publications. These Web sites may also include information about disciplinary actions against a physician by a state's licensing and registration authorities.
Personal information is also readily available on the Internet which includes many different types of information, for example, the authors point out that in New York City by searching just a last name, a patient can obtain a physician's home address, home price, and mortgage information. Other information such as martial status can be inferred and for a fee, "digital background checks" can be done which may include date of birth, criminal records, marriage records, bankruptcy records, small claims court filings, and judgments are often available.
"Social network sites are another way patients can find information about physicians. Web sites such as facebook.com and myspace.com are commonly used by college and graduate students. This is particularly relevant for medical students as they enter residency or practice." Information that a physician has posted in his or her social profile account is available for others to review.
The article also points out that "in some cases, there may be slanderous information about a physician on the Web, published in a blog or on a Web page by a vengeful patient, colleague, or ex-lover. Equally vexing, there may be slanderous information published about someone with the same name as an unlucky physician. There may be few clues available to the Web-searching patient that would allow that patient to know that this is not his or her physician."
The authors recommend that physicians should be aware of their Web presence. Regular Web searching for your name should be conducted and that physicians should be mindful that patients want to know about them and have increasingly better tools to unearth such information. It is suggested that 'taking the initiative of creating one's own Web identity through the development of a practice Web page and limiting access to personal information on social Web pages can allow for effective communication with patients while balancing personal information.'
Web Searching for Information About Physicians
Tristan Gorrindo, MD; James E. Groves, MD
JAMA. 2008;300(2):213-215.
July 08, 2008
Studying The Impact of the InterWeb
A new organization has been formed to study the impact of the World Wide Web. The Web Science Research Initiative (WSRI) is a joint endeavour between the Computer Science and Artificial Intelligence Laboratory (CSAIL) at MIT and the School of Electronics and Computer Science (ECS) at the University of Southampton. It was formed by Sir Tim Berners Lee (father of the Web) and others with overarching goal to facilitate and produce the fundamental scientific advances necessary to inform the future design and use of the World Wide Web.
WSRI aims to establish Web Science as a new academic discipline focusing on the analysis, engineering and social impact of the World Wide Web and to attract young people worldwide to study the economics, psychology, technology and sociology of the Web and to bring the study of ‘Web Science’ into mainstream education. The WSRI group has also joined forces with National Endowment for Science and Technology (NESTA), a unique organization in the UK that promotes innovation. Together, they will bring together leading experts in the world of computer science and communications to create the curriculum for a new generation of Web scientists.
More about WSRI
More about NESTA
More about ECS
More about CSAIL
July 03, 2008
Technology and Smoking Cessation
There is a great deal of information on the Internet about smoking and a number of websites that offer self-help programs for those who wish to give up smoking, but interesting and new technologies are emerging to motivate quitters and help physicians track the progress.
Software
The Handheld Computer Smoking Intervention Tool (HCSIT) was developed by Scot Strayer, MD from the Department of Family Medicine at the University of Virginia for the National Cancer Institute. The software allows clinicians to access data about smoking cessation, drug interactions, addiction evaluations and other information to use in interviews as people begin the effort to quit. The HCSIT is designed for clinicians to assist with smoking cessation counseling at the point-of-care and was developed in accordance with current PHS guidelines. This easy-to-use program can be used with Palm, SmartPhone, and Pocket PC handheld computers.
The HCSIT includes a handheld version of the Fagerstrom Test for Nicotine Dependence. This test assesses a smoker's level of dependency on nicotine and has demonstrated validity and reliability in previous research. The tool guides clinicians through the appropriate questions and makes intervention recommendations based on the level of dependency. When medication therapy is strongly indicated, common prescription information is provided on the handheld tool to assist the physician with dispensing the appropriate medication. Additionally, this tool contains: Public Health Service (PHS) Tobacco Cessation Guidelines; second-line pharmacotherapy; brief motivational interventions for tobacco users (the "5 R's"); and evidence-based recommendations from the PHS Guidelines (the "5 A's").
The software can be downloaded from the Smokefree.gov website
Social Networks
A recent article in the New England Journal of Medicine studied a social network of 12,067 individuals. The research suggested that whole groups of people were quitting in concert and that smokers were progressively moving to the periphery of the social network. The study also found that smoking cessation by a spouse decreased a person's chances of smoking by 67%, smoking cessation by a sibling decreased the chances by 25% and smoking cessation by a friend decreased the chances by 36%. Among persons working in small firms, smoking cessation by a coworker decreased the chances by 34%. Friends with more education influenced one another more than those with less education. These effects were not seen among neighbors in the immediate geographic area.
The authors conclude that "network phenomena appear to be relevant to smoking cessation. Smoking behavior spreads through close and distant social ties, groups of interconnected people stop smoking in concert, and smokers are increasingly marginalized socially. These findings have implications for clinical and public health interventions to reduce and prevent smoking."
Websites
Finding reliable and credible information on the numerous websites can be a challenge for aspiring quitters or for clinicians to recommend to their patients. Beth Bock, PhD from the Department of Psychiatry and Human Behavior at Brown University Medical School is conducting an analysis of the top web search results and evaluating the quality of the websites for smokers. She described in an abstract presented at MedNet that "smokers seeking quality tobacco dependence treatment on the Internet may have difficulty distinguishing among the numerous websites available. Websites that provide direct treatment often fail to fully implement treatment guidelines and do not take full advantage of the interactive and tailoring capabilities of the Internet. Despite the importance of social support in the process of quitting smoking, few sites used chat rooms, electronic message boards, on-line counselor support (e.g., email) systems or other on-line support groups. "
Currently, the best websites for clinicians and consumers are the government based websites like the Health and Human Services Website located at http://www.surgeongeneral.gov/tobacco/ and the Center for Disease Control (CDC) site at http://www.cdc.gov/tobacco/quit_smoking/
These offer a diverse array of links, pamphlets and health information. However, they offer little in the way of blogs or online support networks for smokers who are trying to quit. Some of the most widely used resources for online quitters or potential quitters is About.com: smoking cessation or QuitNet.
Gadgets
Nico-stopper
Looks like an MP3 player but is a cigarette case that locks in your cigarettes and only releasaes them at preset intervals. And as the cigarette is released, the LCD screen flashes self-help messages. (link)
Smoke Signals
The Smoke Signals package enlists your computer into helping you give up smoking. It includes:
* a smart interactive case that holds a pack of cigarettes and monitors your habits and signals when to smoke.
* a personalized Quit Plan that is built to not only match your profile but also adjusts your profile as you progress.
* access to an online progress page which acts as your personal coach.
* daily emails and tips
* a DVD that offers a step-by-step guie to the Smoke Signal Process.
(link)
Quit Key
A handheld computer that you can keep on your key chain. It creates a personal quit smoking program based on information that you provide.
(link)
Quit Smoking Plugin
Give up smoking by public exposure with the Quit Smoking Plugin for weblogs. An interesting tool for those who have their own or are thinking of creating a word press blog. The plugin will display a counter on your blog showing all the relevant numbers - the time quit, how many not smoked, how much money saved, and how many lifetime hours regained.
(link)
References & Supplemental Material
PHS guidlines
Article: A Handheld Computer Smoking Intervention Tool and Its Effects on Physician Smoking Cessation Counseling
Article: NEJM - The Collective Dynamics of Smoking in a Large Social Network
Article: Reliability of Internet- Versus Telephone-Administered Questionnaires in a Diverse Sample of Smokers
Article: The Content, Quality and Usability of Smoking Cessation Treatments on the Internet
Article: Web-Based Smoking Cessation Medication Compliance System
Gadgets Source: HealthBolt
July 01, 2008
EHR Implementation Timeline
So how long does it take to implement an EHR in a clinical practice? According to an article in MedPage Today, approximately 2 years. Consultant Rosemarie Nelson offers an interesting discussion on the steps and timeline needed to make it happen. Her article applies more to group practices but offers some valuable insights into the process.
Step 1: Preparation (timeframe: 90 to 150 days)
The first step involves preparation and becoming familiar with the terminology, features, and functions of the EHR and it is suggested that a visit to practices that have implemented an EHR would be helpful. This step includes reviewing and understanding your work flow and the interaction of others involved in your practice.
Step 2: System Selection (timeframe: 60 to 120 days)
A valuable second step is to contact the hospital(s) that your practice is affiliated with and ask if they provide assistance with EHR solutions. Next, develop a Request For Proposal (RFP) to send to no more than five vendors whose products best meet your practice's EHR-related needs. In the course of evaluating systems, devise a comparative checklist of features, look at budgets and, of course, check vendor references.
Step 3: Implementation (timeframe: 45 to 180 days)
The third step is to develop a formal implementation plan. It should enumerate tasks, the parties responsible for seeing them completed, and deadlines. Updates to the plan should be made available to everyone at regular intervals.
Plan to reduce patient volume during the conversion and the implementation. In the short term, the practice may need to bring on temporary help or outsource chart conversions. Training sessions should be supplemented with simulated or "dry runs" of clinic days so physicians and staff become accustomed to using the system and can begin to identify additional workflow changes that may be needed.
The implementation plan should include a "go live" date and may actually include many such dates, covering different phases of the system. The dates may change depending upon the workflow adaptation and system configuration efforts.
Step 4: Post Implementation (timeframe: 6 to 12 months)
After the EHR is up and running, adjustments to practice operations will need to continue. Policies and procedures should be updated especially the changes related to HIPAA Privacy and Security regulations. If implemented correctly, the EHR can increase your revenues and lower your administrative costs.