December 26, 2008
Interoperability is Key
Mike Leavitt, the U.S. Secretary of Health and Human Services wrote a recent editorial in the Washington Post entitled "Connecting The Medical Dots." He describes that Congress is considering a boost for health information technology in the proposed January stimulus package, but he warns that unless "the funds are tied to standards for the interoperability of health IT systems, the expenditure could do more harm than good."
According to Leavitt, before lawmakers act, they need to think. By supporting and encouraging systems that cannot exchange information, we are "replacing paper-based silos of medical information with more expensive, computer-based silos that are barely more useful. Critical information will remain trapped in proprietary systems, unable to get to where it's needed."
The value to any Health Information System is when they are interoperable, otherwise, clinicians will invest in electronic medical record systems that that cannot share information with other clinicians. "Today, specialists on a patient's team need to use interoperable systems that share medical records, prescription histories, lab results, imaging and clinical notes. System standards are needed to protect privacy and ensure that content — such as patients' diagnoses, allergies, medications, lab tests and medical directives — is standard for every patient, every time."
He points out that Congress has approved a request for higher reimbursement rates for Medicare doctors who e-prescribe. The Institute of Medicine has estimated that more than 1.5-million Americans are injured annually by drug errors. E-prescriptions can greatly reduce that number. He also describes the establishment of Certification Commission for Healthcare Information Technology (CCHIT) that offers a certification process that electronic health records must meet existing interoperability standards. He belives that "any stimulus money for electronic health records should go only to those with CCHIT certification."
He closes by saying "if we're going to build a 21st-century health infrastructure, we need to continue the careful work on harmonized standards that will create one nationwide, interoperable system. That's the only way to make an investment in health IT produce value for providers and patients and improve health care."
Washington Post Article: Connecting the Medical Dots
December 20, 2008
A Roadmap for Telemedicine: Barriers Yet to Overcome
A very interesting special edition of the Journal of Telemedicine and eHealth discusses "A Roadmap for Telemedicine: Barriers Yet to Overcome." The editorial by Charles R. Doarn and Ronald C. Merrell reviews the downturn in the economy and the impact on healthcare delivery. The authors point out "as the economy constricts, many products and services will simply vanish. Budgets for health information technology will take a hit as will many other growth activities in the health sector. While gasoline cost may soon be much lower than record highs, people will still feel the need to bypass expensive doctor visits. These challenges will force change in many different aspects of healthcare delivery. This is the silver lining. Telemedicine technologies have been proven to work. It is a viable option and now is the time to embrace wider adoption. While there is a cost associated with wider adoption, there is an even greater cost for not moving forward with these proven tools."
There are a number of worthwhile articles and a series of white papers that paint a 'roadmap for the future.' Some of the articles address innovative programs, medication compliance, cost-effectiveness, wearable monitors and much more. The best way to introduce the issues and their relevance today is to reprint the abstract of one of the white papers.
Societal Drivers in the Applications of Telehealth
Abstract
Charles R. Doarn, Peter Yellowlees, Deborah A. Jeffries, Denny Lordan, Sally Davis, Glenn Hammack, Thelma McClosky-Armstrong, Joseph Kvedar
The application of telemedicine and e-health tools and the integration of these tools in healthcare is no longer a demonstration, pilot project, or idea. The changing landscape of humanity dictates that new solutions be implemented to address old problems. The landscape is changing with diminishing resources of fossil fuels, aging population, a shortage of skilled labor in healthcare (doctors, nurses, and allied health professionals), and emerging technologies for the personal space, culture, and consumer demand. All are key drivers in altering healthcare delivery, access, and education. The very foundation of medicine needs to change to meet these demands. Access using telehealth will widen and enable our ability to respond to public health issues. This paper addresses the many societal issues facing healthcare delivery and demonstrates how telehealth solutions are key components of the future of healthcare delivery across the globe.
Free access to the articles online at Telemedicine and e-Health
December 19, 2008
More Physicians Switching to E-Prescribing
It is reported that the number of physicians in the U.S. who have adopted electronic prescribing technology may have doubled to more than 70,000 this year, up from 35,000 in December 2007.The number of paperless prescriptions also has been increasing at a rate of 15% per month since August, compared with the 5% to 8% rate increase seen earlier in the year.
It is believed that the growing shift to e-prescriptions might be attributed to a new Medicare rule scheduled to take effect in January 2009 that will offer a 2% payment bonus to physicians who use e-prescribing. According to the AP/Globe, about 10% of U.S. physicians use e-prescribing but "the movement is gaining steam as Medicare warns that its bonus payments are for a short time only." Physicians who still use paper prescriptions after 2012 will face Medicare payment cuts.
It is estimated that the additional $1,000 to $1,500 that physicians could receive through the Medicare incentive might help alleviate the cost burden of adopting an e-prescribing program, which can cost $3,000 per physician. A nationwide e-prescribing network also could generate as much as $156 million in savings over five years, according to HHS Secretary Mike Leavitt. E-prescribing also would help minimize the risk and alert pharmacists of potential adverse drug events, as well as reduce waiting time for patients, the AP/Globe reports.
Sources:
Boston Globe
Kaiser Daily Health Policy Report
December 03, 2008
iPod Touch in Medical Education
Medical students of Ohio State University(OSU) College of Medicine can now carry the equivalent of heavy textbooks and medical references in their lab coat pockets. OSU College of Medicine is the only medical school currently using the iPod touch to give to all its students for educational purposes.
According to the vice dean for education, Dr. Catherine Lucey, "The iPod touch has the potential to positively impact both medical education and the care provided to patients at the bedside.The personal digital assistant puts a wealth of information at the fingertips of our students. They can study when they want and where they want. If they are seeing a patient and a question arises, they can find the answer instantly, to share with them."
This hand-held technology can provide graphics, which allow students to refer to resources such as high quality images of each organ and nerve in the body. They can review images from multiple angles, access videos of medical treatments or surgical procedures, and request a review quiz at any time. In addition, detailed photographs on portable media players can help patients identify their current medications and immediately obtain a list of all potential drug interactions.
Over the next two years, each Ohio State medical student will receive a standard iPod touch, equipped with specific medical software programs planned by the OSU College of Medicine. This effort continues OSU Medical Center’s leadership in the use of technology to improve the quality of education and patient care and offers students the best tools available, to help them provide outstanding patient care.xpand to medical schools across
The Ohio State University College of Medicine also provides podcasts of medical school lectures, making all lectures and medical school curricula available on line, for review at any time. Students have access to the most recently published research articles and the current medical literature.
Dr Lucey points out that "OSU Medical Center is on the cutting edge of a trend that will undoubtedly expand to medical schools across the country."
Mission Statement of OSU Medical Center: Center for Knowledge Management Mobile Services
December 01, 2008
Collective Intelligence
An emerging field called collective intelligence describes a vast volume of digital information that is being recorded by an ever expanding web of sensors, from phones to GPS units to the tags in office ID badges, that capture our movements and interactions. When this is combined with information already gathered from sources like Web surfing and credit cards, our digital identity can tell a lot about us.
A recent NY Times article describes 100 M.I.T. freshmen who, in exchange for a free smartphone, allowed researchers to track their every move. So when they dial another student, researchers know. When they send an e-mail or text message, they also know. When they listen to music, they know the song. Every moment that they have the smartphone with them, they know where each one is, and who is nearby. They have agreed to swap their privacy for smartphones that generate digital trails to be beamed to a central computer. Beyond individual actions, the devices capture a moving picture of the dorm’s social network.
According to the article, "propelled by new technologies and the Internet’s steady incursion into every nook and cranny of life, collective intelligence offers powerful capabilities, from improving the efficiency of advertising to giving community groups new ways to organize." But, everyone acknowledges that if this knowledge is misused, "collective intelligence tools could create an Orwellian future on a level Big Brother could only dream of."
Collective intelligence could make it possible for insurance companies, for example, to use behavioral data to covertly identify people suffering from a particular disease and deny them insurance coverage. Similarly, the government or law enforcement agencies could identify members of a protest group by tracking social networks revealed by the new technology.
Everyday technologies have become so powerful that protecting individual privacy may no longer be the only issue. Now, with the Internet, wireless sensors, and the capability to analyze an avalanche of data, a person’s profile can be drawn without monitoring him or her directly.
Using Behavior to Influence Technology and Vice-Versa
"GOOGLE and its vast farm of more than a million search engine servers spread around the globe remain the best example of the power and wealth-building potential of collective intelligence. Google’s fabled PageRank algorithm, which was originally responsible for the quality of Google’s search results, drew its precision from the inherent wisdom in the billions of individual Web links that people create.
The company introduced a speech-recognition service in early November, initially for the Apple iPhone, that gains its accuracy in large part from a statistical model built from several trillion search terms that its users have entered in the last decade. In the future, Google will take advantage of spoken queries to predict even more accurately the questions its users will ask.
And, a few weeks ago, Google deployed an early-warning service for spotting flu trends, based on search queries for flu-related symptoms.
The success of Google, along with the rapid spread of the wireless Internet and sensors — like location trackers in cellphones and GPS units in cars — has touched off a race to cash in on collective intelligence technologies.
A company called Sense Networks has developed two applications, one for consumers to use on smartphones like the BlackBerry and the iPhone, and the other for companies interested in forecasting social trends and financial behavior. The consumer application, Citysense, identifies entertainment hot spots in a city. It connects information from Yelp and Google about nightclubs and music clubs with data generated by tracking locations of anonymous cellphone users.
The second application, Macrosense, is intended to give businesses insight into human activities. It uses a vast database that merges GPS, Wi-Fi positioning, cell-tower triangulation, radio frequency identification chips and other sensors.
The metrics are changing allowing companies to look at things that no one has ever measured previously. Shopping patterns within stores can be measured and if we combine these travel patterns with data on incomes, retailers can gain insights into sales levels and who is shopping at competitors’ stores.
The M.I.T. students aren't concerned about losing their privacy as the researchers have convinced them that they have gone to great lengths to protect any information generated by the experiment that would reveal their identities. Anyway, they all have Facebook pages, e-mail, websites and and blogs.
So do we need to re-define privacy? Perhaps
According to Thomas W. Malone, director of the M.I.T. Center for Collective Intelligence, 'the new information tools symbolized by the Internet are radically changing the possibility of how we can organize large-scale human efforts,for most of human history, people have lived in small tribes where everything they did was known by everyone they knew. In some sense we’re becoming a global village. Privacy may turn out to have become an anomaly.
In 1999, Scott McNealy, the chief executive officer of Sun Microsystems said "consumer privacy issues are a "red herring". You have zero privacy anyway. Get over it."
M.I.T. Center for Collective Intelligence
Electronic Privacy Information Center