ENTRIES TAGGED "health care"

Where did the issue of health data exchange disappear to?

More visible at Health Privacy Summit than Health Datapalooza.

On the first morning of the biggest conference on data in health care–the Health Datapalooza in Washington, DC–newspapers reported a bill allowing the Department of Veterans Affairs to outsource more of its care, sending veterans to private health care providers to relieve its burdensome shortage of doctors.

There has been extensive talk about the scandals at the VA and remedies for them, including the political and financial ramifications of partial privatization. Republicans have suggested it for some time, but for the solution to be picked up by socialist Independent Senator Bernie Sanders clinches the matter. What no one has pointed out yet, however–and what makes this development relevant to the Datapalooza–is that such a reform will make the free flow of patient information between providers more crucial than ever.

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Sequencing, cloud computing, and analytics meet around genetics and pharma

Bio-IT World shows what is possible and what is being accomplished

If your data consists of one million samples, but only 100 have the characteristics you’re looking for, and if each of the million samples contains 250,000 attributes, each of which is built of thousands of basic elements, you have a big data problem. This is kind of challenge faced by the 2,700 Bio-IT World attendees, who discover genetic interactions and create drugs for the rest of us.

Often they are looking for rare (orphan) diseases, or for cohorts who share a rare combination of genetic factors that require a unique treatment. The data sets get huge, particularly when the researchers start studying proteomics (the proteins active in the patients’ bodies).

So last week I took the subway downtown and crossed the two wind- and rain-whipped bridges that the city of Boston built to connect to the World Trade Center. I mingled for a day with attendees and exhibitors to find what data-related challenges they’re facing and what the latest solutions are. Here are some of the major themes I turned up.

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Citizens as partners in the use of clinical data

A Knowledge Currency Exchange for health and wellness

This article was written together with Mike Kellen, Director of Technology at Sage Bionetworks, and Christine Suver, Senior Scientist at Sage Bionetworks.

The current push towards patient engagement, when clinical researchers trace the outcomes of using pharmaceuticals or other treatments, is a crucial first step towards rewiring the medical-industrial complex with the citizen at the center. For far too long, clinicians, investigators, the government, and private funders have been the key decision makers. The citizen has been at best a research “subject,”and far too often simply a resource from which data and samples can be extracted. The average participant in clinical study never receives the outcomes of the study, never has contact with those analyzing the data, never knows where her samples flow over time (witness the famous story of Henrietta Lacks), and until the past year didn’t even have access to the published research without paying a hefty rental fee.

This is changing. The recent grants by the Patient-Centered Outcomes Research Institute (PCORI) are the most visible evidence of change, but throughout the medical system one finds green shoots of direct patient engagement. Read more…

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Changes in the health care system driven by self-service and DIY health

Apps reflect the public's pressing health concerns

Health care is migrating from the bricks-and-mortar doctor’s office or care clinic to the person him or herself at home and on-the-go–where people live, work, play, and pray. As people take on more do-it-yourself (DIY) approaches to everyday life–investing money on financial services websites, booking airline tickets and hotel rooms online, and securing dinner reservations via OpenTable–many also ask why they can’t have more convenient access to health care, like emailing doctors and looking into lab test results in digital personal health records.

The public clamor for digital outreach by health providers

85% of U.S. health consumers say that email, text messages, and voicemail are at least as helpful as in-person or phone conversations with health providers, according to the Healthy World study, Technology Beyond the Exam Room by TeleVox. Furthermore, one in three consumers admits to being more honest when talking about medical needs via automated voice response systems, emails, or texts than face-to-face with a health provider.

And three in ten consumers believe that receiving digital health care communications from providers—such as texts, voicemail, or email—would build trust with their providers. Half of people also say they’d feel more valued as a patient via digital health communications. When people look to engage in health with an organization, the most important enabling factors are trust and authenticity.

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Health IT is a growth area for programmers

New report covers areas of innovation and their difficulties

infofixO’Reilly recently released a report I wrote called The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. Along with our book Hacking Healthcare, I hope this report helps programmers who are curious about Health IT see what they need to learn and what they in turn can contribute to the field.

Computers in health are a potentially lucrative domain, to be sure, given a health care system through which $2.8 trillion, or $8.915 per person, passes through each year in the US alone. Interest by venture capitalists ebbs and flows, but the impetus to creative technological hacking is strong, as shown by the large number of challenges run by governments, pharmaceutical companies, insurers, and others.

Some things you should consider doing include:

Join open source projects 

Numerous projects to collect and process health data are being conducted as free software; find one that raises your heartbeat and contribute. For instance, the most respected health care system in the country, VistA from the Department of Veterans Affairs, has new leadership in OSEHRA, which is trying to create a community of vendors and volunteers. You don’t need to understand the oddities of the MUMPS language on which VistA is based to contribute, although I believe some knowledge of the underlying database would be useful. But there are plenty of other projects too, such as the OpenMRS electronic record system and the projects that cooperate under the aegis of Open Health Tools

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Leading by example: two stories

When health care institutions are charging outrageous prices, we need to stand up and say, "That's insane."

I was struck recently by two stories in the New York Times. The first, “Bishops Follow Pope’s Example: Opulence Is Out,” tells how bishop after bishop, either inspired by the Pope’s example or afraid of being shamed for not doing so, is moving out of his expensive, newly renovated residence and emulating Pope Francis’ emphasis on living simply. “Francis has very definitely sent out a signal, and the signal is that bishops should live like the people they pastor, and they shouldn’t be in palaces.”

I contrast this in my mind with the “do as I say, but not as I do” style of leadership shown by the US Congress on health care, where the message of “bending the cost curve on health care,” and limits on “Cadillac plans” was for everyone else. Congress’ own gold-plated plan remained in place, despite posturing to pretend that members of Congress were in the same boat as everyone else.

But when the leaders themselves don’t lead, sometimes individuals stand up to be counted. Read more…

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Advances in health IT must be viewed as a whole

New report ties together devices, data, records, and aspects of care.

Reformers in health care claim gigantic disruption on the horizon: devices that track our movements, new treatments through massive data crunching, fluid electronic records that reflect the patient’s status wherever she goes, and even the end of the doctor’s role. But predictions in the area of health IT are singularly detached from the realities of the technical environment that are supposed to make them happen.

To help technologists, clinicians, and the rest of us judge the state of health IT, I’ve released a report titled “The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care.” It offers an overview of each area of innovation to see what’s really happening and what we need to make it progress further and faster.

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Visualizing Health IT: A holistic overview

O'Reilly report covers major trends and tries to connect the neurons

If visualization is key to comprehending data, the field of health IT calls for better visualization. I am not talking here of pretty charts and animations. I am talking, rather, of a holistic, unified understanding of the bustle taking place in different corners of health: the collection and analysis of genetic data, the design of slim medical devices that replace refrigerator-sized pieces of equipment, the data crunching at hospitals delving into demographic data to identify at-risk patients.

There is no dearth of health reformers offering their visions for patient engagement, information exchange, better public health, and disruptive change to health industries. But they often accept too freely the promise of technology, without grasping how difficult the technical implementations of their reforms would be. Furthermore, no document I have found pulls together the various trends in technology and explores their interrelationships.

I have tried to fill this gap with a recently released report: The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. This posting describes some of the issues it covers.

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Can data provide the trust we need in health care?

Collecting actionable data is a challenge for today's data tools

One of the problems dragging down the US health care system is that nobody trusts one another. Most of us, as individuals, place faith in our personal health care providers, which may or may not be warranted. But on a larger scale we’re all suspicious of each other:

  • Doctors don’t trust patients, who aren’t forthcoming with all the bad habits they indulge in and often fail to follow the most basic instructions, such as to take their medications.
  • The payers–which include insurers, many government agencies, and increasingly the whole patient population as our deductibles and other out-of-pocket expenses ascend–don’t trust the doctors, who waste an estimated 20% or more of all health expenditures, including some thirty or more billion dollars of fraud each year.
  • The public distrusts the pharmaceutical companies (although we still follow their advice on advertisements and ask our doctors for the latest pill) and is starting to distrust clinical researchers as we hear about conflicts of interest and difficulties replicating results.
  • Nobody trusts the federal government, which pursues two (contradictory) goals of lowering health care costs and stimulating employment.

Yet everyone has beneficent goals and good ideas for improving health care. Doctors want to feel effective, patients want to stay well (even if that desire doesn’t always translate into action), the Department of Health and Human Services champions very lofty goals for data exchange and quality improvement, clinical researchers put their work above family and comfort, and even private insurance companies are trying moving to “fee for value” programs that ensure coordinated patient care.

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Disrupting health care with Google Glass

The convergence of hardware and software, and innovation in wearable technology, provides opportunities for disruption.

Editor’s note: this article originally appeared on Advanced Health Information Exchange Resources; this lightly edited version is published here with permission.

I joined the Glass Explorer Program and have started using Google Glass with a focus on finding medical uses for this type of wearable computing technology. While I believe it’s the analytics capabilities that will allow us to realize the value of health information technology, the convergence of hardware and software — combined with an explosion of wearable sensor technology — is providing powerful opportunities for some disruptive innovation in the health care marketplace and the practice of medicine.

Charles Webster, M.D., got me really interested in the potential with his presentation Google Glass and Healthcare Information and Workflow at the 2014 Healthcare Systems Process Improvement Conference, held immediately before HIMSS 2014. Chuck has been posting about Google Glass for some time, and one of his posts on the HIMSS Future Care blog is well worth reading. Some of the insights from his post include:

“There’s lots of interest in Glass use by surgeons, EMTs, and nurses, for hands-free and real-time access to critical information. It’s justified. But there’s also been negative speculation about threats to patient privacy. What will patients think when they see their physician wearing Glass? In my opinion, it will become just another tool they associate with health care workers (less obtrusive than the head mirror that used to be a symbol of the medical profession). The bigger question should be, what will physicians and others think when they see a patient wearing Glass?”

I decided it was finally time to take the plunge and become a Glass Explorer and got my Google Glass just in time for the annual HIMSS conference to end. For those who have not yet seen Google Glass or don’t understand how the technology works, it is basically a computer strapped to your head in the form of a pair of glasses. It has a heads-up display, voice activation and a growing number of apps. Check out the Google Glass homepage to learn more. When you think about having all of the technology of a smartphone, and then some, incorporated into a pair of glasses, it boggles the mind as to the various use cases for health care. I want to outline just a few and then think about what other innovative possibilities this type of technology could bring to the industry. Read more…

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