"health care" entries
Bringing the knowledge of best practices to the doctor’s point of care
Workflows, EHRS, and social networking
Impatience is said to be the stance of modern technology users, but a doctor sitting with a patient has good reason to be impatient. The afflicted person may be suffering from a condition where lost minutes could mean death, an amputated limb, or severe brain disfunction. Even if the patient’s condition is not so dire, there are probably a half dozen other people with painful complaints twiddling their thumbs in the waiting room while the doctor tries to guess at a course of treatment. And in the US today, guessing is often the only option.
Somewhere in the country, an expert has probably learned all about the medical condition at hand and even presented the solution at a conference. Relatively few medical crises are really new discoveries. But the current system of disseminating information through conferences, journals, and rotations, or even through newer media such as blogs and webinars, cannot reach the beleaguered doctor and patient at the point of care.
I got a glimpse of a solution in the book #SOCIALQI (which has an associate web site) by the multi-disciplinary biomedical researcher Brian McGowan. His first challenge to us is an assertion that the central problem holding back improvements in health care quality is the inadequate dissemination of knowledge. I could match this claim with several other urgent needs in the health care field: inconsistent and distorted recording of patient data, lack of standards for storage and data exchange, and resistance by doctors to patient engagement, to name a few. But McGowan’s first chapter makes a very persuasive argument: if the best practices of each site were instituted throughout the health care system, we’d save thousands of lives and drastically lower costs. Read more…
Have an idea for a health care startup?
DreamIt, UPenn, and IBC offer you an unfair advantage.
I sit down now and then with Roy Rosin at the East coast hub of health care business networking, the Gryphon Cafe in Wayne, PA. (I’m saying that only slightly tongue in cheek.) Roy was the long-time Chief Innovation Officer at Intuit and now holds that role with the University of Pennsylvania Health System. Our conversations tend to be wide ranging, but this morning he let me know that he’s been working on a partnership between Penn Medicine and Independence Blue Cross to fund a health care incubator with DreamIt Ventures in Philadelphia.
If you are working on a health-related startup this is worth your time because it’s being funded by the largest provider and payer in the region. This will give your startup access to both sides of the payer/provider equation in a meaningful way (the aforementioned “unfair advantage”). The application deadline is coming up fast on February 8. Details can be found here.
Open source developers combine efforts in the health care field
A report from an Open Health Tools meeting
I had a chance to listen in a recent meeting of Open Health Tools, a trade association bringing together companies, academics, and standards bodies who create open source software tools for all stages of the health care field. Open Health Tools has been around since 2007 and is attracting some impressive new members. The achievements of this “ecosystem” (as they call it) may soon put to rest the dismissive attitude many people in health care have toward open source.
A Tough Location for a Procedure
Free and open source software has lots of barriers yet to overcome in health care, similar to but in a somewhat different configuration from the barriers in other fields where it has triumphed (government, finance, commerce). Liability is at the top of everyone’s mind in health care. They have to be assured that J. Random Hacker has not just checked in a poorly tested update to the program they’re installing on their ICU monitoring station. There are many responsible stewards of open source EHRs (several packagers of the VA’s VistA project, as just one example, have spoken at our Open Source Convention) but the buyers have to understand better what is entailed in vetting and maintaining open source software.
Health care providers, outside of research institutions with technically adventurous staff, also prefer turn-key solutions. These to some extent are deceiving, because every institution needs to customize the software heavily for its own needs, and many regret the proprietary solutions they’ve tied themselves to when they find out how hard (sometimes beyond anyone’s definition of feasibility) or costly the customizations are. They are still afraid of open source’s fluidity, however. Read more…
Printing ourselves
At its best, 3D printing can make us more human by making us whole.
Tim O’Reilly recently asked me and some other colleagues which technology seems most like magic to us. There was a thoughtful pause as we each considered the amazing innovations we read about and interact with every day.
I didn’t have to think for long. To me, the thing that seems most like magic isn’t Siri or self-driving cars or augmented reality displays. It’s 3D printing.
My reasons are different than you might think. Yes, it’s amazing that, with very little skill, we can manufacture complex objects in our homes and workshops that are made from things like plastic or wood or chocolate or even titanium. This seems an amazing act of conjuring that, just a short time ago, would have been difficult to imagine outside of the “Star Trek” set.
But the thing that makes 3D printing really special is the magic it allows us to perform: the technology is capable of making us more human. Read more…
DocGraph: Open social doctor data
An inside look at DocGraph, a data project that shows how the U.S. health care system delivers care.
Notice, October 2015: Certain versions of this data have been retracted. Please read more here.
At Strata RX in October I announced the availability of DocGraph. This is the first project of NotOnly Development, which is a Not Only For Profit Health IT micro-incubator.
The DocGraph dataset shows how doctors, hospitals, laboratories and other health care providers team together to treat Medicare patients. This data details how the health care system in the U.S. delivers care.
You can read about the basics of this data release, and you can read about my motivations for making the release. Most importantly, you can still participate in our efforts to crowdfund improvements to this dataset. We have already far surpassed our original $15,000 goal, but you can still get early and exclusive access to the data for a few more days. Once the crowdfunding has ended, the price will go up substantially.
This article will focus on this data from a technical perspective.
In a few days, the crowdfunding (hosted by Medstartr) will be over, and I will be delivering this social graph to all of the participants. We are offering a ransom license that we are calling “Open Source Eventually,” so participants in the crowdfunding will get exclusive access to the data for a full six months before the license to this dataset automatically converts to a Creative Commons license. The same data is available under a proprietary-friendly license for more money. For all of these “releases,” this article will be the go-to source for technical details about the specific contents of the file.
Driven to distraction: How Veterans Affairs uses monitoring technology to help returning veterans
Fujitsu provides the Sprout device to collect and analyze sensor data in real time
Veterans Affairs is collaborating with Fujitsu on a complex and interesting use of sensor data to help rehabilitate veterans suffering from Post Traumatic Stress Disorder (PTSD). I recently talked about this initiative with Dr. Steven Woodward, Principal Investigator of the study at the VA Palo Alto Health Care System, and with Dr. Ajay Chander, Senior Researcher in Data Driven Health Care at Fujitsu Laboratories of America (FLA).
The study is focused on evaluating strategies for driving rehabilitation. During deployments, veterans adapt their driving behavior to survive in dangerous war zones that are laced with combat fire, ambushes, and the threat of improvised explosive devices. Among veterans suffering from PTSD, these behaviors are hard to unlearn upon their return from such deployments. For example, some veterans veer instinctively into the middle of the road, reacting to deep-seated fears of improvised explosive devices. Others refuse to stop at stop signs for fear of attack. Other risky behaviors range from road rage to scanning the sides of the road instead of focusing on the road ahead. At-fault accident rates are significantly higher for veterans upon return from a deployment than before it.
The VA’s research objective is to understand the triggers for PTSD and discover remedies that will enable veterans to return to normal life. For the study, the VA instrumented a car as well as its veteran driver with a variety of sensors that collect data on how the car is being driven and the driver’s physiology while driving it. These sensors included wireless accelerometers on the brake and accelerator pedals and on the steering wheel, a GPS system, and an EKG monitor placed on the driver and wired to an in-car laptop for real-time viewing of cardiological signals, as well as manual recording of the driver’s state and environmental cues by an in-car psychotherapist. With such a system, the VA’s goal was to record and analyze driving trails of veterans and assess the efficacy of driving rehabilitation techniques.
As Dr. Woodward explained, the VA had been assessing veterans’ driving habits for quite a while before getting introduced to Fujitsu’s real-time monitoring technology. ASsessments had been a significant challenge for multiple reasons. On the data collection and visualization front, the disparate sensors, the laptop, and the power supplies added up to a significant in-car IT footprint. More importantly, since all sensor systems were manufactured by different vendors and didn’t share data with each other, the data streams were not synchronized. This made it difficult for the VA researchers to get an accurate understanding of how the driver’s physiology coupled with the car’s drive and location data. Read more…
Doctors rate doctors in HealthTap’s medical quality project
Physician/patient knowledge sharing site branches out into quality measures
HealthTap, a network of physicians and patients, routinely breaks new ground and tries bold experiments in the area of generating trust. I remember how, in my first posting about the company, I questioned whether the company could sign up both patients and doctors and extract the information it planned to offer. Its current network of more than 16,000 physicians vindicates CEO Ron Gutman.
HealthTap has always included a modest “Agree” button that lets a doctor approve of a particular posting by another doctor, but now the company is delving much deeper into the mission of externalizing information that has long remained hidden. They are conducting a series of initiatives to rate doctors. The one announced today, the Top Doctors competition openly asks doctors to rate each other. Every specialist has strong opinions about who is best in his or her field, and is willing to direct patients to the most respected colleagues, but never have they been asked to publicize their opinions.
Gutman is confident that this gambit will pay off. Doctors are naturally competitive, he says, and will sign up to rate one another. He is asking for extremely fine-grained ratings: not just for “best eye surgeon,” but for “best retinal surgeon.” This kind of detail matches the requests made by anxious patients.
Patients will also be able to rate their physician’s bedside manner. Such ratings are known to be very subjective and poorly correlated with clinical results, so the physician and patient ratings will be presented separately on HealthTap. Read more…
How to open an industry: data points from Strata Rx
O'Reilly conference brings together health care and data
O’Reilly’s first conference devoted to health care, Strata Rx, wrapped up earlier this week. Despite competing with at least three other conferences being held on the same week around the country on various aspects of health care and technology, we drew a crowd that filled the ballroom during keynotes and spent the breaks networking more hungrily than they attacked the (healthy) food provided throughout.
Springing from O’Reilly’s Strata series about the use of data to change business and society, Strata Rx explored many other directions in health care, as a peek at the schedule will show. The keynotes were filmed and will soon appear online. The unique perspectives offered by expert speakers is evident, but what’s hard is making sense of the two days as a whole.
In this article I’ll try to show the underlying threads that tied together the many sessions about data analytics, electronic records, disruption in the health care industry, 21st-century genetics research, patient empowerment, and other themes. The essential message from the leading practitioners at Strata Rx is ultimately that no one in health care (doctors, administrators, researchers, regulators, patients) can practice their discipline in isolation any more. We are all going to have to work together.
We can’t wait for insights from others, expecting researchers to hand us ideal treatment plans or doctors to make oracular judgments. The systems are all interconnected now. And if we want healthy people, not to mention sustainable health care costs, we will have to play our roles in these systems with nuance and sophistication.
But I’ll get to this insight by steps. Let’s look at some major themes of Strata Rx. Read more…
Data from health care reviews could power “Yelp for health care” startups
Data-driven decision engines will need patient experience to complete the feedback loop.
Given where my work and health has taken me this year, I’ve been thinking much more about the relationship of the Internet and health data to accountability and patient-driven health care.
When I was looking for a place in Maine to go for care this summer, I went online to look at my options. I consulted hospital data from the government at HospitalCompare.HHS.gov and patient feedback data on Yelp, and then made a decision based upon proximity and those ratings. If I had been closer to where I live in Washington D.C., I would also have consulted friends, peers or neighbors for their recommendations of local medical establishments.
My brush with needing to find health care when I was far from home reminded me of the prism that collective intelligence can now provide for the treatment choices we make, if we have access to the Internet.
Patients today are sharing more of their health data and experiences online voluntarily, which in turn means that the Internet is shaping health care. There’s a growing phenomenon of “e-patients” and caregivers going online to find communities and information about illness and disability.
Aided by search engines and social media, newly empowered patients are discussing health conditions with others suffering from disease and sickness — and they’re taking that peer-to-peer health care knowledge into their doctors’ offices with them, frequently on mobile devices. E-patients are sharing their health data of their own volition because they have a serious health condition, want to get healthy, and are willing.
From the perspective of practicing physicians and hospitals, the trend of patients contributing to and consulting on online forums adds the potential for errors, fraud, or misunderstanding. And yet, I don’t think there’s any going back from a networked future of peer-to-peer health care, anymore than we can turn back the dial on networked politics or disaster response. Read more…
Strata Rx is a wrap
Watch live keynotes from this week's Strata Rx Conference in San Francisco.
The intersection of big data and health care was explored at the O’Reilly Strata Rx Conference. The event has concluded, but you can still access an archive of videos, photos, and speaker slides. Read more…