"medical" entries
Singin’ the Blues: visions deferred at HIMSS health IT conference
The main concerns of health reformers don't rise to the top of health provider agendas
HIMSS, the leading health IT conference in the US, drew over 32,000 people to New Orleans this year (with another thousand or two expected to register by the end of the conference). High as this turn-out sounds, it represents a drop from last year, which exceeded 37,000.
Maybe HIMSS could do even better by adding a “Clueless” or “I don’t believe in health IT” track. Talking to the people who promote health IT issues to the doctors and their managers, I sense a gap–and to some extent, a spectrum of belief–in the recognition of the value of gathering and analyzing data about health care.
I do believe that American health care providers have evolved to accept computerization, if only in response to the HITECH act (passed with bipartisan Congressional support) and the law’s requirements for Meaningful Use of eleectronic records. Privately, many providers may still feel that electronic health records are a bad dream that will go away. This article presents a radically different view. I think electronic health records are a bad dream that will go on for many years to come. I’ll expand on this angle when blogging from HIMSS this year.
Harvard Medical School derives richer health research through patient app
Critical data on hypoglycemia not collected before
In a mobile, texting, socially engaged society, one would expect medical researchers to move beyond clipboards and phone surveys to make the most of technology. Harvard Medical School and Boston Children’s Hospital are starting to do that with a series of studies they’ve done querying people with diabetes, a growing population with multiple, severe health needs. Elissa Weitzman, an assistant professor at HMS and Children’s Hospital, discusses a recent study that she and her team published, using a social network called TuDiabetes, the open source patient data repository Indivo (developed at HMS), and an app they developed called TuAnalyze.
Android offers a standard platform for health care apps
Android TV systems provide low-cost interactive care
Video systems can streamline hospital care in all sorts of ways from displaying messages (“Quiet time is 1 to 2 PM today”) to taking patient surveys, showing patients their X-Rays, and helping patients view their records from their beds. But most of these systems lie outside the budgets of small and rural hospitals. Healthcare Information is halving the costs of the systems, largely by deploying Android in their sets, and is selling them to smaller healthcare institutions that could not afford them before. The use of Android also permits hospitals to choose among the hundreds of thousands of standard apps available in App Stores.
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Sequence of screens showing path through a patient survey
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…
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…
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…
Open source software as a model for health care
A doctor looks to software communities as inspiration for her own research
(The following article sprang from a collaboration between Andy Oram and Brigitte Piniewski to cover open source concepts in an upcoming book on health care. This book, titled “Wireless Health: Remaking of Medicine by Pervasive Technologies,” is edited by Professor Mehran Mehregany of Case Western Reserve University. and has an expected release date of February 2013. It is designed to provide the reader with the fundamental and practical knowledge necessary for an overall grasp of the field of wireless health. The approach is an integrated, multidisciplinary treatment of the subject by a team of leading topic experts. The selection here is part of a larger chapter by Brigitte Piniewski about personalized medicine and public health.)
Medical research and open source software have much to learn from each other. As software transforms the practice and delivery of medicine, the communities and development methods that have grown up around software–particularly free and open source software–also provide models that doctors and researchers can apply to their own work. Some of the principles that software communities can offer for spreading health throughout the population include these:
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Like a living species, software evolves as code is updated and functionality is improved.
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Software of low utility is dropped as users select better tools and drive forward functionality to meet new use cases.
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Open source culture demonstrates how a transparent approach to sharing software practices enables problem areas to be identified and corrected accurately, cost-effectively, and at the pace of change.
Sensor-laden glove brings medical examination to the masses
How a sensor glove can benefit the patient-doctor relationship.
Recently a group of three young entrepreneurs showed off a prototype of a glove that contained sensors useful for medical examinations. Their goals were not merely to make diagnosis easier, but to save the doctor/patient relationship from the alienation of modern technology. Medical student Andrew Bishara came into O’Reilly’s Cambridge studio to discuss the glove’s capabilities, how the creators were inspired to design it, and how they plan to productize it.
Here’s the full video from our discussion:
Highlights from the conversation include:
- Introduction to the glove and its purpose in bringing touch back into medicine. [Discussed at the 0:31 mark]
- Some of the purposes of the sensors. [Discussed at the 2:00 mark]
- Software on the device and in the cloud. [Discussed at the 7:58 mark]
- Creating a marketable product from the glove. [Discussed at the 9:54 mark]
- Open hardware. [Discussed at the 13:39 mark]
- How the developers were inspired by Singularity University. [Discussed at the 15:03 mark]