-----
This weekly blog is to explore the larger issues around Digital Health, data security, data privacy and related matters.
I will also try to highlight ADHA Propaganda when I come upon it.
Just so we keep count, the latest Notes from the ADHA Board are dated 6 December, 2018! Secrecy unconstrained! This is really the behavior of a federal public agency gone rogue – and it just goes on!
-----
DeepMind, artificial intelligence and the future of the NHS
Health experts believe artificial intelligence could be the answer to our overwhelmed healthcare system. It isn’t the stuff of science fiction. It’s already here. David Aaronovitch meets the brains behind the technology
The Times, September 14 2019, 12:01am
One morning a few weeks ago Stephen Foot, a warehouseman from Enfield, woke up in a London hospital to discover the unlikely harbinger of a coming medical revolution. This Ghost of Healthcare to Come took the form of a nephrologist at the end of his bed. “That was the last thing I was expecting,” he tells me. “Somebody from the renal department to come and say, ‘Oh, by the way, there’s something going on that has sparked an alert on your kidney.’”
Foot had entered hospital because of his foot. He had stepped out of the bathroom at home and trodden on something. “It was a trinket off a keyring which had a glass bottle of fairy dust in it. But because I’ve got bad neuropathy in my feet, I didn’t feel any pain. And I didn’t think anything of it at the time.”
Foot went back to work but after a couple of days he began to feel “horrible. I had no energy whatsoever.” He went to the GP and was seen by the practice nurse, who looked at his foot. “‘Oh my God,’ she said. ‘It’s all green and it smells.’ So she went and got a doctor.” The doctor referred Foot to the Royal Free Hospital in Hampstead, the great 12-storey town-within-a-city that dominates the local skyline.
Foot was examined, diagnosed, surgery was indicated for the next day and he was put to bed. “Then the kidney people came round and said to me that they’d seen there was a spike in my kidney tests.” Foot was baffled at first. He had felt no pain in that area and he was peeing normally. “They explained it: ‘We’ve been alerted with this new technology we’ve got, which tells us the blood test has shown one of the major indicators of the possibility of acute kidney injury.’”
-----
Data retention should stretch to seven years, Queensland Police says
Currently telcos are required to retain data for 24 months
Rohan Pearce (Computerworld)11 September, 2019 16:08
The Queensland Police Service says that there is a case for extending from 24 months to seven years the length that telcos need to retain ‘metadata’ to comply with Australia’s data retention regime.
The data retention regime is currently subject to statutory review by the Parliamentary Joint Committee on Intelligence and Security (PJCIS). In a submission to the committee’s inquiry, QPS states that in its view the current dataset that telcos must retain to comply with the data retention regime is appropriate.
That data (sometimes described by the government as ‘metadata’ or ‘historical telecommunications data’) covers a range of information about communications, but not the ‘contents’ of the communication (e.g. the words spoken during a call or the body of an email). It includes a range of subscriber and device details as well as the source, destination, timing and duration of a communication, and the location of equipment used for the communication.
-----
Data retention: ATO renews push to be part of ‘metadata’ regime
Agency admits it is still accessing telecommunications data
Rohan Pearce (Computerworld)10 September, 2019 14:41
The Australian Taxation Office has reiterated its frustration at being excluded from the list of government agencies able to obtain warrant-free access to telecommunications ‘metadata’ as part of the data retention regime.
However, the ATO has acknowledged using other provisions of Australian telecommunications legislation to access the same records covered by the data retention scheme, but objects to the costs that it incurs as a result.
The legislation governing data retention authorises metadata metadata access by federal, state and territory police forces, the Australian Criminal Intelligence Commission, a number of anti-corruption and law enforcement integrity bodies, the Department of Home Affairs, the Australian Securities and Investments Commission (ASIC), and the Australian Competition and Consumer Commission (ACCC).
There are two pathways for authorising additional agencies to access data retained as part of the scheme. One is through legislation, the other is via ministerial declaration. However, authorisation via declaration expires at the end of 40 sitting days of the House of Representatives after it comes into effect.
-----
Australian government's data sharing principles far from agreed upon
Getting your consent before sharing your personal data between agencies is still "an area of debate", so why is the government planning to go ahead without consent?
"If we required consent, then data would only be shared where consent was given," writes the Australian government. So it plans to go ahead without your consent.
Yes, this is the "nuanced" position on consent in the Australian government's Data Sharing and Release discussion paper [PDF] that was released last week.
"While consent is important in certain situations, the societal outcomes of fair and unbiased government policy, research, and programs can outweigh the benefits of consent, provided privacy is protected," it asserts.
But the paper fails to justify that assertion.
It acknowledges that there were "robust discussions" about consent, and that consent "remains an area of debate and requires further public discussion". But the only support for the "can outweigh" assertion to remove the need for consent is vague hand-waving and a smattering of unlikely claims.
-----
Google to change the way it presents news
Original news reporting will get new prominence and stay at the top of searches longer as Google addresses a major concern of publishers and reporters that their work was being swamped by copycats.
Google said it wanted to “highlight articles that we identify as significant original reporting”, and give readers a better chance to find the work that sparks many follow-ups.
“This means readers interested in the latest news can find the story that started it all, and publishers can benefit from having their original reporting more widely seen,” Google vice-president of news Richard Gingras wrote in a blog post on Friday.
The changes follow sustained criticism from traditional media organisations that helped spark the Australian Competition & Consumer Commission inquiry into digital platforms.
-----
Global watchdogs welcome ACCC crackdown on tech giants
The world’s leading competition regulators have welcomed Australia’s global lead in cracking down on Facebook and Google over their stronghold on advertising and misuse of people’s data.
In a meeting in New York around 30 heads of competition and antitrust agencies from all parts of the world discussed the landmark report of the Australian Competition and Consumer Commission which has recommended ways to rein in the dominance of US tech giants.
The meeting came only days after Attorneys-General for all 50 US states launched an antitrust investigation of Google and the threat that its dominance poses to competition and consumers.
Australia’s competition tzar Rod Sims, the head of the ACCC, told a closed workshop of competition agency heads at New York’s Fordham University why Australia had taken the lead on challenging the dominance of US tech giants.
-----
Thursday, 12 September 2019 21:04
Digital group says no to code of conduct on fake news
An industry lobby group, that represents the interests of Google and Facebook among others, has told the Australian Government that it does not agree with the creation of an industry code of conduct on fake news, one of the recommendations in the final Digital Platforms Inquiry report released by the ACCC on 26 July.
The Digital Industry Group, which also counts Twitter and Verizon Media among its founders, urged the Government to consider the "unintended consequences" raised by the recommendations and undertake broader consultation before any major reforms are announced.
The Australian Competition and Consumer Commission had recommended a code of practice to regulate the digital ad industry and to govern issues around inaccurate information, with the Australia Communications and Media Authority to handle enforcement.
In a submission to the public consultation on the final report, released by the Australian Competition and Consumer Commission, DIGI said it had issues with numerous recommendations among the 23 made by ACCC chief Rod Sims in the final report.
-----
My Health Record: Connecting Australians with their own health information
First Published September 6, 2019 Editorial
The expansion of My Health Record marks an important change in Australia’s healthcare system. In February 2019, a My Health Record was created for people, unless they chose not to have one. This opt-out participation model resulted in a large number of Australians now having access to My Health Record, with approximately 90.1% of those eligible for Medicare participating in the system at the time of record creation. While a national electronic summary record has been available since July 2012, the move to an opt-out system with the ongoing option to permanently delete their record at any time offers Australians an important choice about how they wish to interact with their personal health information.
There has been a global move to digitise health systems and data over recent years to improve the way clinicians access accurate health information at the point of care. This is hardly surprising given the critical importance of access to high-quality data in delivering safer care and better health outcomes for our patients. Some countries around the world are now developing digital services that allow people to access their own health information. The growth of these “personal health record” systems (Tang et al., 2006) – like Australia’s My Health Record – represent an important change for people, empowering them to play a more active and informed role in managing their health in partnership with their healthcare providers.
-----
https://www.itnews.com.au/news/doctors-warned-about-using-personal-phones-for-clinical-photos-530814
Doctors warned about using personal phones for clinical photos
By Matt Johnston on Sep 11, 2019 7:07AM
GP college issues new guidance.
The Royal Australian College of General Practitioners (RACGP) has cautioned doctors to think carefully before using personal phones for taking clinical photos and how those records are stored.
RACGP president, Dr Harry Nespolon, told iTnews that new guidance from the college on using personal phones for clinical work is about making sure they’re approached in a systematic way that protects both patients and doctors.
He said the ubiquity of phones with quality cameras has meant it’s become common practice for GPs to use their own phones to take photos, which are then uploaded to a patient’s medical record or sent to colleagues for a second opinion.
Doctors have also been known to snap particularly interesting or abnormal cases for the RACGP to use in exams, Nespolon added.
-----
These menstrual tracking apps reportedly shared sensitive data with Facebook
Some of the apps shared things like contraception use and other personal info, according to a UK advocacy group.
By Shelby Brown
September 10, 2019 5:52 AM PDT
New research from UK-based advocacy group Privacy International uncovered that some period-tracking apps were sharing sensitive data with Facebook. Tracking apps like MIA Fem and Maya shared information with the social network, including when the user logged contraception use, monthly periods and menstruation symptoms, the group said Monday.
Privacy International's research, reported earlier by BuzzFeed News, examined apps that it said had millions of downloads. The group found that Maya by Plackal Tech and MIA by Mobapp Development, were sharing extensive amounts of sensitive user information with Facebook and other third parties.
Plackal Tech said it has since removed both the Facebook core software development kit, or SDK, and Analytics SDK from the Maya app across all platforms. The app's CEO, John Paul, said that all data accessed by Maya is essential to the proper functioning of the product. Paul said predicting information pertaining to menstrual cycles is complex and dependent on thousands of variables
-----
GDPR and Digital Health: Is Your Software ‘Fit’ for Purpose?
Digital health technologies are a growing presence in our day-to-day lives - from the step-counter in your smartphone, to online consultations with a GP, to artificial intelligence (AI) virtual patient monitoring. The term ‘digital health’ captures technology of varying complexity, all with the similar aim of engaging with and improving an individual’s health and lifestyle, while improving efficiency. Given the evolution and rising popularity of these technologies on the consumer market, we look at some important data protection considerations that are setting the tone in this new era of digital health products.
What’s so special about health data?
As health, genetic or biometric data is particularly sensitive, its misuse poses greater risks to data subjects. The GDPR therefore designates it as a ‘special category of personal data’ that must be given additional protections. Digital health technology companies need to take care if processing this category of data.
When trying to make their app ‘fit for purpose’, our digital health technology clients often ask us questions like:
· How do I process health data lawfully?
· What privacy notices and pop-up messages should my app display?
· If my digital health app uses AI, does that impose any additional restrictions?
· Are there any restrictions around using automated decision-making?
-----
James Riley
September 7, 2019
Centrelink folds in Robodebt case
Wiping debts: Centrelinks is recalculating debts to nothing when the legal system gets involved
Centrelink has wiped clean the debt at the centre of a second Federal Court case challenging the controversial Robodebt data matching and debt recovery program.
Victorian Legal Aid said on Friday that its client Deanna Amato has been told her Robodebt of $2754 had been wiped, after a recalculation process found the true overpayment to be just $1.48.
The 33-year-old local government employee says Centrelink has refunded her over $1700, after it garnisheered her full tax return earlier this year. At the time, she had never spoken to anyone from Centrelink about the supposed debt.
This is the second of two test cases run by Legal Aid through the Federal Court where Centrelink had wiped the alleged debt before the cases were argued in court.
-----
Monday, 09 September 2019 14:25
Govt should stop misleading people over website blocks
The loud noise that the Federal Government is making over blocking websites that host videos with terrorist content is a futile attempt to show that it is doing "something" to prevent abhorrent material like the video of the Christchurch massacre from being accessible to people in Australia.
But only the uneducated would be deceived by all the talk and bluster.
For that is precisely what it is. Once a file is uploaded to the Internet, no matter where it is done, it is well-nigh impossible to get rid of it. Of course, those without a clue would be blocked by their ISPs.
But there are many people who use virtual private networks. Is the government planning to ban all use of VPNs?
-----
Head-spinning conspiracies: 5G technology joins the club
Authored by Jane McCredie
In the first place, nobody denies that certain harms and damages, which actually and visibly afflict men, animals, the fruits of the Earth, and which often come about by the influence of stars, may yet often be brought about by demons … Malleus Maleficarum, 1486
HUMANS have long believed in the power of evil, or harm, to be transmitted invisibly through the air.
The Malleus maleficarum, or Hammer of witches, was a medieval dummies’ guide to witches, instructing readers on how to unmask, interrogate and ultimately burn them.
While the Malleus’ intricate demonology saw the root cause of evil in supernatural creatures who seduced the all-too-willing witches, these days we are more likely to nominate government conspiracies as the source of all that is bad in the world.
Whether it’s fluoride or vaccines, vocal lobby groups accuse authorities of exposing them to terrible danger while hiding clear evidence of harm.
-----
Govts band together to create national disability dataset
By Justin Hendry on Sep 6, 2019 5:13PM
Pilot to cost $15 million.
Federal, state and territory IT ministers have agreed to pull together a national dataset on disabled Australians to start delivering better services.
The decision, taken at the first sitting of the newly re-badged Australian Data and Digital Council on Friday, paves the way for a federation-wide view of the disability sector.
Described as an “enduring longitudinal National Disability Data Asset”, the dataset is intended to “better understand how people with disability are supported through services, payments and programs” across the country.
It will initially begin life as a $15 million pilot funded by the federal government that will incorporate datasets from the federal, NSW, Victoria, Queensland and South Australian governments.
-----
Toward Comprehensive Patient-Centric Care by Integrating Digital Health Technology With Direct Clinical Contact in Australia
- Penelope Schofield1,2,3,4, BSc (Hons), PhD ;
- Tim Shaw5, BSc (Hons), PhD ;
- Michaela Pascoe2,6, BSc Psych (Hons), PhD
ABSTRACT
Background: There is an escalating crisis in health care, locally and internationally. The current health care model is unable to meet the increasing health care demands.
Objective: The aim of this study was to reconceptualize the provision of health care to produce better outcomes at no greater cost, by placing individuals in the position of authority to direct their own care, in a personalized, integrated health care system.
Methods: In this study, we used the Australian health care system as a model. We reviewed the current landscape of digital health in Australia and discussed how electronic medical records (EMRs) can be further developed into a personalized, integrated health care system.
Results: Some components of an EMR and digital health system are already being used in Australia, but the systems are not linked. A personalized, integrated health care model that is responsive to consumer needs requires not just a passive repository of medical information; it would require a team approach, including the government, health care funders, industries, consumers and advocacy groups, health care professionals, community groups, and universities.
Conclusions: Implementation of a personalized, integrated health care system can result in reduced pressure on the current health care system, and it can result in the delivery of best-practice health care, regardless of location. Importantly, a personalized, integrated health care system could serve as an education platform, “upskilling” not only clinicians but also, more importantly, patients and carers by providing them with accurate information about their condition, treatment options, medications, and management strategies. By proposing personalized, integrated health care, we offer an intelligent model of health care that is ubiquitous, efficient, and continuously improving.
J Med Internet Res 2019;21(6):e12382
doi:10.2196/12382
-----
Comments more than welcome!
David.
30 comments:
Re:
Toward Comprehensive Patient-Centric Care by Integrating Digital Health Technology With Direct Clinical Contact in Australia
https://www.jmir.org/2019/6/e12382/
"ABSTRACT
Background: There is an escalating crisis in health care, locally and internationally. The current health care model is unable to meet the increasing health care demands.
Objective: The aim of this study was to reconceptualize the provision of health care to produce better outcomes at no greater cost, by placing individuals in the position of authority to direct their own care, in a personalized, integrated health care system."
Could someone help me.
How realistic is it to expect people to be able direct their own healthcare? This claim is at the heart of the myhr "value proposition" so it's important to validate - or debunk - this claim.
There seem to be two assumptions
1. Doctors do not already discuss and agree with patients what the best treatment for the patient should be and how they are to be treated
2. Patients better understand their symptoms, test results, diagnoses and optimum treatment than someone who has done over a decade of medical training and has had (probably) years of experience.
Are these assumptions valid? Realistic?
My view is that both are, in general, (there are always exceptions) invalid and unrealistic, but I really want to be told if I'm wrong and why.
Bernard, I suggest we need to consider three issues:
1. the basis upon which we would reconceptualize our health system in order to address the crisis of growing demand and ballooning costs; the way we think about the concept of productivity is from production and fundamentally unfit for purpose;
2. the manner by which doctors, nurses and allied health clinicians can exercise effective control over the design of their models of care and the translation of these into effective enabling information flows; process is where the improvements in safety, quality and efficiency arise, not in a static EMR/EHR;
3. the manner by which we achieve substantial improvement in the quality of cooperation and collaboration, including effective involvement of patients and carers in the design of the healthcare services they benefit from and depend upon.
A place to start would be to have a serious look at the Renal Network spanning the ACT and Southern NSW Local Health District. I know because I am a Renal Transplant patient enjoying the benefits in their revolution in the quality of cooperation and collaboration.
Excellent John. You have pin-pointed root-core elements which are not easily solved, hence ever so conveniently and all too often ignored.
The manner by which (how best to) (what approach to adopt):
- when re-conceptualizing our health system
- how effective control over the design of (their) models of care can be exercised
- how effective information flows can be achieved
- how substantial improvement in the quality of cooperation and collaboration can be achieved
John,
Your scope/context is wider than mine, which is narrower - primarily the practice of clinical medicine.
Given that, I entirely agree with "process is where the improvements in safety, quality and efficiency arise, not in a static EMR/EHR;"
IMHO, what needs to change are processes of clinical medicine - an area that has recieved little attention, other than observations about current shortcomings; and there are plenty of those, including the futility of a static EMR/EHR.
@11:51 AM "when re-conceptualizing our health system"
Let's start / stop right there. Every hyped-up health bureaucrat, peak body 'expert', big-C Consultant, academics and multiple opportunistic technology actors, all have different ideas on how the health system should look and feel. And they all congregate round the table to push their ideas and drown each other out. And the end-result is .......... LOL.
@ 12:43 "your scope/context is wider than mine, which is narrower - primarily the practice of clinical medicine."
Are you saying that the problem that must first be 'fixed' is to change the way clinical medicine is practiced?
Not first, but if you do your research you'll find out that there are a lot of things that could and should be done a lot, lot better.
And clinical medicine is at the heart of the health system.
@1:12 PM It's a huge diversely complex system. Where would you start and who would listen?
Start with what the doctor actually does. Who will listen is the million dollar question.
I'm relying on others who better understand clinical medicine. I'm trying to understand the processes, not so much the content
If you are interested, read these books. It is very revealing.
Medical nemesis. The Expropriation Of Health
Ivan Illich, 1976
Follies and Fallacies In Medicine
Petr Skrabanek, James McCormick 1998
ISBN 1 870781 09 0
Crossing the Quality Chasm: A New Health System for the 21st Century
Committee on Quality of Health Care in America, Institute of Medicine 2001
ISBN: 0-309-51193-3
The Creative Destruction of Medicine: How the digital revolution will create better health care, Dr Eric J Topol, 2012
ISBN 978-0-465-02550-3
Improving Diagnosis in Health Care
Committee on Diagnostic Error in Health Care, Institute of Medicine 2015
ISBN 978-0-309-37769-0
Great references, even as far back as 1976.
Trying to understand the processes, not so much the content, is fraught with potholes and obstacles. The horse and cart are often inter-changeable. Not infrequently the content will determine the processes. So you will need to have a good understanding of content and therefore a fairly broad deep understanding and perspective of the role and impact of content.
I have only discovered seven processes in clinical medicine. Identifying how each process is currently being delivered is not that hard - you need to look at how clinicians are trained.
Another useful reference is
The Oxford handbook of thinking and reasoning
edited by Keith J. Holyoak, Robert G. Morrison.
ISBN 978-0-19-973468-9
Specifically
Chapter 37 Medical Reasoning and Th inking
Vimla L. Patel, Jose F. Arocha, and Jiajie Zhang
The references will give you, in part, the current state, there are other areas where clinical medicine is in trouble.
The really hard part is knowing what to do about it.
Implementing simplistic solutions from other industries might deliver some improvements at the risk of making things worse - e.g. overwhelming clinicians with lots of low value data and distracting them with administrative tasks to feed the computer.
I can tell you one thing for certain, this approach has not and will not deliver what is needed - the transformation of clinical medicine.
Like all true transformations, the change will come from thinking outside the box. In this case the box is one of medical science and technology. Both will be involved, but neither can deliver the change.
Mmmm, seven processes in clinical medicine. I like these, albeit 8.
1. Question, 2. Listen, 3. Observe, 4. Examine, 5. Test, 6. Analyse / Diagnose, 7. Treat, 8. Record.
I presume that your 7 processes in clinical medicine are an integral part of the patient journey. Is there a simple list of the 7 processes you can share with us?
Bernard, not many would know what you mean by 7 processes.
Bernard, my scope is necessarily wider and deeper than yours because in my view we have to have a solution framework that covers clinical reform, investment to achieve said reform and a way to address the constraints imposed by organization-centric thinking and acting, and the constraints imposed by EMR/EHRs.
The priority has to be enabling clinically-initiated reform because that is where the knowledge resides about the opportunity and the case for reform. Our challenge is to bring those opportunities to the table and enable progress to be made.
When I say the knowledge I am referring, in the first instance, to what changes in clinical practice would yield the results we seek--at the core we are talking about improved safety, quality and efficiency.
But it is actually more than that. It can include reconsideration of fundamental roles, responsibilities and obligations as well as the more vexing governance-related questions about how the public and private sectors of health can work together as well as service delivery crossing geographic, jurisdictional boundaries and professional silos.
For example, the Renal Network made some fundamental changes to rights and responsibilities, operates across the public and private boundary, and operates under a modified governance structure to facilitate the crossing of geographic and jurisdictional boundaries.
In regard to the investment case, the knowledge of where the opportunities lie provides the foundations for larger-scale roll-out of local innovation. Organized purposeful collaboration makes this a whole lot easier.
It is equally important that such innovations are not used as a Big Stick, such as occurred with the introduction of DRGs in the 1990s. We don't need to tell doctors how to practice. Some clinical teams already know what they would like to be able to do if only the barriers were lowered and some of the roadblocks removed. This is not to say that their ideas are not open to challenge; rather that the current top-down and technology-driven approaches actively stymie progress.
I would equally add that process and content have to go together because they are about process and action, particularly at the patient-specific level.
Finally, when you place the doctors, nurses and allied health at the centre of clinical reform and start to enable them to take more control of the evolution of health service delivery and new models of care and new business models, you are inevitably going to run up against organization-centric constraints--the most difficult of which is the Hospital Information System.
Whew. As you can see I have been privileged to be involved in a wide array of this larger health system discourse over the last 25 years. The real joy is seeing clinicians setting off on these journeys, facing the hardships and overcoming them through committed collaboration to deliver substantial improvements in health service delivery, particularly for patients and carers across a wide geographic expanse.
@5:32 PM The 8 processes you refer to reflect the steps a clinician goes through with the patient. All quite valid and fundamental processes in the doctor / patient interaction. However I think Bernard is referring to business-type processes as opposed to clinical processes. It would be more meaningful and less confusing if that was defined / clarified at the outset.
The processes I've used to model clinical medicine are:
1. Gather data to identify the current status of the patient (diagnosis)
2. Develop a prognosis (i.e predict what's likely to happen to the patient)
3. Identify options/choices
4. Agree with the patient the best option
either 5. refer to a specialist or 6. implement treatment (which can include do nothing)
7 Monitor the patient and loop back to 1.
@6:58 AM Interesting. Thank you for sharing the processes you’ve used to model clinical medicine. They are all valid, each step being an essential part of a patient’s journey.
Your first process step encompasses 6 embedded processes in order to arrive at “(diagnosis)” as notated @ 5:32 PM. (1. Question, 2. Listen, 3. Observe, 4. Examine, 5. Test, 6. Analyse / Diagnose).
Your second process step "developing a prognosis" and your third process step "determining options and making choices" are both arrived at by being based on current knowledge developed from past research and statistical predictions.
Your fourth process step is a subjective process discussing options with the patient and determining the patient’s wishes.
Your fifth and sixth process steps being "specialist referral and / or initiating treatment" equate to @5:32 PMs step 7. Treat which incorporates both initiating treatment and, if required, specialist referral.
Your seventh process step encompasses on-going management, review and monitoring of the patient. It closes the loop, such that if the patient is ‘cured’ they are discharged and the case-event is closed, otherwise progress to regular review and monitoring by returning to your first process step.
Not to be overlooked is 5:32 PMs step 8. Record, which you may wish to include as an essential part of each process; essential, because the record forms the foundation for communicating information about the patient to those who need to receive it.
@2:11 PM What you have described is basically the foundations upon which medicine is taught and practiced.
Reviewing Bernard’s comments @ 12:59 PM – my scope is primarily the practice of clinical medicine; and @ 1:12 PM there are a lot of things that could and should be done a lot, lot better, and clinical medicine is at the heart of the health system; and @4:12 PM identifying how each process is delivered is not that hard – you need to look at how clinicians are trained.
And at 2:21 PM Anon said “What (the processes) you have described is basically the foundations upon which medicine is taught and practiced”.
The conclusion I have come to from this discussion is that Bernard wants to change the way clinicians are trained in order to effect a “transformation of clinical medicine” (@4:12 PM).
re: "The conclusion I have come to from this discussion is that Bernard wants to change the way clinicians are trained in order to effect a “transformation of clinical medicine” (@4:12 PM). "
Almost.
I want to change the way clinicians are supported when doing their job.
Question:
How does current technology actually help doctors to diagnose patients?
For instance, in the Institute of Medicine reference, Improving Diagnosis in Health Care, there is a graph of "Number of journal articles published on health care topics per year from 1970 to 2010. Publications have increased steadily over 40 years."
In 2010 there were about 750,000 articles, the number having doubled in the previous ten years. The number now is probably well over 1.2million
It says in the article:
"health care professionals have difficulty keeping up with the breadth and depth of knowledge in their specialties. For example, to remain up to date, primary care clinicians would need to read for an estimated 627.5 hours per month (Alper et al., 2004). McGlynn and colleagues (2003) found that Americans receive only about half of
recommended care, including recommended diagnostic processes. Thus, clinicians need approaches to ensure they know the evidence base and are well-equipped to deliver care that reflects the most up-to-date information."
Furthermore, there are over 10,000 rare diseases which up to 10% of the population suffer from at any one time. Each disease may be rare but the total number of patients is significant.
How can clinicians keep up with existing knowledge, never mind new knowledge?
IMHO, clinicians are being overwhelmed by technology not helped.
re: "What you have described is basically the foundations upon which medicine is taught and practiced."
I have developed a conceptual model based upon my research/observations of the way medicine is conducted. so it's not surprising you recognise it
Medicine today implements that model in a certain way constrained by the knowledge and technology of the past.
What I'm trying to describe is a way to change the practice of clinical medicine to make it more effective and efficient.
My belief is that new tools and techniques need to be introduced into clinical medicine, not to bring about a wholesale replacement of existing methods etc, but to add to them in such a way that helps both clinicians and patients.
Bernard just pointing out when you use “technology” you refer to information technology? There all all sorts of technologies that do make medicine a marvel of our modern age, let’s not confuse that with the elephant in the room.
By technology I mean all forms of technology. Medical devices, biomedical devices, Xray, MRI, fMRI, CT scanners, drug delivery systems, test/monitor devices, prosthesis - anything that measures or impacts a patient.
@7:12 PM So are you saying that you want to change the practice of clinical medicine by introducing some new technology(ies) which will integrate all the data from "all the forms of technology" you just listed "in such a way that helps both clinicians and patients"
??? "new tools and techniques need to be introduced into clinical medicine". This sounds like a grand plan but how realistic is it?
@4:42 PM "Medicine today implements that model in a certain way constrained by the knowledge and technology of the past."
It sounds like you want to deploy technology like "Medical devices, biomedical devices, Xray, MRI, fMRI, CT scanners," and also 12 lead ECGs, Ultrasound, biometric markers, PET, EEG, MEG" differently from the way it is currently being used with the aim of improving medical knowledge and bringing about a new way of practicing clinical medicine.
@4:29 PM "clinicians are being overwhelmed by technology not helped." I disagree, all the technology listed at 7:12 PM, and there is a lot more very sophisticated technology to boot, is helping not hindering and certainly not overhauling. The only thing I can see that is overwhelming clinicians and hindering them in clinical practice is the inept design of the technology information systems used for recording patient clinical information. The My Health Record is a standout example.
I seem to remember lots of software innovation in the late 90's as actual software developers tried to develop software that doctors would actually pay money for. Sadly it was replaced by drug company sponsored "free" software and later we witnessed the effects of the government "helping" by handing out $$ to implement their idea of "useful". We now have the debacle where no one will actually correctly implement anything unless they get government $$ and government don't even insist that medical software/messages comply with any standards. The potential adverse events from that are quite scary and will be happening if it was actually looked for.
It really irks me when they step in and try and micromanage the most silly things in a day surgery and keep insisting on standards and "policies" on the most silly things that should be handled expectantly by trained people and yet let highly malformed messages and non-compliant software that directly effects patient care carry on as if its no big deal. My only conclusion is that IT is beyond their intellectual capacity so they just try and regulate simple common sense, which is against common sense!
After arriving at work first call is from another gastroenterologist who wants me to send Liver biopsy report. I tell them exact date and time they received it and the exact time the file was consumed.
They look up their system and say "That's a blank file" Its from one of the biggest pathology providers in the country and the failure to actually present the content of a liver biopsy report is a recipe for medical disaster. There solution is to have it faxed. I suggested they contact their software provider but didn't seem interested, I guess they are used to errors?
This must be happening hundreds of times a day all over the country, but no one investigates issues with software, its about time they did! So much carry on about medical error, but you can use software that has had no proper testing done on it!
Post a Comment