Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Saturday, October 26, 2013

Weekly Overseas Health IT Links - 27th October, 2013.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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CHOP Researchers Introduce Data Navigation Tool

October 17, 2013
A team of informatics experts and biomedical researchers at The Children's Hospital of Philadelphia (CHOP) have created a software toolkit that aims to help researchers navigate different forms of data.
The software toolkit, called Harvest, is an open-source, interactive framework that helps users navigate quickly among different types and levels of healthcare data from individual patient records to aggregated reports of all patients in a database. The software allows users to query data by different subjects, such as age or ethnicity, individual blood test results or MRIs, or including or excluding specific diagnoses.
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Toolkit designed to make biomedical data exploration easier

October 18, 2013 | By Susan D. Hall
Researchers have developed an open-source platform for creating software applications that make complex data understandable and accessible to those without sophisticated informatics expertise.
Commercial analytics tools tend to require biomedical researchers to understand underlying data models before being able to effectively explore and use large data sets, according to an article at the Journal of the American Informatics Association.
Researchers at the Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania have validated the platform, called Harvest, on two test cases: pediatric cardiology diagnostic and procedure data, and infectious disease data published by the OpenMRS open-source electronic health record (EHR) project.
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EHRs can integrate genomic information to improve patient care

October 14, 2013 | By Marla Durben Hirsch
Electronic health records can help accelerate and advance the use of genomic medicine, as demonstrated in several articles published in a special issue of Genetics in Medicine, the official journal of the American College of Medical Genetics and Genomics.
The publication, meant as a "getting started" guide for the integration of genomic information and EHRs, includes a series of articles written mostly by members of the National Human Genome Research Institute-sponsored Electronic Medical Records and Genomics (eMERGE) Network, a federally funded consortium of nine institutions that have pioneered the use of EHRs. The authors note that these advances cannot be accomplished without the use of EHRs.
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Big opportunities, still, for IT vendors

Posted on Oct 17, 2013
By Mike Miliard, Managing Editor
The healthcare market, especially health IT, remains "highly fragmented," with lots of openings for entrepreneurs who can solve providers' "pain points," according to the latest trend report from Berkery Noyes.
The report analyzes merger and acquisition activity for the healthcare sector during the first three quarters of 2013 and compares it with data from 2012. This market includes information and technology companies servicing the pharmaceutical, healthcare payer, and healthcare provider spaces.
"The healthcare market remains highly fragmented, with lots of opportunities for entrepreneurs with unique ideas looking to start companies that solve important pain points along the healthcare continuum," said Tom O'Connor, managing director at Berkery Noyes, in a press statement. "Large strategic buyers are also looking to acquire unique content/software solutions that are solving challenges in the healthcare market and are growing rapidly, offering exit opportunities for entrepreneurs at very attractive prices."
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£1m national leaflet drop on care.data

16 October 2013   Rebecca Todd
The government will spend £1m sending a patient information leaflet about the controversial care.data programme to every household in England.
As part of a joint £2m public awareness campaign being run by NHS England and the Health and Social Care Information Centre, 22m homes will receive the leaflet in January and extractions will begin in spring next year.
The total cost includes around £800,000 in funding for a helpline to answer people’s questions about the scheme, to help take the pressure off GP practices.
The A5 leaflet will not be addressed to anybody in the household, but will clearly indicate that it is from the NHS and explain how people can opt-out of their data being extracted.
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Report: Feds must make security less burdensome for workers

October 17, 2013 | By Susan D. Hall
Though insiders say federal agencies such as the U.S. Department of Health & Human Services and the Department of Veterans Affairs are vulnerable to cybersecurity threats, federal employees report bypassing burdensome security measures when those measures interfere with their work.
Federal security pros often fail to take user experience into account when implementing security measures, according to a new report by public-private partnership MeriTalk and underwritten by Akamai Technologies. The report urges federal security pros to work together with federal employees to ease their particular pain points while tightening security, according to an announcement.
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Sharp HealthCare Rises to the Challenges Posed by This Digital Age

by Fred Bazzoli Thursday, October 17, 2013
When Sharp HealthCare in San Diego flipped the switch to move to an electronic health record system about a dozen years ago, sorting out duplicate records and multiple patient identities was a big problem.
"When we first started the department in 2001, we were creating 18 duplicates a day across the whole system," said Tommy Egbert, supervisor of Sharp's master patient index department. "Now, we're doing about four duplications a month, so it's had a huge impact."
In addition to gaining experience over the years, Sharp has added patient identification technology, such as palm vein recognition biometrics, to avoid mix-ups with patient identities and records. Because of its efforts to keep duplications out of its records, it's been able to accurately share patient information within the system, increasing patient safety and reducing unnecessary services, thus saving money.
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The Case for Computer-Based Health Care

By Darius Tahir
October 16, 2013
The victory of Watson, an artificial-intelligence system designed to dominate the quiz show Jeopardy!, over the country's best nerds in 2011 may not be the equal of John Henry struggling against a steam-powered drill in the annals of man versus machine. But the replacement of Jeopardy!'s human competitors with a computer algorithm may signal a trend that could soon spread through the health care sector as Obamacare is implemented.
That's the prophecy of venture capitalist Vinod Khosla. Khosla, a prominent Silicon Valley investor, has predicted that computers will replace 80 percent of what doctors do in a couple of decades. The shift could counter another health-sector trend: stagnant productivity, which the Affordable Care Act aims to address with financial incentives for effective, efficient care, and which could encourage a move toward digital doctoring.
Between 1990 and 2010, productivity in the health care sector declined by 0.6 percent annually as employment increased by 2.9 percent, according to Robert Kocher, now a venture capitalist at Venrock, in an October 2011 editorial in the New England Journal of Medicine. Increasing productivity might bridge this disconnect, and computers could be part of the solution.
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Lack of encryption brings breach blunder

Posted on Oct 16, 2013
By Erin McCann, Associate Editor
Device encryption may seem like a fairly straight forward undertaking, but it's proven one which HIPAA-covered entities and business associates frequently forgo -- much to their chagrin down the road when they're notifying individuals of a privacy breach involving unencrypted personal data. 
Legal Aid Society of San Mateo, Calif. is now seeing this firsthand. The public interest law firm recently notified 3,200 clients that their protected health information was compromised after 10 unencrypted laptops containing clients' Social Security numbers, medical data, names and dates of birth were reported stolen. 
"We are sorry that this incident occurred and want to assure you we are carefully reviewing our procedures and practices to minimize the risk of recurrence," wrote LASSM Executive Director M. Stacey Hawver, in an Oct. 10 letter mailed out to affected clients. 
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Two Watson-based tools offer docs real-time analysis

October 16, 2013 | By Susan D. Hall
Scientists have trained IBM's "Jeopardy!" champ Watson to interact more naturally with doctors in two new projects aimed at improving patient care.
The work is a collaboration between IBM Research and the Cleveland Clinic along with Lerner College of Medicine of Case Western Reserve University.
WatsonPaths aims to help doctors diagnose patients and solve medical problems. To do so, it can understand spoken language and can consult reams of medical research in an instant, reports Crain's Cleveland Business.
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Cleveland Clinic, IBM Making Progress on Watson Supercomputer

OCT 15, 2013 3:14pm ET
A year after starting work with IBM to develop ways for the Watson supercomputer to support medical training and serve as a doctor’s assistant, the Cleveland Clinic has issued a progress report that includes two new technologies.
The clinic and IBM have developed WatsonPaths, a new process to train the supercomputer to interact with clinicians in a way that is more natural, enabling them to understand the data sources that Watson consulted and how it made recommendations.
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Watson joins the fight against cancer

Posted on Oct 18, 2013
By Mike Miliard, Managing Editor
First he won on Jeopardy!, now he's going to try to beat leukemia. The University of Texas MD Anderson Cancer Center announced Friday that it will deploy Watson, IBM's famed cognitive computing system, to help eradicate cancer.
The two organizations will leverage Watson's computing power to help clinicians uncover insights from MD Anderson's vast patient and research databases, officials say. After a yearlong collaboration, the two will showcase a prototype of MD Anderson's Oncology Expert Advisor, powered by Watson.
That technology seeks to integrate the knowledge of MD Anderson's clinicians and researchers, and to advance the cancer center's goal of treating patients with the most effective, safe and evidence-based standard of care available, say officials. Starting with the fight against leukemia, the Oncology Expert Advisor aims to help clinicians develop and fine-tune treatment plans for patients, while helping them recognize adverse events that may occur throughout the care continuum.
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Hurdles to big data use in healthcare more social than technical

October 16, 2013 | By Ashley Gold
Are the real hurdles to using big data in healthcare social and not technical? A report authored by Gina Neff, a professor in the department of communication at the University of Washington in Seattle argues just that, saying that big data won't cure us because although data-intensive modeling has immense potential, figuring out how to use it is a bigger challenge.
"The ways in which health technology innovators have talked about the power of data neglects key aspects of the social interoperability or integration of data into health solutions," Neff's report says. "How will such data be integrated into care providers work practices; through the complex routines of clinics and hospitals; and into existing legal, social, political and economic frameworks?"
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Big Ideas From The Forbes Healthcare Summit

Todd Hixon, Contributor
The Forbes Healthcare Summit in New York last week brought together very senior people across the U.S. healthcare spectrum: CEOs of big insurance companies, R&D heads of top pharma companies, CEOs of major medical centers, and CEOs of a few of the key upstarts: AthenaHeath, ASAP Urgent Care, Rothman Institute, MinuteClinic, etc. Here’s a summary of the big ideas that emerged.
No One Thinks Health Reform Is Going Away. Regardless of the drama in Washington, health reform is going ahead, and the major institutions are working to adapt to it. Beyond the ACA* the big driver for this is patient empowerment, which was the theme of the conference. Patients are being forced to pay more of the cost of their care, and because of this plus social change, they are taking more control and demanding more information and service.
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Is ONC more essential than shutdown reflects?

By Tom Sullivan, Editor
There is little debating that when HHS drafted its contingency blueprints for a government shutdown, the architects of that strategy had to make some very difficult decisions — literally gutting ONC among those.
“The fact is ONC’s work is very important and it does disappoint that they aren’t able to continue doing that,” former deputy principal director of ONC David Muntz said in an interview with Government Health IT after leaving the office for a new job. “Because ONC is focused on deployment of HIT, anything that might slow that down, I think, is unfortunate.”
Muntz was not alone in expressing such disappointment. And with meaningful use Stage 2 commencing on the same day much of the government closed down, not to mention the health insurance exchanges opening, the timing was, at best, ill-fated.
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Study: EHRs a Big Factor in Influencing Physician Satisfaction

OCT 14, 2013 4:10pm ET
Physicians believing they provide or facilitate high-quality care have higher professional satisfaction and how they feel about their electronic health records system plays a big role in that satisfaction.
Those are the key findings in a new study from RAND Corporation, which conducted in-depth surveys with 220 clinicians and administrators in 30 practices across six states. The American Medical Association sponsored the study.
“In the practices we studied, physicians approved of EHRs in concept, describing better ability to remotely access patient information and improvements in quality of care,” report authors note. “Physicians, practice leaders and other staff also noted the potential of EHRs to further improve both patient care and professional satisfaction in the future, as EHR technology--especially user interfaces and health information exchange--improves.
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Provider workflow suffers after poor EHR implementation process

October 16, 2013 | By Dan Bowman
While one intention of electronic health record implementation is to improve provider workflow, that was hardly the case for pair of southern California hospitals, Medscape Medical News reported.
In fact, EHR implementation had the exact opposite effect for residents at both Riverside County Regional Medical Center in Moreno, Calif., and Pomona Valley Hospital Medical Center in Pomona, Calif.; it increased the average time of residents for seeing patients and charting the visits from 21 minutes to 37 minutes.
"Some of us were really excited. We thought it would improve patient care," Maisara Rahman, M.D., who helps to train family-medicine residents at Riverside County, said during a talk at the American Academy of Family Physicians' annual meeting in San Diego in September, according to Medscape. "But when implementation started, we saw inefficiencies."
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Advice to the next National Coordinator

Posted on Oct 10, 2013
By John Halamka, CareGroup Health System, Life as a Healthcare CIO
Over the next few months, Jacob Reider will serve as the interim National Coordinator for Healthcare IT while the search continues for Farzad Mostashari's permanent replacement.
What advice would I give to the next national coordinator?
David Blumenthal led ONC during a period of remarkable regulatory change and expanding budgets. He was the right person for the "regulatory era."
Farzad Mostashari led ONC during a period of implementation when resources peaked, grants were spent, and the industry ran marathons every day to keep up with the pace of change. He was the right person for the "implementation era."
The next coordinator will preside over the "consolidate our gains" era. Grants largely run out in January 2014. Budgets are likely to shrink because of sequestration and the impact of fiscal pressures (when the Federal government starts operating again).
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CIOs push for patient ID progress

Posted on Oct 15, 2013
By Neil Versel, Contributing Writer
The patient identification issue refuses to go away, mainly because nobody has quite figured out how to assure proper patient identity when engaging in health information exchange. At the College of Healthcare Information Management Executives Fall CIO Forum in Phoenix last week, some leading hospital CIOs emphasized the operational, clinical and financial importance of accurate patient matching.
Joey Sudomir, senior vice president and CIO of Texas Health Partners – the healthcare management affiliate of Arlington, Texas-based Texas Health Resources – said it costs about $600 to $800 to remediate duplicate patient identities following hospital discharge.
The IT department at Sharp HealthCare in San Diego has 10 full-time-equivalent employees just to investigate and clean up duplicate records, at a cost of about $1 million a year, according to Senior VP and CIO Bill Spooner. Matching also goes on in other departments of the health system, so the overall price tag is probably significantly higher, Spooner said.
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EHR, informatics, health IT jobs 2.5% of all healthcare hiring

Author Name Jennifer Bresnick   |   Date October 11, 2013  
It might not sound like much, but 2.5% of all healthcare jobs are directly related to EHR system implementations, informatics, and other health IT strategies, according to research published in Industrial Relations: A Journal of Economy and Society. Most of the 434,282 positions open between 2007 and 2011 are due to opportunities created by the HITECH Act, says Aaron Schwartz and colleagues, with 39% of job listings posted by healthcare providers themselves.
Implementation support was the most sought-after skill, with 43% of listings requiring system installation, purchasing, or workflow design responsibilities.  This is not in the least surprising when correlated with the first stage of the EHR Incentive Program and the mad rush for providers to switch from paper to electronic record keeping.  The HITECH Act was associated with an 86% increase in monthly job postings containing the phrases “electronic health record” or “clinical informatics,” Schwartz says.
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Biometric Tools Edge Into Health Care

by John Moore, iHealthBeat Contributing Reporter Tuesday, October 15, 2013
The term "biometrics" refers to measuring human characteristics -- a central task of health care since the invention of the science.
Indeed, industry executives contend that biometrics aren't anything new in health care, noting that X-rays, computerized tomography scans and a host of other medical technologies all represent ways to measure the human body. What is new, however, is the use of biometric authentication in health care. This technology aims to use human traits such as fingerprints and iris patterns to validate identity. Biometric authentication is just beginning to play a role in health care, which some observers find surprising.
"Health care is a strange environment in the sense that on the clinical side of health care we probably have some of the ... world's best technology," said Paul Donfried, chief technology officer at LaserLock Technologies, a security technology vendor. "On the business side of health care, it is almost the opposite. We actually have some of the most antiquated IT systems and IT infrastructure you can find anywhere."
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HIX, A Disaster Foretold, Needs Time

Scott Mace, for HealthLeaders Media , October 15, 2013

It would be easy to focus on the price of the federal government's health insurance marketplace and expect it to work better than some Web startup launched by a couple of heavily-caffeinated kids. But it wouldn't be fair.

No one ever said information technology was foolproof. Even the most advanced systems today have their glitches. Now we can add healthcare.gov to the list.
Last week, at the CHIME conference, my informal poll of healthcare CIOs found broad agreement that it's no surprise the federal health insurance exchange Web site, healthcare.gov, has been overwhelmed by the number of unexpected visitors and other basic flaws.
Here's one example of how bad it is: A New York Times researcher successfully registered, but despite "more than 40 attempts over the next 11 days," was reportedly unable to log into healthcare.gov.
"I know the government spends a lot of money on their contractors and Web sites, and I also know that it's very difficult for them to make changes because of the process the government may go through," said Pam McNutt, senior vice president and CIO of Methodist Health System in Dallas, TX.
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Robot Surgery Damaging Patients Rises With Misleading Marketing

OCT 10, 2013 1:26pm ET
Porter Adventist Hospital in Denver announced last year that Warren Kortz, a general surgeon on the medical staff, was the first in the Rocky Mountain region to use a technique known as robotic surgery to remove gall bladders through one incision in the belly button.
The operation, performed while the doctor sits at a video- game-like console, was “taking advantage of another breakthrough in robotic surgery” and is “easier on the patient,” the hospital said in a press release.
“It’s Star Wars stuff,” Kortz was quoted as saying in another article put out by the hospital touting another operation, robot-assisted parathyroid surgery, in 2010. “My prediction is it will eventually replace everything else.”
What the hospital and Kortz didn’t reveal was the risk. Even as Kortz promoted robotic surgery, 10 patients he treated suffered injuries or complications between 2008 and 2011, according to an April complaint by the Colorado Medical Board. Five had arteries punctured or torn. Objects were temporarily left inside two, and others had nerve damage. One died and another needed cardiopulmonary resuscitation. The complaint charges Kortz with 14 counts of unprofessional conduct, including sometimes not advising patients on alternatives to the robot.
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HIE shows cost savings in emergencies

Posted on Oct 14, 2013
By Mike Miliard, Managing Editor
Beyond improving the quality of emergency care, giving physicians access to data from a health information exchange saved nearly $2,000 per patient during a study unveiled Monday by the American College of Emergency Physicians.
The research tracked patient care over a 12-month period, starting February 2012, during which there were 325,740 patient encounters and 7,525 log-ons to the HIE by 231 eligible clinicians at 11 emergency departments in South Carolina, according to ACEP. The study was based on a sample of 532 patients from this population who had information available in the HIE and for whom the clinicians caring for the patients completed a survey.
"Nearly 90 percent of participants [89 percent] said that quality of patient care was improved, and 82 percent of participants said that valuable time was saved, reporting a mean time savings of 105 minutes per patient," according to study author Christine Carr, MD, of the Medical University of South Carolina, in a news release.
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Empathy essential for patient engagement success

October 14, 2013 | By Susan D. Hall
Though technology can go a long way to help engage patients in their own health care, a little empathy can be an essential ingredient, according to an article published at CIO.com.
Wearable tech and medical devices, patient portals, personal health records and mobile apps hold the potential to improve care, but to do so, patients and physicians must use them and organizations must integrate them into traditional efforts to engage patients, the article says.
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Health Insurance Exchanges Plagued By Data Errors

Health insurance exchanges, especially the one run by Uncle Sam, are having problems sending files that can be opened and that have complete information.
The unexpected volume of visitors that overwhelmed the federally operated health insurance exchange last week is only one of many problems confronting this entity and the state-based exchanges.
For starters, some insurance companies have received faulty enrollment data from the U.S.-run insurance exchange, according to insurance industry consultants interviewed by Bloomberg News. Either the plans have been unable to open files forwarded to them from the exchange or have found that the information on the enrollees is incomplete.
According to consultant Bob Laszewski, the plans are trying to fix the errors manually. Another consultant, Dan Schuyler, told Bloomberg that unless these problems are rectified in the next few weeks, some enrollees might not have coverage on Jan. 1, 2014.
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Enjoy!
David.

Friday, October 25, 2013

Now This Is The Real Bleeding Edge. Fantastic Stuff Out Of Science Fiction!

This stuff seeming almost from the future appeared a little while ago.

Watson joins the fight against cancer

Posted on Oct 18, 2013
By Mike Miliard, Managing Editor
First he won on Jeopardy!, now he's going to try to beat leukemia. The University of Texas MD Anderson Cancer Center announced Friday that it will deploy Watson, IBM's famed cognitive computing system, to help eradicate cancer.
The two organizations will leverage Watson's computing power to help clinicians uncover insights from MD Anderson's vast patient and research databases, officials say. After a yearlong collaboration, the two will showcase a prototype of MD Anderson's Oncology Expert Advisor, powered by Watson.
That technology seeks to integrate the knowledge of MD Anderson's clinicians and researchers, and to advance the cancer center's goal of treating patients with the most effective, safe and evidence-based standard of care available, say officials. Starting with the fight against leukemia, the Oncology Expert Advisor aims to help clinicians develop and fine-tune treatment plans for patients, while helping them recognize adverse events that may occur throughout the care continuum.
"One unique aspect of the MD Anderson Oncology Expert Advisor is that it will not solely rely on established cancer care pathways to recommend appropriate treatment options," said Lynda Chin, MD, professor and chair of genomic medicine and scientific director of the Institute for Applied Cancer Science at MD Anderson, in a press statement.
"The system was built with the understanding that what we know today will not be enough for many patients," she added. "Therefore, our cancer patients will be automatically matched to appropriate clinical trials by the Oncology Expert Advisor. Based on evidence as well as experiences, our physicians can offer our patients a better chance to battle their cancers by participating in clinical trials on novel therapies."
First in Watson's sights: leukemia, which causes nearly one-third of all cancer deaths in children and adolescents younger than 15 years, according to the Leukemia and Lymphoma Society.
The technology is expected to be accessible to the cancer center's network of clinicians through a computer interface and supported mobile devices, say MD Anderson officials. This provides clinicians – and in turn, patients – with immediate, worldwide access to MD Anderson's expertise and resources, and to IBM Watson's technology prowess in quickly extracting crucial insights from large volumes of complex data.
With more than 100,000 patients cared for each year, MD Anderson has amassed a huge trove of clinical oncology data, but extracting usable insights from it all has proven difficult. Watson will try to extract and make sense of crucial information that might be otherwise trapped in databases, or in the electronic medical records of other providers.
Lots more here:
We also have this from the bleeding edge.

The Rapid Advance of Artificial Intelligence

By JOHN MARKOFF
Published: October 14, 2013
The jubilant and occasionally squealing attendees appeared to have no idea that next door a group of real-world wizards was demonstrating technology that only a few years ago might have seemed as magical.
The scientists and engineers at the Computer Vision and Pattern Recognition conference are creating a world in which cars drive themselves, machines recognize people and “understand” their emotions, and humanoid robots travel unattended, performing everything from mundane factory tasks to emergency rescues.
C.V.P.R., as it is known, is an annual gathering of computer vision scientists, students, roboticists, software hackers — and increasingly in recent years, business and entrepreneurial types looking for another great technological leap forward.
The growing power of computer vision is a crucial first step for the next generation of computing, robotic and artificial intelligence systems. Once machines can identify objects and understand their environments, they can be freed to move around in the world. And once robots become mobile they will be increasingly capable of extending the reach of humans or replacing them.
Self-driving cars, factory robots and a new class of farm hands known as ag-robots are already demonstrating what increasingly mobile machines can do. Indeed, the rapid advance of computer vision is just one of a set of artificial intelligence-oriented technologies — others include speech recognition, dexterous manipulation and navigation — that underscore a sea change beyond personal computing and the Internet, the technologies that have defined the last three decades of the computing world.
“During the next decade we’re going to see smarts put into everything,” said Ed Lazowska, a computer scientist at the University of Washington who is a specialist in Big Data. “Smart homes, smart cars, smart health, smart robots, smart science, smart crowds and smart computer-human interactions.”
The enormous amount of data being generated by inexpensive sensors has been a significant factor in altering the center of gravity of the computing world, he said, making it possible to use centralized computers in data centers — referred to as the cloud — to take artificial intelligence technologies like machine-learning and spread computer intelligence far beyond desktop computers.
Apple was the most successful early innovator in popularizing what is today described as ubiquitous computing. The idea, first proposed by Mark Weiser, a computer scientist with Xerox, involves embedding powerful microprocessor chips in everyday objects.
Steve Jobs, during his second tenure at Apple, was quick to understand the implications of the falling cost of computer intelligence. Taking advantage of it, he first created a digital music player, the iPod, and then transformed mobile communication with the iPhone. Now such innovation is rapidly accelerating into all consumer products.
“The most important new computer maker in Silicon Valley isn’t a computer maker at all, it’s Tesla,” the electric car manufacturer, said Paul Saffo, a managing director at Discern Analytics, a research firm based in San Francisco. “The car has become a node in the network and a computer in its own right. It’s a primitive robot that wraps around you.”
Here are several areas in which next-generation computing systems and more powerful software algorithms could transform the world in the next half-decade.
Lots more here:
This is really getting just more and more exciting. Both are must reads!
David.

Thursday, October 24, 2013

I Think This Is One Of The Most Important Economist Editorials In A Long While. Science May Have Lost Its Way.

This appeared late last week.

How science goes wrong

Scientific research has changed the world. Now it needs to change itself

Oct 19th 2013 |From the print edition
A SIMPLE idea underpins science: “trust, but verify”. Results should always be subject to challenge from experiment. That simple but powerful idea has generated a vast body of knowledge. Since its birth in the 17th century, modern science has changed the world beyond recognition, and overwhelmingly for the better.
But success can breed complacency. Modern scientists are doing too much trusting and not enough verifying—to the detriment of the whole of science, and of humanity.
Too many of the findings that fill the academic ether are the result of shoddy experiments or poor analysis (see article). A rule of thumb among biotechnology venture-capitalists is that half of published research cannot be replicated. Even that may be optimistic. Last year researchers at one biotech firm, Amgen, found they could reproduce just six of 53 “landmark” studies in cancer research. Earlier, a group at Bayer, a drug company, managed to repeat just a quarter of 67 similarly important papers. A leading computer scientist frets that three-quarters of papers in his subfield are bunk. In 2000-10 roughly 80,000 patients took part in clinical trials based on research that was later retracted because of mistakes or improprieties.
What a load of rubbish
Even when flawed research does not put people’s lives at risk—and much of it is too far from the market to do so—it squanders money and the efforts of some of the world’s best minds. The opportunity costs of stymied progress are hard to quantify, but they are likely to be vast. And they could be rising.
One reason is the competitiveness of science. In the 1950s, when modern academic research took shape after its successes in the second world war, it was still a rarefied pastime. The entire club of scientists numbered a few hundred thousand. As their ranks have swelled, to 6m-7m active researchers on the latest reckoning, scientists have lost their taste for self-policing and quality control. The obligation to “publish or perish” has come to rule over academic life. Competition for jobs is cut-throat. Full professors in America earned on average $135,000 in 2012—more than judges did. Every year six freshly minted PhDs vie for every academic post. Nowadays verification (the replication of other people’s results) does little to advance a researcher’s career. And without verification, dubious findings live on to mislead.
----- Lots Omitted
Science still commands enormous—if sometimes bemused—respect. But its privileged status is founded on the capacity to be right most of the time and to correct its mistakes when it gets things wrong. And it is not as if the universe is short of genuine mysteries to keep generations of scientists hard at work. The false trails laid down by shoddy research are an unforgivable barrier to understanding.
What does this mean for those interested in e-Health. To me the implication of all this means a number of things
First we need assessments of e-Health and publications that are done with a view to being replicable and transparent.
Second we need the end points being examined in the studies to be clinical outcome focussed and to be demonstrably achievable in the real world. The difference between finding an effect with a bespoke hand crafted solution in just one hospital and seeing an improvement in population health based measures related to Health IT is just vast.
Third we need to make sure, as the article points out, that failures are documented to we can be sure lessons learnt are being properly documented and understood.
Fourth we need to be sure that whatever is measured in a study is genuinely clinically meaningful.
Last for me we really do need to see publication when it is likely to make a difference rather than just because the publish or perish paradigm is active. I would much rather read 20 quality meaningful publications a year than the zillion abstracts that seem to always be floating around and which make it very hard so see to wood for the trees.
The scientific endeavour has made a great contribution to the world but if don’t focus on quality (and replicability) rather than quantity we may do ourselves enormous harm.
The pressures on Australian Universities at present are pretty extreme and it is important these pressures do not lead to poor quality rushed research.
David.

Wednesday, October 23, 2013

This Is A Reassuring Finding On Patient Access To Pathology Results. Makes Most Happy Apparently.

The following popped up a little while ago.

Patients like seeing lab results online

October 7, 2013 | By Ashley Gold
Patients able to view their lab results online overwhelmingly reacted positively to being able to do so, according to a new study published in the Journal of Participatory Medicine.
The study conducted an email survey of Kaiser Permanente members who had viewed at least one test result online in the last year, with 1,546 respondents. According to the study, survey participants reported, "high levels" of satisfaction, appreciation, calm, happiness and relief. Few were confused, upset or angry at being able to see lab results online. 
After reviewing results online, the most common actions were discussing results with family and friends, looking up information online or making a graph of results over time. It was also important for doctors to set patients' expectations--in doing so, they were less likely to follow up on test results by calling, emailing or setting up new appointments, according to the study.
"The findings that patients largely react positively to seeing test results online should be reassuring to physician practices that are considering adding a patient portal with PHR to their practice websites," study authors wrote. The study results could serve as a good reason to expand test outcomes online for practices already using patient portals.
…..
To learn more:
- read the
study
Lots more here with additional relevant links.
This is a useful study and is really worth close reading:
The direct link is here:
The full paper is accessible for free.
One worry is that a small but significant minority - considering the number of results that are generated were confused, anxious or angry.
Clearly having the doctor being able to set expectations and to comment directly to the patient are useful features.
David.

Tuesday, October 22, 2013

Does Anyone Else Find This Rather Confusing? NASH Strikes Again It Would Seem!

The following appeared a little while ago.

NASH PKI certificates

About NASH PKI certificates

Healthcare providers and participating supporting organisations need to have a National Authentication Service for Health (NASH) Public Key Infrastructure (PKI) certificate to access the Personally Controlled Electronic Health (eHealth) Record system.
For example, your organisation needs a NASH PKI certificate to securely access the eHealth record system to add information to your patient's eHealth record.
Depending on the NASH PKI certificate you’re issued with:
  • you can access the eHealth record system
  • you can identify other healthcare providers and supporting organisations who send health information to you
  • any information you send to other healthcare providers is secure and any unauthorised change can be detected, and
  • any information you send can be made confidential and can only be opened by the person or organisation it is addressed to
However NASH PKI certificates can't be used to access the Healthcare Identifiers (HI) Service or claim Medicare benefits.
NASH PKI certificates were previously called Department of Human Services eHealth Record Individual or Organisation PKI Certificates. If you currently use an eHealth record PKI certificate and you renew your certificate, you will receive a NASH PKI certificate, and it will be valid for 2 years.
Lots more is found here:
Two things stuck me here.
First NASH now seems to have been implemented as a simply as a name change - so it seems that commentary that NEHTA did not know what they were doing and should have just gone straight to Medicare Australia for help right from the start was close to the truth.
Secondly why are we now expecting people to have different PKI certificates for the IHI Service and Medicare Claiming and for the PCEHR? Why can’t a practice have an organisational certificate for billing and individual certificates for access to the PCEHR?
Here is the page that tells you all about the older system.
Surely there could have been a simpler way that might have made life a lot easier for practices. So much for the Government ambition to reduce red-tape!
David.

Monday, October 21, 2013

Weekly Australian Health IT Links – 21st October, 2013.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Well, quite an interesting week with the peak GP body coming out and wanting some PCEHR improvements and or changes. Will be interesting to see if there is any response.
As far as I can tell we have had no substantive health policy of any sort announced since the election. Going to ground hardly describes just how quiet the Ministers have been since the election. Either they have nodded off or there is a lot of paddling happening under the apparently serene swan on the surface.
Time will tell.
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Doctors ready to pull plug on eHealth

By Julian Bajkowski 
Australia’s long and troubled efforts to create a functioning national system of electronic health and medical records system is once more close to collapse.
The Australian Medical Association has expressed serious concerns over clinician input into the project following the shock resignation of highly respected clinical representative Dr Mukesh Haikerwal from the National eHealth Transition Authority (NeHTA) this week.
Other crucial clinical advisors, including Dr Nathan Pinksier and other clinical leads are also understood to have quit signalling a severe breakdown in relations between doctors and Department of Health and Ageing.
A loss of confidence by doctors in either DoHA or or NeHTA would, in practical terms, shut-off political life support for the circa $1 billion Personally Controlled Electronic Health Record (PCEHR) project because the scheme cannot work unless doctors voluntarily agree to use it.
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Concerns over clinical use of e-health records

16th Oct 2013
GENERAL practice leaders have called on the federal government to address concerns about the clinical use of the personally controlled electronic health record (PCEHR) after the project’s most senior leaders quit en masse.
In August, five of the top National E-Health Transition Authority (NEHTA) clinical leads, including the project’s most vocal proponent, Dr Mukesh Haikerwal, resigned amid reports of souring relations between the advisers and the Department of Health and Ageing because of claims the department was taking an increasingly central role in the rollout.
Today, United General Practice Australia (UGPA) – the umbrella group comprising the AMA, the RACGP, the RDAA and others – said the government, which is now the PCEHR operator, must make an “urgent priority” of addressing “significant clinical utility issues” associated with it.
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GPs raise concerns over e-health record system

Australia’s general practice (GP) leaders are calling on the federal government to heed what they say are concerns raised by GPs regarding the “significant clinical utility issues” associated with the Personally Controlled eHealth Record (PCEHR) system.
The GPs, through the United General Practice Australia (UGPA) – the overarching organisation comprising a number of Australia’s medical bodies- say the government needs to give urgent priority to addressing the issues with the PCEHR system.
According to the UGPA, its members meeting in Canberra unanimously agreed that the focus of the PCEHR needs to be redirected to clinical utility and standardisation to ensure seamless clinical adoption.
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Dubbo trailing on eHealth uptake

By PHILIP LY

Oct. 14, 2013, 4 a.m.
PEOPLE of Dubbo have been slow to take up the federal government's eHealth record system rolled out more than a year ago.
According to a spokesperson for the Australian Government Department of Health, there are around 1000 residents who have registered for the personally controlled eHealth record system (PCEHR) in Dubbo, which stores all medical records to make receiving the right treatment faster, safer and easier.
"In Dubbo, the Western NSW Medicare Local (WML) is supporting the uptake of consumer education and registration for the PCEHR... which currently has one million patients nationally," the department spokesperson said.
eHealth gives individuals the power to determine what records go into a secure online summary of personal medical information.
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Confirmation needed on e-script incentive

16 October, 2013 Nick O'Donoghue
The Pharmacy Guild of Australia is seeking urgent confirmation that the new Federal Government will deliver the Electronic Prescription Scanning Incentive, which was announced by Labor before the recent election.
Under the proposal by the previous government, pharmacists would be eligible to claim up to $2000 per pharmacy if they use electronic prescription scanning systems, as reported by Pharmacy News.
David Quilty, Guild executive director, said the incentive was fully funded under the Fifth Community Pharmacy Agreement, and was “a critical step along the road towards a paperless script environment”.
“We have no reason to believe that the new Minister [for Health, Peter Dutton] is not committed to this incentive,” he said in the Guild’s Forefront newsletter today.
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Telstra sees growth in Asia, e-Health, NAS and connectivity

By Owen Raskiewicz - October 15, 2013
Today Telstra (ASX: TLS) shareholders went to company’s AGM armed with over 1,600 questions on the NBN, remuneration, dividends and redundancies.
Chair Catherine Livingstone and CEO David Thodey passed briefly over redundancies and dividends, telling shareholders the telco has performed well and they expect dividends to be reviewed on a six-month basis in 2014. The future of the NBN remains largely unknown as a result of ongoing reviews within the NBN Co.
Telstra also defends its position on offshoring as the dynamics of the industry change, allowing more customer service online whilst improved standards means overseas call centres have no excuses regarding poor service. In addition Mr Thodey said, “Ultimately, our aim is to keep creating new jobs that are sustainable in an increasingly digital, mobile and global world, and that’s what we’re doing.”
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Health Information Technology WA (HITWA) 2013

By Australian Ageing Agenda on September 18, 2013 in Conferences & Events
HITWA 2013 – WA’s premier e-health and health informatics event
•Friday, 8 November at the Perth Convention and Exhibition Centre
Don’t miss this unique opportunity to attend the only dedicated event that deals specifically with the unique challenges and opportunities for e-health in Western Australia. You will hear from and network with national leaders and experts.
This year’s conference theme, “The Road to Reform: Challenges, Innovations and Success” brings together a diverse range of industry professionals and academics to share their knowledge and stories.
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Quality health records in Australian primary healthcare - A guide

Quality health records in Australian primary healthcare: A guide was developed by an inter-professional Advisory Group in consultation with colleagues across the Australian primary healthcare sector. The guide is:
  • designed to assist health professionals produce, manage and use high quality health records that are fit for a range of purposes including safe clinical decision making, good communication with other health professionals, trustworthy partnerships with patients and effective continuity of patient care.
  • applicable to all health professionals operating in the Australian primary healthcare sector whether as solo practitioners, members of single-discipline practice teams, members of multidisciplinary practice teams or members of larger organisations.
  • comprehensive in covering electronic health record systems, paper-based health record systems and hybrid health record systems and describes a set of core principles and practical examples to illustrate particular principles in day-to-day clinical practice. 
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Older people net savvy but web costs can leave them lonely

Date  October 15, 2013

Kate Hagan

Older Victorians with home internet are more connected to their families and communities but cost is a major barrier, leaving many isolated.
A VicHealth survey of 25,000 Victorians has highlighted a digital divide that is having a detrimental effect on the health and wellbeing of those aged 65 years and older.
The survey showed that use of the internet at home declined with age, with 98 per cent of 18 to 24-year-olds having home access compared with 43 per cent of those older than 75.
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Slow NBN rollout contributing to digital literacy deficit

"If you don't have the NBN, you won't generate the digital literacy to maximise the use of it," says Flinders University's associate head of ICT
The slow roll out of the National Broadband Network is contributing an ongoing digital literacy deficit across Australia, especially in telehealth, according to speakers at the Connected Australia event in Sydney.
“There's a lot of up-skilling to do, in particular at the home end or recipient end of healthcare. There's a notion of build it and they will come: If you don't have the NBN, you won't generate the digital literacy to maximise the use of it. So it's a little like chicken and egg,” said Professor Colin Carati, associate head of ICT at Flinders University.
Roy Monaghan, national telehealth delivery officer at the National Aboriginal Community Controlled Health Organisation (NACCHO), agreed, saying the lack of reliable broadband in remote and rural Australia has contributed to a digital divide.
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Stephen Conroy 'root cause' of NBN woes

  • Anthony Klan and Annabel Hepworth
  • The Australian
  • October 15, 2013 12:00AM
FORMER communications minister Stephen Conroy was the "root cause" of Labor's "abysmal" handling of the National Broadband Network, according to construction industry heavyweight David Chandler.
Mr Chandler, who was the deputy chairman of Labor's $14 million inquiry into the school buildings stimulus scheme, said Senator Conroy's attempt to blame NBN delays on contractors was an "awful attempt to rewrite history".
Addressing an Australian Computer Society event in Sydney on Friday, Senator Conroy cited a "failure of the construction industry to mobilise resources" for the NBN's woes.
But Mr Chandler said the NBN delays were a result of a lack of skills within the former communications department and an "arrogant indifference" from Senator Conroy's office regarding solving problems when they arose.
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Fibre backers admit Labor NBN failures

SUPPORTERS of a fibre-to-the-home National Broadband Network agree that Labor's targets for the NBN were flawed and "overly ambitious".
Speaking at an Australian Computer Society luncheon last week, former communications minister Stephen Conroy admitted it was "undeniable" that NBN Co had failed to meet its targets and said he would not be barracking for his old job back on the opposition frontbench.
He said the fibre rollout was "significantly lagging due to the failure of the construction industry to mobilise resources" and nominated two major decisions that had impeded the NBN rollout.
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Queensland Health seeks servers for UNIX hardware replacement project

Invitation for offer covers four buildings and has expected contract period of five years.
The Queensland Department of Health has invited bids to install servers for a UNIX hardware replacement project.
The UNIX project aims to upgrade the ICT powering healthcare services in the state, prioritising “critical failing or at capacity UNIX hardware” across the department, according to an invitation to offer dated 11 October.
Under the invitation, the department seeks a single supplier who can provide four SPARC T4-1 and eight SPARC T5-2 servers, Oracle standard system installation services and Oracle premier support. The tender covers four of the department’s buildings in the state and has an expected contract period of five years.
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Obamacare portal suffers from common e-health government disorders

The Affordable Care Act site has malfunctioned due to scalability issues, political squabbling and unreasonable deadlines
The U.S. governments healthcare portal is under emergency care, afflicted by ailments that have sickened many government IT health systems worldwide.
Two weeks after it opened, users still struggle to gain access and sign up for insurance under the terms of the Affordable Care Act, President Barack Obama's signature legislation.
Financial, technical and managerial missteps caused the crisis, and fixing the US$400 million system could take up to two months, the New York Times wrote on Sunday.
The causes for the fiasco are varied and include unfeasible deadlines, scalability issues and bickering politicians.
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Suzanne Robinson: Healthy change

Suzanne Robinson
Monday, 14 October, 2013
AUSTRALIA’S new federal government has a lot to do to improve population health and maintain Australia’s place as a high performing health care system.
Existing primary care services are fragmented and focused largely around general practice, hospital services are costly and overutilised, and the system fails to seriously focus on disease prevention and health promotion activity. There are also gaps and inequities in access to services and variations in health outcomes between different population groups.
The system is often criticised for being provider-centric rather than patient-focused.
There have also been some whisperings around the fate of Medicare Locals under a Coalition government.
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Bionic man lives with artificial parts

  • AP
  • October 14, 2013 10:07AM
A TEAM of engineers has assembled a robot using artificial organs, limbs and other body parts that comes tantalizingly close to a true "bionic man."
The parts hail from 17 manufacturers around the world. This is the first time they've been assembled together, says Richard Walker, managing director of Shadow Robot Co. and the lead roboticist on the project.
"(It's) an attempt to showcase just how far medical science has gotten," he says.
The term "bionic man" was the stuff of science fiction in the 1970s, when a popular TV show called "The Six Million Dollar Man" chronicled the adventures of Steve Austin, a former astronaut whose body was rebuilt using artificial parts after he nearly died.
Walker says the robot has about 60 to 70 per cent of the function of a human. It stands six-and-a-half feet tall and can step, sit and stand with the help of a Rex walking machine that's used by people who've lost the ability to walk due to a spinal injury. It also has a functioning heart that, using an electronic pump, beats and circulates artificial blood, which carries oxygen just like human blood.
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Microsoft releases Windows 8.1, a year in the making

Date October 17, 2013 - 12:10PM

Ryan Nakashima

Microsoft is releasing its long-awaited Windows 8.1 upgrade as a free download starting Thursday night.
It addresses some of the gripes people have had with Windows 8, the dramatically different operating system that attempts to bridge the divide between tablets and PCs.
Windows 8.1 still features the dual worlds that Windows 8 created when it came out last October.
On one hand, it features a touch-enabled tile interface resembling what's found in tablet computers.
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Enjoy!
David.