The Impact of Web 2.0 and Big Data on Health Care.

The Journal of Medical Internet Research (JMIR) Vol 10 Issue 3.0 is publishing an interesting issue on the impact of Web 2.0 technologies on Healthcare.

The abstract of the introductory editorial is below.

Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness

Gunther Eysenbach, MD, MPH

Corresponding Author:

Gunther Eysenbach, MD, MPH

Centre for Global eHealth Innovation

University of Toronto and University Health Network

90 Elizabeth Street

Toronto ON M5G 2C4

Canada

Phone: +1 416 340 4800 ext 6427

Fax: +1 416 340 3595

Email: geysenba [at] uhnres.utoronto.ca

ABSTRACT

In a very significant development for eHealth, a broad adoption of Web 2.0 technologies and approaches coincides with the more recent emergence of Personal Health Application Platforms and Personally Controlled Health Records such as Google Health, Microsoft HealthVault, and Dossia. “Medicine 2.0” applications, services, and tools are defined as Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies and/or semantic web and virtual reality approaches to enable and facilitate specifically 1) social networking, 2) participation, 3) apomediation, 4) openness, and 5) collaboration, within and between these user groups. The Journal of Medical Internet Research (JMIR) publishes a Medicine 2.0 theme issue and sponsors a conference on “How Social Networking and Web 2.0 changes Health, Health Care, Medicine, and Biomedical Research”, to stimulate and encourage research in these five areas.

(J Med Internet Res 2008;10(3):e22)
doi:10.2196/jmir.1030

KEYWORDS

Cooperative Behavior; Education; Information Storage and Retrieval; Interpersonal Relations; Organizational Innovation; Social Behavior; User-Computer Interface; Online Systems; Patient Education as Topic; Terminology as Topic; Medical Record Linkage; Self Care; Internet; Health Communication; Collaboration; Research

The full editorial is found here:

http://www.jmir.org/2008/3/e22/

The table of contents for the whole issue is found here:

http://www.jmir.org/2008/

The full editorial and the associated articles are well worth a browse.

On a similar Nature has published a series of articles on what is termed ‘Big Data’. The following is part of the introductory editorial

Editorial

Community cleverness required

Abstract

Researchers need to adapt their institutions and practices in response to torrents of new data — and need to complement smart science with smart searching.

The Internet search firm Google was incorporated just 10 years ago this week. Going from a collection of donated servers housed under a desk to a global network of dedicated data centres processing information by the petabyte, Google's growth mirrors that of the production and exploration of data in research. All of which makes this an apt moment for this special issue of Nature, which examines what big data sets mean for contemporary science.

'Big', of course, is a moving target. The portability of the tens of gigabytes we carry around on USB sticks would have seemed like fantasy a few years ago. But beyond a certain point, as an increasing number of research disciplines are discovering, the vast amounts of data are presenting fresh challenges that urgently need to be addressed.

The issue is partly a matter of the sheer scale of today's data sets. Managing this torrent of bits has forced more and more fields to move to industrial-scale data centres and cutting-edge networking technology (see page 16). But the data sets are also becoming increasingly complex. As researchers study the inner workings of the cell, for example, they now gather data on genomic sequences, protein sequences, protein structure and function, bimolecular interactions, signalling and metabolic pathways, regulatory motifs — on and on. No wonder even the smartest scientists turn with relief to advanced data-mining tools, online community collaborations (see page 22) and sophisticated visualization techniques (see page 30).

Sudden influxes of data have transformed researchers' understanding of nature before — even back in the days when 'computer' was still a job description (see page 36). Unfortunately, the institutions and culture of science remain rooted in that pre-electronic era. Taking full advantage of electronic data will require a great deal of additional infrastructure, both technical and cultural (see pages 8, 28 and 47).

The full paper and associated material is found here:

http://www.nature.com/nature/journal/v455/n7209/full/455001a.html

Nature 455, 1 (4 September 2008) | doi:10.1038/455001a; Published online 3 September 2008

While not specifically health related it is clear there is great relevance for the health sector.

Both sets of article deserve a close review.

David.

Health Portal Technologies - Evolving at High Speed.

Two very interesting and exciting examples of Health Information Technology Portals came to my attention this week. I found both very interesting and encouraging.

The first I came upon as a result of this press release announcing a portal to support a Health Information Exchange (HIE).

Park Ridge Hospital “Go Live” Completes Phase I of Western North Carolina HIE Powered by MEDSEEK Physician Portal

HIE Will Connect Ambulatory EMRs to MEDSEEK’s Enterprise Portal During Phase II

BIRMINGHAM, Ala.--(BUSINESS WIRE)--MEDSEEK, a leading provider of enterprise portal connectivity solutions, today announced that Western North Carolina Health Information Exchange (HIE) implemented MEDSEEK’s physician portal at Park Ridge Hospital. This “go live” completes the first phase of its e-health initiative by enabling all 16 participating facilities to exchange patient data electronically. During phase II, MEDSEEK’s physician portal will connect physician office EMRs to the HIE network.

“With the completion of Phase I, we plan to pilot data exchange between community physicians and inpatient facilities this fall, which will further advance clinical decision-making and patient care across our region,” said Gary Bowers, Executive Director of the Western North Carolina Health Network. “MEDSEEK excelled when faced with the challenge of connecting five different information systems across 16 hospitals to deliver the right data from the right systems in real-time. The MEDSEEK physician portal allows our doctors to pull up a new patient’s history, recent medications, lab results, emergency contact and primary care physician within seconds. The portal has generated significant overall productivity gains by streamlining clinical workflow, eliminating repeat tests and reducing the potential for medical errors.”

The WNC Data Link HIE was the first regional health information organization in North Carolina and remains one of the largest in North America. The MEDSEEK physician portal is deployed at all 16 hospitals within the HIE: Angel Medical Center, CarePartners, Cherokee Indian Hospital, Harris Regional Medical Center, Haywood Regional Medical Center, Highlands-Cashiers Hospital, The McDowell Hospital, Mission Hospitals, Murphy Medical Center, Pardee Memorial Hospital, Park Ridge Hospital, Rutherford Hospital, Blue Ridge Regional Hospital, St. Luke’s Hospital, Swain County Hospital and Transylvania Community Hospital.

"MEDSEEK's physician portal has improved emergency care for patients across western North Carolina by enabling physicians to access most patient records — from any of the 16 hospitals in our network — within minutes instead of hours or days," said David M. Poorbaugh, MD, medical director and practicing emergency physician at 730-bed Mission Hospital in Asheville, N.C., which is part of Mission Health System.

"Before the MEDSEEK portal, we had to get a release from the patient, fax it to medical records and wait an interminable amount of time for somebody to be available to find and fax the records to you. It was unreliable and a very, very slow process," said Dr. Poorbaugh. "The portal has made a fundamental difference in how we treat patients in the emergency department. Anytime you have better integration of patient health records, it improves patient care. I wouldn't want to be without the portal and all the emergency physicians using it share my opinion."

Added Bowers, “In the past, a rural patient would see a specialist at a tertiary hospital, undergo treatment and return to their primary care physician without the vital details needed for continuing care. Now, the rural physician can pull up the specialist's notes, test results, prescribed medications and discharge summaries at a click of the mouse. This makes our physicians very happy – and our patients safer, and healthier.”

MEDSEEK enables clinicians to view patient data across all of the disparate systems in an enterprise with a single sign-on. The intuitive interface encourages clinicians to quickly adopt the secure, easy-to-use system. The portal also provides patient-physician interaction via secure eConsults to further enhance communications.

“To achieve a true, longitudinal patient record, hospitals must start with real-time access to complete patient data from anywhere in the HIE,” explains Peter Kuhn, president of MEDSEEK. “Our physician portal supplies the Western North Carolina HIE with the flexibility, personalization, and functionality required to realize their e-Health vision of providing a centralized access point for viewing all patient data, securely, quickly and easily.”

More here:

http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20080903005630&newsLang=en

I then noticed the following.

MEDSEEK Leads in KLAS ® Rankings for Clinical Portal Solution

MEDSEEK Leads KLAS ® Portals Segment as of August 22, 2008.

Birmingham, AL (PRWEB) September 4, 2008 -- MEDSEEK , a leading provider of enterprise portal management solutions, announced today it leads in KLAS® rankings for its Clinical Web Portal software solution.

KLAS ® is an independent healthcare market research firm that gathers data about clinical portal solutions from CIO's, Directors, and other healthcare providers about software functionality, solution performance, technical support and service. According to the August 26, 2008 Platinum KLAS ® database, MEDSEEK has the highest current performance ratings, outscoring all other clinical portal solutions.

Peter Kuhn, President of MEDSEEK commented, "MEDSEEK's superior ranking in the KLAS ® report highlights our effort to provide comprehensive eHealth solutions." Kuhn added, "We frequently receive high praise from our clients on our ability to deliver complex installations on time and on budget. The KLAS rating validates our reputation as an organization that consistently delivers on our commitments."

More here:

http://www.prweb.com/releases/2008/09/prweb1279174.htm

It seems that at present MEDSEEK is the market leader. Having gone to their site (www.medseek.com) and explored for a while I can see why. There is a lot of useful functionality brought together here.

A day or so later I noted the following.

Wolters Kluwer to Buy UpToDate

September 4, 2008

Medical reference publisher Wolters Kluwer Health has announced it will acquire UpToDate Inc., a vendor of electronic, point-of-care clinical decision support software.

…..

More information is available at wkhealth.com and uptodate.com.

http://www.healthdatamanagement.com/news/acquisition26898-1.html?ET=healthdatamanagement:e586:100325a:&st=email&channel=decision_support

A quick visit here shows why WK Health were prepared to pay the required millions for the company. This was clearly a well thought portal providing clinical decision support for both health professionals and consumers.

All in all two very interesting portals that provide some useful ideas as to how Australia should be looking at architecting its national e-Health efforts.

David.

HIMSS Analyses The Global EHR Situation – Important Report.

The following press release appeared a day or say ago.

Healthcare IT - "It's A Sleeping Giant"

HIMSS Global Enterprise Task Force (GEFT) investigates implementation of electronic health records (EHRs) in 15 countries around the world

CHICAGO (Sept. 5, 2008) – Recognizing common threads that affect all EHR implementations in 15 countries, the Global Enterprise Task Force of the Healthcare Information and Management Systems Society (HIMSS) has released “Electronic Health Records: A Global Perspective.” The extensive study reviewed healthcare IT progress in Europe, Asia Pacific, Middle East and North America.

The 16-member task force looked at various EHR components within each country, including, security, quality, financing sources and barriers to adoption. Amid many variations, four common factors emerged that affect implementation of the electronic health record throughout the world. They are:

• Funding
• Governance
• Standardization and interoperability
• Communication

“This comprehensive report provides actionable lessons learned from each of the countries we reviewed. Despite the local differences in the logistics of EHR implementation, we found that all of the countries believed in the benefits of health IT and introduced this technology into their respective health systems,” said Steve Arnold, MD, MS, MBA, CPE, chair of the task force and president/CEO, Healthcare Consultants International, Lagrangeville, NY. Walter W. Wieners, FHIMSS, co-chaired the task force and is managing principal, Walter W. Wieners Consulting, Sausalito, Calif.

The 119-page report presents findings on EHR implementation by country in five categories. Each chapter features an overview of the country’s electronic health record status followed by a review of achievements, barriers and recommendations in the different areas.

National EHR Program introduces the electronic health record approach by each country by reviewing two vital areas of implementation. National IT/ICT Status & Strategy describes existing IT/ICT status and strategy for the future implementation of a national EHR system. The section on the National/Regional EHR Approach looks at how the country approached acceptance, adoption, deployment, operation and support of a national EHR and health information exchange (HIE) system.

EHR Governance reviews the legal and/or regulatory mechanisms, and policies and procedures in place, that either enable or hinder the implementation and deployment of EHRs and HIE.

The Technology section provides a wide perspective on the architecture and applications of the EHR system with topics of the personal health record, non-health communities and EHR integration beyond the country’s borders also covered. An update on the progress of technology Adoption provides an overview of EHR, PHR and HIE services with implementation success stories from the countries with more mature EHR systems.

Available metrics of successful EHR/PHR/HIE Outcomes, and financial ROI Benefits and Implementation Experiences, are described in this section. With health IT recognized as an evolving technology, Next Steps summarizes each country’s plans.

“It’s imperative to view healthcare IT solutions in the global context,” said Patricia Wise, RN, MSN, MA, FHIMSS, vice president, Health Information Systems, HIMSS. “By documenting what worked and what didn’t, the white paper offers an expanded perspective on the progress, and challenges, of EHR implementation throughout the world.”

The HIMSS Global Enterprise Task Force, formed in 2006 under the HIMSS Enterprise Information Steering Committee, includes industry leaders from around the world who provide expert analyses from a local perspective.

The work group plans to update and expand the report in future editions and calls on interested health IT experts throughout the world to contribute. Contact the HIMSS Europe office at europe@himss.org for more information on participation.

The white paper, “Electronic Health Records: A Global Perspective,” is available on the HIMSS Web site.

The release is found here:

http://www.himss.org/ASP/ContentRedirector.asp?ContentId=68380&type=HIMSSNewsItem

The report is directly downloadable here:

http://www.himss.org/content/files/200808_EHRGlobalPerspective_whitepaper.pdf

Thanks to Joanne Lessard (one of the Canadian contributors) for bringing this to my attention.

Pity Australia is just not on the real radar – except in the Executive Summary .

David.

NEHTA and Openness – Just What is the Problem?

In the last week there has been a lot of press commentary about the appointment of the new NEHTA CEO. All well and good but equally there have been some worrying comments from the old acting CEO as well.

The four that struck me were the following in discussion about the Stakeholder Reference Forums that have recently been conducted and the conflation of that with the planned IEHR.

From ZDNet we have:

“The Forum was set up in part as a response to a review by the Boston Consulting Group published last year.

Members of the forum signed a non-disclosure agreement which bound them from talking about specific topics, however some information was released.

The major priorities agreed upon at the first meeting were the development of an e-health business case for consideration by the Council of Australian Governments meeting in October this year, as well as devising a five-year plan.

The first major e-health implementations the group wanted NEHTA to focus on were developing systems for electronic discharge summaries, pathology reports, specialist referrals and medication management.”

Full article here (Suzanne Tindal):

http://www.zdnet.com.au/news/software/soa/NEHTA-appoints-new-CEO-/0,130061733,339291719,00.htm

Next again from ZDNET we have:

“Howard said that the gag order was so that NEHTA could share more information, not less, and was in line with normal corporate standards. "NEHTA is a company that has responsibilities and the directors of it have liabilities that any company has," he said.

"It's about being able to engage with members and share budget figures, issues and taking feedback from that forum. There could be a point where we could discuss the inner workings of the company, which means they need to be covered by confidentiality arrangements."

A major challenge for Australia's e-health plans has been achieving consensus amongst state health agencies and medical providers on how to transition away from paper-based systems.

"Today that common vision does exist... Right now there is a focus on high value transaction services and standardising information so that clinicians can access it at the point of care," said Howard.”

Full article here (Liam Tung):

http://www.zdnet.com.au/news/software/soa/NEHTA-denies-stakeholder-gag-/0,130061733,339291756,00.htm

Then we have from the Australian Financial Review:

“The new NEHTA chief executive comes into the organisation as it prepares to submit a business case for a national electronic health record to the Council of Australian Governments next month.

Mr Howard has shepherded the business case through its final stages and Mr Fleming will be briefed on the contents of the document over the coming weeks.”

Full article here (Ben Woodhead):

http://www.afr.com/home/viewer.aspx?EDP://20080902000030260789&section=information&title=E-health+body+adds+to+commercial+talent

And from the Australian we have:

Mr Howard said reports that stakeholders taking part in recent reference forums had been "gagged" were untrue.

"In fact, having participants sign non-disclosure agreements means we are able to share NEHTA's inner workings -- all the way to business cases, financial budgets and work programs - with them," he said. "Our intention is to give a greater voice and power to these parties.

"Naturally, NEHTA is a (not-for-profit) company, the owners are the governments of the nation, but there are directors that have direct liabilities just like any other company director. Managing those responsibilities means we have to have these constraints."

Full article here (Karen Dearne):

http://www.australianit.news.com.au/story/0,24897,24297934-15306,00.html

What is being reflected here in my view is a passion to keep secrets that is totally unjustifiable. I don’t give a hoot whether NEHTA is a company, a trust or actually part of the Government. It is planning to put a major funding proposal to Government (in the form of the Councils of Australian Government - COAG) and is claiming it therefore can say nothing.

This is just rubbish.

No one wants to see the detailed budget spreadsheets. However the public should be provided with the following.

1. A detailed description of what NEHTA is proposing.

2. A broad outline of any planned timetables and implementation plans.

3. Details of the Privacy Impact Statement that has confirmed the plan is privacy protective (Not a promise to do the work after it is funded)

4. In industry impact analysis (who are the winners and losers if the project goes ahead).

5. A broad outline of the projected costs and the value that will derive from going forward.

None of this is commercially sensitive. To provide such information would make sure there is the right amount of accountability, discussion and scrutiny of the plans. Briefing a few selected stakeholders in secret just does not cut it in my view!

Given the CEO change I am hoping for a dramatic improvement in openness very soon. The old way is just not good enough.

Final remark, – also given the CEO change - I would be very surprised if we see anything go to COAG before December 2008 at the earliest.

David.

Useful and Interesting Health IT Links from the Last Week – 07/09/2008

Again, in the last week, I have come across a few reports and news items which are worth passing on.

These include first:

What the Presidential Race Means for Technology

Kathryn Mackenzie, for HealthLeaders Media, September 2, 2008

Now that the presidential nominees have chosen their running mates, the buzz surrounding the upcoming election has intensified. As the three senators and the governor from Alaska enter the final leg of the race, I thought I'd take a look at how the contenders could impact the role technology plays in healthcare.

Their overall healthcare reform plans pretty much follow party lines. The Democratic nominee is promising healthcare for all and the creation of a National Health Insurance Exchange that will act as a watchdog group and help reform the private insurance market. The Republican nominee stresses the role of personal responsibility in reforming the healthcare system and emphasizes prevention and offers tax credits as an incentive to help people buy insurance.

Both candidates have a plan for wider adoption of healthcare information technology—though Barack Obama's plan is more detailed than John McCain's.

Obama says he would invest $10 billion a year over the next five years to move the U.S. healthcare system to broad adoption of standards-based electronic health information systems, including electronic health records. He will also phase in requirements for full implementation of health IT. Just as an aside, when Democratic vice presidential candidate Sen. Joe Biden was running for president, he proposed spending $1 billion per year on a similar plan. Obama also promises to appoint the nation's first chief technology officer who would coordinate the government's technology infrastructure, work on issues of transparency, and "employ technology and innovation to solve our nation's most pressing problems."

McCain's plan is a bit more vague. "We should promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines," according to his Web site. Experts say that addresses one of the biggest barriers affecting wider adoption of telemedicine. His running mate, Alaska Gov. Sarah Palin already has experience in that arena. Earlier this year, she introduced the Alaska Health Care Transparency Act, which aimed to increase access to healthcare in rural areas through telemedicine and telehealth.

More here:

http://www.healthleadersmedia.com/content/218073/topic/WS_HLM2_TEC/What-the-Presidential-Race-Means-for-Technology.html

This is a useful summary for us on the other side of the pond on what each of the major parties have in mind for Health IT. Worth a read.

Second we have:

Long-distance health care

By Chris Birk

SPECIAL TO THE POST-DISPATCH

08/27/2008

On a dresser next to the bed, a small electronic box is helping Ovelet Coates stay healthy.

Twice a day, the device instructs Coates, 91, to step on a scale and then to take her blood pressure. The scale and pressure cuff are connected to the box, which, in turn, is connected to the phone line in her spotless Bethesda Orchard apartment.

After Coates takes her vital signs, the information is transmitted to her home health nurse, who monitors the data daily to look for problems or patterns.

"It took a little while at first until I got used to it," Coates said. "It doesn't take but a couple of minutes."

Heralded as both time and money savers, telemonitoring and telehealth services are gaining a greater foothold in the increasingly costly health care market.

Telemedicine, which combines traditional health care services and telecommunications technology, can range from a surgeon operating on a patient hundreds of miles away to a nurse checking vital signs from the comfort of her home, according to the American Telemedicine Association.

The burgeoning field has spurred a growing interest in home-health strategies that can help curb costs by minimizing office visits and hospitalization — and may lead to better patient outcomes.

More here:

http://www.stltoday.com/stltoday/business/stories.nsf/healthcare/story/4897A96EF4A99E19862574B200083042?OpenDocument

It is important to note how these technologies are being progressively implemented around the world with active thrusts underway in Australia, Canada, UK and the US.

Third we have:

http://www.computerweekly.com/Articles/2008/09/01/232097/barts-underestimated-impact-of-it-system.htm

Barts underestimated impact of IT system

Author: Tony Collins

Posted: 16:58 01 Sep 2008

Barts and The London NHS Trust said today [1 September 2008] it had underestimated the impact of going live with a new system under the NHS's £12.7bn National Programme for IT [NPfIT].

Difficulties in scheduling patients for appointments have led to operating theatres and clinics being unused at times, despite high demand for them.

The trust is funding nearly £1m for extra temporary staff relating to the NPfIT go-live from its reserves. And it faces a further £1.5m shortfall in income because it may not be able to bill its local primary care trust for the patients it sees and treats.

A spokesman for Barts and The London NHS Trust told Computer Weekly an "intensive programme of measures is in place" which "will allow us to return to our previous performance levels as quickly as possible".

The trust has "apologised publicly to patients, GPs and staff for the difficulties they have experienced," he said.

The spokesman was responding to Computer Weekly's questions after the trust published board papers on its website describing "significant" ongoing problems after the implementation of the Care Records Service,

The trust has had difficulty maintaining an overview of which patients have been treated for what following roll-out of the system. It is paid according to the information it provides to the local primary care trust on the patients it sees and treats. But the trust warns in its latest board papers that income may be much less due to difficulties gathering accurate information on who has been seen for what and when.

More here:

This report shows just how hard system implementation can be and how the impacts can be quite significant for patients and budgets. Careful planning, especially in large and complex teaching hospitals.

Sounds like some system providers are about to be sued.

http://www.computerweekly.com/Articles/2008/09/01/232085/royal-free-considers-compensation-claim-for-cerner-problems.htm

Royal Free considers compensation claim for Cerner problems

Fourth we have:

Hurricane technology predicts premature baby blow-ins

• Jill Stark
• September 5, 2008

PREGNANT women may be able to know if they are at risk of a premature birth with the development of technology normally used to predict the path of hurricanes.

Melbourne researchers are developing a world-first program that they believe could halve the premature birth rate and reduce newborn deaths. About 17,000 babies are born prematurely each year in Australia but doctors have little way of knowing which women will be affected.

Now, engineers from the University of Melbourne and doctors from the University of Newcastle are developing a computerised system that can predict who is at high risk.

The technology works by tracking the hormone levels of pregnant women to look for patterns that might identify differences between those who will give birth at term and those who will give birth before 37 weeks.

Other variables such as the woman's age, weight, previous pregnancy history and whether she is a smoker, are fed into a computerised system to assess risk. The forecasting system is similar to that used to predict the paths of hurricanes and is believed to be the first time it has been used in a medical setting.

More here:

http://www.theage.com.au/national/hurricane-technology-predicts-premature-baby-blowins-20080904-49yc.html

This is a very interesting piece of work indeed. It seems the team have identified the key determinants of premature birth and given the options available to now delay delivery and save young lives a worthwhile piece of work indeed!

Fifth we have:

Local software to reduce hospital bottlenecks

More accurate than existing methods

Rodney Gedda (Techworld Australia) 02/09/2008 16:14:00

New software developed by the Australian e-Health Research Centre claims to assist hospital emergency medical staff to better gauge demand on their services.

The Patient Admission Prediction Tool (PAPT) uses historical data to allow hospital staff to see what the patient load will be like in the next hour, that day, the next week, or even on holidays with varying dates, like Easter.

PAPT was developed in collaboration with clinicians from Gold Coast and Toowoomba Hospitals, Griffith University and Queensland University of Technology.

Director of emergency medicine at Gold Coast Hospital Dr David Green said accurate forecasting will assist many areas of health management – from basic bed management and staffing to scheduling elective surgery.

Green also believes PAPT will reduce stress for staff and improve patient outcomes.

Australian e-Health Research Centre research director Dr David Hansen said PAPT has so far improved prediction of patient presentation and admission in two hospitals with “very different populations”.

More here:

http://www.computerworld.com.au/index.php?id=902475446&eid=-255

This is an interesting idea but I really wonder just how predictable demand in A&E can really be. Having run a large metropolitan Accident and Emergency Department (Royal North Shore) for a number of years I know it only took one occasional major accident or medical crisis to totally derail any efforts at consistent patient flow and load throughout the department.

I would be curious to know what mechanisms were built in to handle the inevitable unexpected (Do I sound like Mr Rumsfeld?)

Last we have the slightly more technical article for the week:

Google Chrome to tackle Internet Explorer

Mike Harvey | September 02, 2008

GOOGLE will today launch its own web browser called Google Chrome in another expansion by the search giant into the building blocks of the internet.

Google Chrome will take on the might of Microsoft’s Internet Explorer, which dominates the browser market with a 74 per cent share.

News of the beta launch of the product in 100 countries came with the leaking of a 28-page comic book by Google to a blog, Google Blogoscoped, which outlined the specifications and innovations in the new browser with a series of illustrations.

It said that Chrome -- www.google.com/chrome -- would feature a new format for tabs, the ability to view web pages as thumbnails and better features on the address bar.

There have been rumours about a Google browser for years and reports suggested that Chrome has been in development for at least two years.

Google confirmed the launch in the blog and said: “We can add value for users and, at the same time, help drive innovation on the web. We realised that the web had evolved from mainly simple text pages to rich, interactive applications and that we needed to completely rethink the browser. What we really needed was not just a browser, but also a modern platform for web pages and applications, and that’s what we set out to build.”

Initially it will be for Windows users, but versions for Mac and Linux will be available soon, the blog said.

More here:

http://www.australianit.news.com.au/story/0,24897,24281430-15306,00.html

This is clearly the technical news for the week! I wonder just how far Google plans to extend its reach. My initial impression is that it works very well indeed but still has a way to go to surpass Firefox. Will be interesting to see its evolution of the new browser war over the next year or so.

More next week.

David.

Virtual In-Home Care Moves Forward.

The following really interesting set of technologies have been got together to make a difference.

Virtual healthcare system makes house calls

Voice-activated systems extend healthcare to patients' homes

By Ann Bednarz , Network World , 08/21/2008

Four months go by, on average, between scheduled checkups for patients with chronic diseases such as diabetes, obesity and hypertension. A lot can happen between visits, and researchers at Boston Medical Center are pioneering ways to stay virtually connected with patients so that any healthcare issues can be addressed without delay.

The goal is to provide guidance and information when patients need it, during their daily lives and not just during scheduled doctor visits, says Robert Friedman, a physician and head of a team at Boston Medical Center that's developing telephone-based systems for delivering virtual care.

Go to the URL below to see an illustration of the way the system is linked together.

"What we're trying to do is catch problems earlier and then facilitate physicians and other health professionals to do something earlier," says Friedman, who is chief of the Medical Information Systems Unit at Boston Medical Center. "We're also educating people how to take care of themselves, encouraging them, monitoring what they do, and counseling them. There's a psychological and behavioral intervention component to it, too."

Using speech recognition and interactive voice response (IVR) technologies, Friedman and his team have developed automated applications that screen patients by emulating what a healthcare professional might do.

Patients dial the systems from their homes, or the systems make outbound calls (particularly if someone misses a virtual appointment). They're prompted to input information, such as their blood pressure or weight, using speech or keypads. They're also asked questions such as whether they are exercising, sticking to a diet and taking medication regularly. The system analyzes the data and provides patients with feedback and coaching, using digitized human speech or text-to-speech generators. It also alerts appropriate parties if there are signs of trouble or indications that someone's healthcare regimen needs to be modified.

"It's in real time, so someone is on the phone, taking their blood pressure or answering a question, and that's being reported to physicians or clinicians electronically," Friedman says.

Much more here:

http://www.networkworld.com/news/2008/082108-networker.html?hpg1=bn

It was also good to note the last paragraph of the article:

“Progress is being made, however. Boston Medical Center today is overseeing virtual healthcare projects around the world, including in Sweden, China and Australia. "This type of model will be a regular part of the healthcare system throughout the world," Friedman says. "The hardest thing to do is predict when."

The following is related.

http://www.ama-assn.org/amednews/2008/09/01/bisa0901.htm

Virtual medicine: Companies using webcams for real-time patient encounters

Two ventures promise to bring video-enabled doctors' visits to more patients, but physician groups caution that most medical care requires in-person contact.

By Emily Berry and Pamela Lewis Dolan, AMNews staff. Sept. 1, 2008.

Seems doctors are always worried they might miss out on a consultation fee!

That so many technologies are now being integrated to assist with the care of people as they age is definitely a sign of the times. We all may need this stuff at some time in our lives!

David.

Personal Health Records – The Future Discussed.

The following series of articles appeared recently.

Will PHRs rule the waves or roll out with the tide?
By Ken Terry

Rick Schooler, vice president and chief information officer of the Orlando (Fla.) Regional Health System, a seven-hospital network, has high hopes for electronic personal health records. In the future, he believes, portable, patient-controlled, Web-based PHRs will form the basis for regional and national health information networks and give providers access to comprehensive health data on each patient.

But he’s skeptical that they’ll catch on with the public anytime soon. For that to happen, he says, the government needs to create PHR standards for data transfers and privacy, vendors have to make the information understandable to consumers, payers have to pressure providers to transfer clinical data to PHRs, and employers and health plans have to give consumers incentives to use PHRs to manage their health. “There’s got to be a motivating factor to cause the individual to want to make use of the record,” Schooler says.

The entrance of Microsoft, Google and other well-financed players into the PHR space—as well as a Medicare pilot in South Carolina—undoubtedly will raise the visibility of the service. But while more than 200 different models are available on the Web today, only 1 percent to 4 percent of the population takes advantage of them, according to consumer research polls from the Markle Foundation and Harris Interactive.

One reason is privacy. Although 65 percent of respondents to a 2006 Markle Foundation survey said they “would like access to all of their own medical information” online, 80 percent worried about the privacy of electronic records and that their health care information might be misused or sold. When asked by Harris Interactive in 2006 to rank their top concerns regarding online health information, 68 percent of respondents put privacy as their top worry, followed closely by security at 66 percent.

While those polls look broadly at the topic of electronic records, the Markle Foundation, in a survey released in June, asked specifically about PHRs and found a high level of concern: 57 percent of people who said they were not interested in opening a PHR ranked privacy and confidentiality as their primary concerns.

It’s also unclear what type of PHR will gain public acceptance. Records that consist mainly of patient-entered data have gotten little uptake. Even when PHRs are prepopulated with claims data, as they are for 70 million consumers who have insurer- or employer-provided records, just 1 percent to 7 percent of people use them, according to industry observers.

The most substantial use of PHRs to date has occurred in big group practices like those of Cleveland Clinic, Group Health Cooperative and Kaiser Permanente. In those groups, patients have access to PHRs mirroring the electronic medical records of their physicians, as well as to secure messaging services that connect them with the practices.

To some observers, a method of linking doctors to patients online is a prerequisite for a PHR to gain any degree of consumer acceptance. “The PHR that doesn’t connect into your doctor is like an ATM without any money in it,” declares Ed Fotsch, M.D., president and CEO of Medem, which offers a PHR that includes secure online messaging.

Similarly, John Halamka, M.D., chief information officer of Beth Israel Deaconess Medical Center in Boston, which has offered its PatientSite PHR for eight years, views the doctor-patient link as indispensable. “From our perspective, you can’t separate the PHR and the messaging. If I’m going to share a lab result with you, and you have a question, you need to have the loop closed with me.”

Some experts disagree. “It’s a mistake for us to prejudge and formalize what the desirable features of these new applications will be,” says David Lansky, president and CEO of the Pacific Business Group on Health. “There may be huge numbers of people who get great benefit to their health [from a PHR] in ways that don’t involve connectivity to the health care system, and we should encourage that, not inhibit it.”

Much more here – with links to additional material:

http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/08AUG2008/0808HHN_FEA_MedRecords&domain=HHNMAG

This article and set of sidebars are a useful summary of the PHR state of play as of August 2008. Highly recommended reading.

David.

Working Out if Health IT is Worthwhile and Adds Value.

The following useful discussion appeared a few days ago

The quest for value

By Nancy Ferris

Peter Orszag, an economist and director of the Congressional Budget Office, has a high-deductible health insurance plan and a health savings account. But making those purchasing decisions wasn’t easy, he said.

“It is often difficult as a nonmedical professional to determine what is or is not valuable,” Orszag recently told the House Budget Committee.

Experts are struggling to make the same determinations about health information technology. As part of its mission to attach a dollar value to every bill Congress acts on, CBO issued a report in May questioning the value of health IT.

“No aspect of health IT entails as much uncertainty as the magnitude of its potential benefits,” the report states.

Although health IT could enable changes to U.S. health care, it has little value on its own, Orszag said. Without other reforms, “it doesn’t generate the kind of results many people would hope for,” he added.

CBO’s report questioned an often-quoted 2005 Rand study that estimated the value of health IT to be $80 billion in annual savings once 90 percent of hospitals and doctors adopt it. CBO took issue with Rand’s methodology and conclusions.

Lead researcher Richard Hillestad has appeared before Congress several times to defend the Rand study. He said the $80 billion savings level might be delayed for 10 to 15 years based on the slow rate of health IT adoption, but he stuck with the estimate.

However, he added, “the potential savings we calculate are spread among stakeholders — insurers or payers, providers, and individuals — so such savings are not necessarily savings the government might realize from programs to enhance the adoption” of health IT.

Orszag and Hillestad agreed on one thing: In Hillestad’s words, “The broad adoption of [health IT] systems and connectivity should be considered necessary but not sufficient steps toward real health care transformation that delivers efficient and effective care at the right time.”

In other words, health IT could be the basis for desired changes in health care.

A public good? That’s something many state and federal policy-makers have begun to recognize. Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, said last month, “Health IT adoption is likely to be a key component of health care reform.”

But he and others continue to wrestle with questions of who will benefit from health IT and who should pay for it. Some experts are urging them to view health IT as a public good, comparable to the interstate highway system or state universities.

“The financial benefits…may be very large, but many of the benefits may accrue to society,” said Dr. David Westfall Bates, medical director of clinical and quality analysis at Partners HealthCare System in Boston.

CBO endorsed the concept in its report, stating: “The technology has some characteristics of a public good — that is, a good that would be provided in a less-than-optimal amount by private markets if the government did not intervene.”

Much more here:

http://www.govhealthit.com/blogs/ghitnotebook/350530-1.html

Nancy Ferris also provides some useful additional information here with a range of sidebar lists.

http://www.govhealthit.com/print/4_20/features/350520-1.html

Peter Orszag from the Congressional Budget Office (CBO) has had a long interest in health care costs.

See:

http://aushealthit.blogspot.com/2008/02/useful-and-interesting-health-it-links_10.html

and

http://aushealthit.blogspot.com/2008/06/useful-and-interesting-health-it-links_22.html

The report being discussed is found here:

http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm

The core point in this discussion relates to the distribution of benefits when Health IT is purchased and implemented. Sadly those who incur most of the expenses are not those who receive direct benefits – hence the argument that Health IT does not provide good value.

However, if the total impact of Health IT is assessed that argument simply does not stack up. Read the long blog entry for the details. It is important to understand the value linkages in this domain to put coherent arguments for adoption.

The following paragraphs from late in the second Ferris article make this point clearly.

“That failure to get the ROI relates very clearly to my losing my job,” Mingle said. Officials reorganized the IT staff and eliminated his position, and though they offered him another job, he chose not to accept it.

“There’s a belief that you install a system like this and the ROI accrues to you passively,” Mingle said. “It doesn’t. It’s not a passive thing.”

“To really make it work, you have to start handling your patients differently, start handing off your work to one another differently, and even redistributing the work among the people there and building new skills in the people there,” he said. “And if you don’t do that, those key returns on investment become elusive.”

Orszag made a similar point, although he was speaking as an economist assessing the big picture. “If you just plop a health IT system down in the middle of a fragmented [health care] system, with financial incentives that encourage more care rather than better care and without a system for using the information that is coming out of the health IT structure to improve quality, you are not going to get very much,” he said.”

The basic truth is that pure cash based ROI is not the way to think of health IT. It is the process, quality and safety benefits – which are non-cash – that really matter and which save lives. The mix of cash neutral and additional quality and safety makes Health IT a no-brainer.

The concept of a ‘value case’ rather than a pure business case is where our thinking now needs to be!

Two useful efforts indeed!

David.