Health by Southwest?

Although most health and HIT technophiles probably have never heard of it, The Austin Interactive Technology festival, (or South by Southwest [SXSW] as it is otherwise affectionately known) may soon become a “must attend” event for those serious about staying ahead of the health technology innovation curve. Last year almost 20,000 people attended. This year before it is all done there'll be more than 1,000 panels and presentations spread across 15 Austin Texas campuses.

Recently at SXSW, Ray Kurzweil made a presentation about his vision of a technology enhanced future. Kurzweil has been called a “genius" by the Wall Street Journal, and "the ultimate thinking machine" by Forbes. He was the principal developer of the first CCD flat-bed scanner, the first omni-font optical character recognition, the first print-to-speech reading machine for the blind, the first text-to-speech synthesizer, the first music synthesizer capable of recreating the grand piano and other orchestral instruments, and the first commercially marketed large-vocabulary speech recognition.

Mr Kurzweil believes that humans and technology are blurring and will eventually merge. (most of us have already grown smart phones and other digital devices at the ends of our fingers.) "We live in a human-machine civilization where everybody has been enhanced with computer technology," he told a capacity crowd of more than 3,000. "They're really part of who we are.” Kurzweil believes technology is advancing so fast that previously unimaginable inventions will be a reality within decades. He cited nanotechnology -- microscopic computers -- that will be 1,000 times more powerful than human blood cells and injected in people's bloodstreams to give them superhuman endurance. He also believes computer technology is democratizing society by empowering people."You can start world-changing revolution with the power of your ideas and the tools that everyone has," he said. "A kid in Africa has access to more information than the president of the United States did 15 years ago." He also predicted that "Siri will get better.", Moore's Law, will become outdated and useless in the next 8 years and in the future search engines aren't going to wait to be asked. They'll be listening [to humans] in the background. And [the search results] will just pop up."

Speculation, fantasy you say? Perhaps. What’s clear is that while everything has not come to pass, in 1960, the things we thought we would have and do in the year 2012 are in many cases, well beyond our 1960’s imaginations! So if things continue as they have, Healthcare in 2052 will likely look very different than what it looks like today, and technology will have a large role to play in what it does looks like. Healthcare leaders should embrace and help lead this inevitable change or else they will be forced to get out of the way and simply follow the innovation of others.

FMI - http://www.cnn.com/2012/03/12/tech/innovation/ray-kurzweil-sxsw/index.html

Participatory Medicine 2.0

Original post can be found at Project Health Design

In “Participatory Medicine: Must You Be Rich to Participate?” in the Journal of Participatory Medicine, Graedon and Graedon pose a question: “Is the participatory movement leaving [the non-affluent] behind?” Their article suggests that only the affluent members of our society can afford care that is participatory. Their premise appears to be built on two assumptions that should be regarded as faulty.

Redefining patient engagement

The first is that the only engagement relevant to the participatory community is the engagement between a patient and a clinical provider. The primary causes of morbidity and mortality in contemporary society are chronic diseases. By definition, individuals have these ailments for up to 30 or 40 years. Antecedents of atherosclerosis (fatty streaks) have been documented in 10-year-old children (5), yet most individuals only become aware of the existence of a problem after the age of 50. As such, the actions, behaviors and exposures that impact health begin early in life and are often the result of engagement with a vast array of individuals (relatively few of which are medical providers). In addition, most patients are actually in clinical settings for a relatively short period of time over the course of their lives. In other words, most of the interactions, or participation, that govern the important behaviors that impact health occur outside of the clinical setting and between patients and non-clinicians.

This reality is in no way an attempt to downplay the importance of either clinical encounters or clinical providers, but rather an attempt to illustrate the fact that when we fail to understand the full context of participatory medicine, we may similarly fail to understand the true barriers, drivers and opportunities for participatory medicine to make a difference. More importantly, we may also be unable to fully understand why patients have such difficulty achieving clinical goals or why well-intentioned and elegantly designed interventions yield only marginal results. In fact, emerging data suggest that patients are participating in their health care in a big way, just not as much with their health care providers.

Patients turn to the Internet for health information and support

For the first time ever, more Americans are turning to the Internet for health and medical information than are turning to health care providers.(1) In addition, emerging evidence suggests that the Internet has considerably more influence over consumer health decisions and actions than traditional channels like print, TV and radio.(3) The numbers of online health seekers have swelled to more than 175 million people to date.(6) Increasingly, they report having become informed and empowered. They have generally been able to find what they are looking for and report that the Internet is increasingly helping them to connect to emotional support and practical help for dealing with their health issues.(2) In fact, racial and ethnic minorities and the poor appear to be using some forms of technology more than their non-minority counterparts.(4)

We can argue and speculate as to why these things are happening or the long-term impact of these shifts, but the reality is that these shifts are, in fact, happening. These changes may represent an important opportunity to reach and engage many patients, including those who historically have been left behind. The most important questions then become:

Do our evolving notions of what health care and participatory medicine need to become include the realities in which patients live?
Will current and future health care providers embrace these realities and lead the inevitable change?
If not, we may be destined to well-intentioned but largely unrealistic notions that ultimately leave the health care system far behind where many patients are already going.

References

1) Cybercitizen Health v8.0. 2008. New York, NY, Manhattan Research.
2) E-Health Solutions for Healthcare Disparities. New York: Springer Pubs; 2008
3) Cybercitizen Health v9.0. 2010. New York, NY, Manhattan Research.
4) Korzenny F, Vann L. Tapping into thier connections: The multicultural world of social media marketing. 2009. Talahassee, FL, Florida State University Center for Hispanic Marketing Communication.
5) Tanganelli P, Bianciardi G, Simoes C, et al. Distribution of lipid and raised lesions in aortas of young people of different geographic origins (WHO-ISFC PBDAY Study). World Health Organization-International Society and Federation of Cardiology. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb 1993; 13(11): 1700-10
6) Taylor H. Cyberchondriacs on the rise? [electronic article]. 2010.

Warming up to HIT?

As docs struggle do patients suffer?

Maureen McKinney is reporting today in Modern Healthcare that physicians who own their practices may require more help to implement electronic health records than those who do not. Using survey data from more than 150 physicians, taken during a Massachusetts eHealth Collaborative pilot, researchers from Boston-based not-for-profit system Partners HealthCare assessed physicians' perceptions about the difficulties associated with EHR implementation. Of all the respondents, more than half said implementation was "somewhat difficult," while 35% called the EHR implementation process "very difficult." Roughly a quarter of responding physicians who did not have any ownership stake in their practices said they considered implementation very difficult. But that share jumped to 38% for physicians with full or partial ownership.
Physician owners may perceive the implementation process as more challenging because they have to consider the financial risks involved, the authors wrote. "Because ownership is generally associated with greater levels of responsibility for day-to-day practice operations and management, these physicians probably experienced more underlying challenges associated with EHR implementation and workflow transformation," according to the study. "Physician owners probably bear financial risk for failure of implementation out of proportion to payers or publicly funded health plans who benefit from patient safety and quality but not as directly from practice efficiency or revenue cycle management." These problems may well fall disproportionately on racial or ethnic minority physicians or those practising in medically underserved areas or areas predominated with patients from lower socioeconomic backgrounds.. As such it may also have an impact on patient outcomes, contributing to healthcare disparities.Physician owners may benefit from increased training and additional financial support when implementing EHRs, the authors said. If all providers and patients are to bequitably recieve the benefits that EMR's and other forms of Health IT have to offer, stategies will need to be developed to enable these providres to overcome these challenges.

FMI read http://www.modernhealthcare.com/article/20120120/NEWS/301209989#ixzz1k1WW12Gl?trk=tynt

Next Gen PHR's that Zing!

Personal Health Record (PHR) utilization in the US is dismal and not going anywhere fast. Many take this to mean that the concept has no value to consumers. I tend to believe the potential value is great but the currently available PHR tools and platforms are usability, functionality and interoperaboility nightmares that provide unfulfilling user experiences. (I will tell you how I really feel in a few minutes!) That may soon change. SysCon Media is reporting today (http://www.sys-con.com/node/2124318) on an intriguing concept that a company called Cloud Ventures in Canada is developing. A soon to be released white paper describing their so called ‘ONE Cloud Services’ tool which is a platform design for Cloud services based on OpenNebula that’s intended to deliver a suite of application services that tie in to the E-Health Ontario ONE program, sounds very interesting! A key part of this is capability for a ‘Personal Cloud EMR‘.
Personal Cloud
Personal Cloud refers to the aspect of how the Cloud will evolve to become a ‘Personal Data Store’ for all of our files and records. It’s a topic that was initially envisioned by Identity experts like Drummond Reed, and has since matured into mainstream developments such as consumer services from vendors like Iomega. These two different perspectives highlight the two critical foundations – The storage services for your files and data, and then also the standards and architecture for the emerging ‘Identity Ecosystem’ that will provide the mechanisms for controlling the security features for how it is shared with others.
This ecosystem will take many years to fully evolve and includes core building blocks such as OAuth which enables “Social Sign-on”, a means of joining up web sites via usernames and passwords, that vendors like Janrain cater for.
It then extends from here right through to a sophisticated ‘dataweb’ where these foundations facilitate sharing of all kinds of personal data. Frameworks for enabling and managing this data flow include the Kantara UMA program, and the OASIS XDI protocol.
These developments will enable all kinds of opportunities for service providers, ranging from simply managing the authentication process as a service, like Verizon, through to “data as a service”, where banks, utilities and other key organizations provide data for online real-time web services.
Personal Cloud EMR
As well as general purpose file sharing this Personal Cloud ecosystem will evolve to cater for various industry-specific functions, like a ‘Personal Cloud EMR’ – Electronic Medical Record. In short why have a centralized model where the hospital stores all of the electronic patient records in one big application. Why not instead have a distributed approach, where each patient stores their own record, via their own account, on the Cloud?
Considering that even advanced countries like Canada are still struggling with EMR adoption rates, it’s a hugely powerful idea to instead harness ‘the Crowd’ to tackle it.
Personal Cloud services, in combination with dataweb control mechanisms, will make the ideal combination possible – Very easy sharing of information in an entirely secure and controlled manner.
A blog from Anil John provides a simple but clear example of how it will be possible through this system to specify data is shared in a very granular manner, demonstrating the user-centric control of information that UMA and XDI are intended for.
While it remains to be seen if this idea will work any better for EMR’s than any of the current and emerging systems (not likely), it could be a significant boon to the nascent PHR world, taking them from clunky electronic mediums for text, graphic and other data storage to personal, point of need, real time, health and social service enabling platforms. If this comes to fruition, we might just begin to see the revolution in PHR utilization and patient engagement in their health and healthcare that many believe is required for substantial and sustained improvements in population health.

EHR's help improve Healthcare Disparities

iHealthbeat is reporting that Primary care physicians could help address health disparities between black and white patients if they implement electronic health records, according to a study published in the Archives of Internal Medicine. For the study, researchers examined federal government survey data from 2007 and 2008 on 17,000 U.S. primary care visits where physicians recorded patients' blood pressure. According to the study, 69% of blacks and 75% of whites who received care at primary care offices that used paper-based medical records had their blood pressure relatively under control. At physician offices that used EHRs, 75% of blacks and 78% of whites had acceptable blood pressure levels, the study found. Lipika Samal, an author of the study from Brigham and Women's Hospital in Boston, said more research is needed to discern why the gap in blood pressure between whites and blacks closed when EHRs were used. (Joelving, Reuters, 1/10).
FMI: http://www.ihealthbeat.org/articles/2012/1/10/ehrs-can-help-address-health-care-disparities-study-finds.aspx#ixzz1jA7ARsnq

New Health IT Agency?

iHealth News is reporting today that a new Institute of Medicine report due out on Thursday will say that an entirely new regulatory agency is needed to oversee this largely unregulated sector, which can also injure or kill patients if it’s not operating properly. In pushing for a new oversight body, the respected Institute of Medicine, an independent research and advisory organization, is explicitly advising that the Food and Drug Administration (FDA) not be tasked with the job — a recommendation that is bound to be controversial.
The eagerly anticipated report, titled “Health IT and Patient Safety: Building Safer Systems for Better Care,” will be publicly released Thursday. The report details nine other recommendations for how to ensure patient safety when doctors and other health care providers use health information technology, or health IT. The findings from the report were presented October 28 to the Department of Health and Human Services (HHS) and its agencies.

Though a variety of studies have concluded that the use of health IT may improve patient safety, mistakes made in the systems or difficulty using the technology can lead to serious injury or death, according to the report. An allergy might be omitted from a computer record, for example, or an incorrect medication dosage might be recorded. In Rhode Island, a Lifespan computer glitch caused about 2,000 patients to receive the wrong types of medications. In another instance in March 2009, an unattended patient suffered multiple seizures for hours after a computer failed to alert doctors the patient was moved from the intensive care into their ward.
In its report, the IOM committee says the FDA would likely restrict market innovation in health IT, which could also jeopardize patient safety. Stringent regulations “can negatively impact the development of new technology by limiting implementation choices and restricting manufacturers’ flexibility to address complex issues,” the report says. The FDA currently receives voluntary reports of health IT-related incidents, but has no resources or protocols through which to take action; the agency has long fought a losing battle with health IT vendors over trying to monitor the technology.
The report also notes the agency does not have the investigative capabilities, funding or manpower to regulate devices such as electronic health records, personal health records or health information exchanges.
To adequately oversee health IT safety, the committee recommends that the secretary of health and human services create and fund a new independent watchdog agency, along the lines of the National Transportation Safety Board. Like NTSB, the new agency would conduct investigations and make recommendations for all stakeholders, including the secretary of the health and human services, vendors and health care organizations. Vendors of the technology would be required to report adverse events, while reporting would be voluntary for clinicians. Like NTSB, though, the new agency would also have no enforcement power.
The panel also recommends that the HHS secretary publically report on the progress of health IT safety each year, beginning in 2012. If the secretary determines at any time that adequate safety progress has not been made, only then should the FDA take the regulatory lead and be given the resources to do so, the report recommends, adding that the agency should be developing a framework now to be prepared.
The committee ruled out other agencies — including the Office of the National Coordinator, the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality — as possible contenders for the position.

In its report, the IOM panel also recommended that another study be done to quantify health IT-related deaths, serious injuries or unsafe conditions so that the safety concerns can be properly addressed. “You can only improve what you measure,” says the report.
Other recommendations in the report: establishing and enforcing criteria for the safety of electronic health records, funding a new Health IT Safety Council to set standards for safety, and requiring all health IT vendors to publicly register and list their products with the Office of the National Coordinator. FMI go to http://www.iwatchnews.org/2011/11/07/7325/panel-recommends-new-agency-regulate-safety-health-information-technology/?utm_source=iwatchnews&utm_medium=site-features&utm_campaign=most-active