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Informaticopia July 3, 2008

Posted by Hans in : news , add a comment

For those of you who aren’t already aware, Informaticopia is a great blog run by Rod Ward and colleagues.  The blog presents "eclectic news and views on health informatics and elearning" and is based in the UK, but reports on worldwide issues.  I’ve been following Informaticopia for a few years now and have learned greatly from it.

Just recently, Rod and co were recognized for their great work with a nomination for a Computer Weekly blog award.

Why do I like Informaticopia?  Several different reasons:

If you haven’t done so already, please check out the blog.

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Writing to come & a new blog of interest June 29, 2008

Posted by Hans in : resources, site announcement , add a comment

Apologies for not writing much lately, but things are very hectic.  I do, however, have several posts planned and some drafts written up.  I just haven’t too much time to sit down and flesh out my thoughts.

In the meantime, I would like to suggeset another blog that came to my attention that may be of interest to you.  It is titled "e-Health Tech:  e-Health Technology, Research, Initiatives and Education" and can be found at "http://e-healthtech.org/"

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Worlds colliding…industry vs. academia May 13, 2008

Posted by Hans in : academics, nature of ehealth, opinion , add a comment

It’s interesting to see how differently ehealth is viewed by academics and industry.  To one, ehealth is the potential of using new mediums to explore ideas and possibilities, while to the other, ehealth is more of a means to an end.

For the past few years, I’ve been in the academic world exploring the limits of our existing evaluation theory as applied to ehealth innovations.  As a researcher (or perhaps more aptly, ‘would be’ researcher), I focused on the concepts of ehealth and how one could evaluate these constructs.  The pursuit was academic and intellectual, even though I tried my best to remain grounded in solving, what I perceived to be, real problems.  Perhaps that’s why much of my writing and thinking on this topic has been focused on the patient and how users of the technology (health care providers included) can be empowered by ehealth.

More recently, I’ve been exposed to the industry perspective of ehealth.  In this world, ehealth is all about programs and projects, about deployment schedules, funding options, and providing the framework to move a health care system along.  Here, there really isn’t any time for or value of the rigorous methodological approaches (and debates) surrounding randomized control trials, systematic reviews, or even articulating an epistemological viewpoint on how knowledge is constructed or derived.  Ehealth, in this context, is a business matter that requires analysis, forecast, and action.

For me, I feel somewhat stuck between two worlds, not having left the academic/research world, and yet being asked to help address some industry problems.  Discussions in the realm of industry hardly mention patients except in strategy/vision documents.  Ehealth is big business, dominated by government bodies and vendors.

I’m not saying that one is better than the other.  I merely point out something that wasn’t *real* to me until recently.  I always knew that industry is different and operated differently than the research world, but perhaps I was a bit naive about how much difference there really is.

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An update May 9, 2008

Posted by Hans in : site announcement , add a comment

I know I haven’t written anything in quite some time.  I’ve been caught up in a few projects that have been taking up my time, but I plan on posting some thoughts based on the recent experiences I’ve had.

  1. I hope to do some posting about my experiences with my dentist and how technologies are being used in that area of health care.
  2. Some thoughts about the dichotomy between industry and academia in terms of the outlook of ehealth
  3. Some thoughts on recent developments in the mobile/handheld world. By this, I mean specifically Apple’s iPhone and some of the potential implications for health care

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Google Health: the beginning or the end of ehealth as we know it? February 21, 2008

Posted by Hans in : news , add a comment

Google announced the launch of a pilot project in collaboration with the Cleveland Clinic to provide select patients access to their medical record using the Google health platform.

According to the Associated Press, Google will:

begin storing the medical records of a few thousand people as it tests a long-awaited health service that’s likely to raise more concerns about the volume of sensitive information entrusted to the Internet search leader.

The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google’s new service, which won’t be open to the general public.

Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that’s also required to use other Google services such as e-mail and personalized search tools.

I think we’ve all known that something like this was coming. I’m just surprised that Google decided to jump directly in with such large undertaking. I would have predicted (and even suggested) starting with something a little less ambitious.  Does Google’s entry (and Microsoft’s Health Vault) change the ehealth landscape?  Is this the "tipping point" where we get to see tangible progress in ehealth that benefits patients?

Regardless, I think Google’s involvement will provide more publicity to the entire field, and also provide some additional competition to the industry. I’m curious to see how the established parties will respond.

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A new architecture for EHRs? February 5, 2008

Posted by Hans in : analysis , 4comments

Amidst the efforts to develop the elusive electronic health record (EHR) and to modernise our health care systems are many technical challenges that need to be addressed.  One significant challenge is integrating information from a variety of difference sources (i.e., lab systems, pharmacy systems, scheduling systems, directories, nursing and physician notes, etc) and to present this information in a coherent, user friendly fashion.  In the past, I’ve participated in some of the technical discussions regarding potential solutions and let me tell you that there are no easy solutions.  We’re talking about massive amounts of data needing to be transferred between different points.  Then we also need to talk about how to take this data and make the information accessible to the health care provider (and ultimately the patient) at the time and place needed.

From my understanding, much of this integration work has gone along the path of developing systems that function as "dashboards" by collecting and aggregating information from various sources.  I discussed this concept with Khaled El-Emam in the past and he indicated that database technology isn’t yet sophisticated enough to do massive real-time push updates.  It can be done on a small scale, but the model doesn’t scale.  I noted this point when the University Health Network (UHN) started moving towards an enterprise clinical data ware-house.  The original thought was to update all of the hospitals clinical systems in real time as new patient data was created.  Unfortunately, practical limitations forced the real-time aspect to be abandoned.  I wasn’t privy to the final solution, but I’m told that the solution that was agreed upon was batch updates nightly for things that were time dependent and weekly (or even monthly) updates for other types of data.  We’re talking about a single hospital corporation having difficulty updating its own systems - granted, UHN is one of Canada’s largest hospital corporations and has three main hospital sites with over 10,000 staff, so we’re not talking about a small organization.

I was notified of a proposed alternative method of integrating information within an electronic health record by Vitaly Latush.  He outlines:

"an alternative approach to implementation of a nation-wide easily accessible electronic health record solution based upon the "publish-discover" paradigm successfully used on the global scale to manage immense volumes of non-integrated information available through the Internet"

His main argument against the current architecture/model is that integrating data from all of the different data sources is far too complex because it is based on exchanging data based upon standardized rules.  Latush suggests that a model based on how the Internet currently operates is far more efficient and ultimately more effective.

In this alternative model, he suggests that data sources, be it physicians in an office, labs, or hospitals should only be responsible for "announcing" that new data is available and then providing access to this information.  I would assume that some sort of RSS technology (or a derivative) would be used.  Instead of waiting for some program or system to take this data and integrate it into a dashboard, users would search for information, like they do on Google or any other type of search engine.  Health information would be aggregated by some sort of unique patient identifiers or other keywords.

Latush suggests the following advantages of this model over the existing architecture:

  1. Minimum integration effort - searching for information is now the main function
  2. Based on *proven* Internet principles
  3. Does not require new technologies or skills
  4. Can be built on top of existing health information systems very easily
  5. Facilitates incremental incremental improvements of the functional EHR
  6. Suited for unstructured data manipulation
  7. Cost-efficient in terms of up front cost and maintenance
  8. Self-organizing

 After reading the white paper, I have to admit that the idea is interesting and deserves some investigation.  Here are some thoughts I have about this idea:

Again, this idea sounds very interesting.  From my understanding of things here in Ontario, I believe that some of these concepts may be adopted already or at the very least being discussed.  As the health system moves toward regionalized and integrated models, the need to share information becomes greater.  Regardless of your thoughts on this specific proposal, I think the value is in the discussion and generation of new ideas.  As well all know, health care is important but sometimes takes a back-seat to more "sexy" things like new technologies or recent events.

I highly recommend you read Vitaly Latush’s blog post on this topic or read his white paper, titled "EHR 2.0 - new Electronic Record concept".

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Conference announcement: HAND-HELD [un] conference - Mar. 20, 2008 @ Toronto, Canada January 29, 2008

Posted by Hans in : conferences & conventions , add a comment

I came across this announcement for a conference that sounds very interesting.  It’s called "HAND-HELD:  an [un]conference harnessing digital storytelling to improve health".  I’m intrigued by the description of the event:

HAND-HELD is an [un]conference that explores how digital storytelling and new media can be harnessed to improve health care when the tools of creation are placed in the hands of citizens.

The event will showcase the remarkable results of an 18-month participatory media project, I WAS HERE. We put digital cameras into the hands of young mothers who have experienced homelessness to document their lives, and their experiences with the healthcare system.  Their photography and video work will be the starting point for the conversations during the day.

HAND-HELD will bring together a small, hand-picked selection of health-care professionals, academics, media-makers, politicians, decision-makers and young parents who have experienced homelessness — all experts — in a unique open-source day to envision our collective future of health-care in a democratic and digital age.

A while back, I wrote a series on my personal predictions of disruptive technologies in health care.  In my final summary, I identified the patient as the ultimate disruptive force.  Not sure if I’ll be able to attend, but I’m going to try and make it.  The [un]conference is to take place on Thursday March 20th, 2008 in downtown Toronto at the MaRS Centre.

To make things even more ironic, I had an opportunity to catch-up with an old colleague of mine, Dr. Carlos Rizo, and we had a wonderful time talking about our own patient experiences and hopes for transforming health care a system that is actually about the patient.  We hope to do some work together in the future on this topic, so I’m hopeful for some new and exciting developments.

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A glimpse at Google health? January 24, 2008

Posted by Hans in : news , add a comment

Seems like Google is doing things in the background regarding their health product.  Another blog reported a Google Health login page.  Some of the features listed on the login page sound like things I predicted with my "prescription for Google Health".  Definitely something to be on the lookout for, especially given Microsoft’s foray into ehealth with their HealthVault offering.

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A voice against irrational exuberance in ehealth January 23, 2008

Posted by Hans in : academics, analysis, opinion, research , 1 comment so far

For those interested in a somewhat contrarian viewpoint about ehealth, I suggest you check out Scot Silverstein.  I just recently came across his site documenting some "common examples of health care IT difficulties".  You can also listen to his interview available via the Government Health IT site - an excellent site.

In his interview, Dr. Silverstein raises some very important points:

My interest in Dr. Silverstein’s work is in our common view on technology:  that there’s great potential to make positive changes, but that success isn’t a certainty - what is commonly referred to as "technological determinism".  I’ve written as far back as 2004 about technological determinism and ehealth, namely to be skeptical about the absolute certainty that the IT professionals have about ehealth (e.g., my post about IBM building computer models to solve health care’s woes).  I think it’s important to have a balanced view on being hopeful of the possibilities, but also being realistic about the challenges (some final thoughts from a 2005 ehealth conference).

I hope to do some more reading on his website to see what other nuggets I can glean from his work.

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Is this the future of peer review? January 22, 2008

Posted by Hans in : academics , add a comment

Came across an interesitng report of how an "author used blog comments to peer review a book".  Before dismissing this report, please consider that the book "examines the study of video games, and the blog in question is Grand Text Auto, an academic blog founded in 2003 that deals with ‘digital narrative, poetry, games and art.’".

Given some of the moves toward open access publishing for all government supported research projects, looks like the academic publishing world may be undergoing some change.

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