MyChart: One Toronto hospital’s e-health triumph – The Globe and Mail

Good example from Toronto’s Sunnybrook Hospital of a successful and running patient portal, with 20,000 users. Would love to have this rather than my own cobbled together ‘system’. Quote:

Dr. Calvin Law, a cancer surgeon at Sunnybrook, noted there were initially some concerns that direct access to medical records would cause confusion or increase anxiety among patients. Instead, MyChart has led to better-informed patients, he said.

Doctors normally have a limited amount time to spend with each patient. During these relatively brief appointments, patients may not comprehend or remember everything they are told. By being able to review their doctor’s notes, patients gain a greater understanding of their condition. And if a doctor’s notes contain medical terminology or information that patients don’t understand, they can raise questions at their next appointment.

“It empowers the patients so much more – like we are in it together. And it is a whole new way of doing medicine,” said Law.

MyChart: One Toronto hospital’s e-health triumph – The Globe and Mail.

How Big Data Became So Big – Unboxed – NYTimes.com

How big data became the new marketing term for businesses, in contrast to some of the dryer terminology like ‘data mining’, ‘business intelligence’ and ‘data analytics’. Quote:

IT may seem marketing gold, but Big Data also carries a darker connotation, as a linguistic cousin to the likes of Big Brother, Big Oil and Big Government.

“If only inadvertently, it does have a sinister flavor to it,” says Fred R. Shapiro, editor of the Yale Book of Quotations.

Big Data’s enthusiasts say the rewards far outweigh the risks. Still, smart technologies that promise to observe, record and make inferences about human behavior as never before should prompt some second thoughts — both from the people building those technologies and from the people using them.

How Big Data Became So Big – Unboxed – NYTimes.com.

When Medical Informatics Clashes With Medical Culture – Informationweek

Notes how the lack of information on costs hampers more informed choices by doctors and patients. A number of articles have talked about the particularly opaque nature of costing and billing in the US (although I expect that the HMOs have fairly good data and reimbursement schedules), as do the more public universal systems in other countries. Quote:

Many physicians would argue that ignoring these more remote diagnoses means putting costs ahead of patients’ welfare, and that’s simply unethical. But Rosenbaum and Lamas point out in their recent NEJM editorial, Cents and Sensitivity–Teaching Physicians to Think about Costs, “Considering cost serves not only the equitable distribution of finite services but also the real interests of individual patients. Medical bills, after all, are among the leading causes of personal bankruptcy.”

Those bills would be significantly lower if physicians stopped ordering unnecessary procedures. And there’s now solid evidence to show that some routine diagnostic and screening tests really are a waste of money.

Among the worst offenders: screening EKGs, chest X-rays before outpatient surgery, and CT scans or MRIs after a patient faints. Unnecessary tests have become so prevalent that nine major medical organizations have launched “Choosing Wisely” campaigns to educate clinicians and the public about wasteful testing.

When Medical Informatics Clashes With Medical Culture – Healthcare – Electronic Medical Records – Informationweek.

Better medicine, brought to you by big data — Cloud Computing News

Some concrete examples of how ‘big data’ is improving medicine and healthcare:

  1. Genomics
  2. Business intelligence for doctors to analyse hospital-wide data
  3. Semantic search to improve search results (more plain language search)
  4. Hadoop (?) for everything – identifying unsuspected adverse side effects from multi-drug combinations, or analysing medical images
  5. IMB’s Watson diagnostic tool
  6. Getting ahead of disease by identifying predictors
  7. Data scientist in residence
  8. Crowdsourced science – see PatientsLikeMe website

Worth a quick read.

Better medicine, brought to you by big data — Cloud Computing News.

X-rays and iPads: The network healthcare evolution | Ars Technica

An overview piece on some approaches to more aggressive use of technology to:

  • Monitor patients’ health more proactively with networked devices, ranging from wirelessly networked medicine bottle lids to worn or embedded sensors that report back on vital signs;
  • Coordinate care with the help of analytic tools in the cloud and a wealth of individual and collective patient data; and
  • Connect physicians directly with patients over PCs or mobile devices for between-appointment follow-ups.

And of course the easy, an obvious applications for iPads (imaging, not just x-rays), particularly with the latest model and its HD display.

And the usual obstacles and challenges to making this happen, ranging from privacy considerations to compensation.

X-rays and iPads: The network healthcare evolution | Ars Technica.

The online presence of health information empowers patients

One of the more optimistic, almost utopian version of how online information and related eHealth applications will improve healthcare outcomes at reduced cost. One of the bigger challenges is figuring out where can online activity appropriately replace traditional contact, with increased efficiencies, and where does it simply increase overall demand for healthcare, at increased cost and time, as well as the investment in infrastructure required to provide an effective online presence.

The ‘baby steps’ that I see with my family doctor (office completely electronic, all paper scans into the system), at the Blood and Marrow Transplant clinic (good EHR for all hospital related records, but hopeless paper-based notation of clinic visits, and openness to email communications – which I try to use sparingly), and some of the new monitoring devices that allow us, not just the ‘quants’, to more closely monitor our health, will likely be the way that change occurs incrementally.

The online presence of health information empowers patients.

The Prognosis for Medical Innovation – NYTimes.com

A good short piece on innovation in healthcare, and how sometimes the big, shiny and new can be overshadowed by smaller, incremental changes that deliver better outcomes (e.g., checklists, smartphone home monitoring applications, and progress towards electronic health records). The key point is to have good data to know which new technology and/or procedures result in greater improvement in outcomes, to assist investment and use decisions.

The Prognosis for Medical Innovation – NYTimes.com.

Look to technology to reduce health costs

I am a bit less optimistic about technology and cost reduction, given the systemic complexity, as well as how technology allows us to do more, and incur higher costs. Quote:

But the coming changes are not just in technology but in the distribution and work of providers. With shortages of physicians, especially primary care physicians, appropriate integration of nurse practioneers and physician assistants can not only partially compensate but provide quality interaction with patients, augment preventive programs and enhance care coordination for those with chronic illnesses. And although there is considerable controversy as to appropriate scope of practice, it is certainly clear that the interaction of PCPs with NPs and PAs can enhance the totality of patient care.  Similarly, expect to see more mental health delivered by psychologists and social workers; visual care by optometrists; and hearing care by audiologists.

Look to technology to reduce health costs.

Health Systems Spending Billions to Prepare for the “Last Battle” – Forbes

An insightful article on how existing eHealth platforms tend to have a transactional approach (people in and out of the hospital) rather than chronic disease (ongoing relationship). Quote:

The healthcare providers who have demonstrated dramatically positive results with challenging patient populations recognize that there are two main care approaches. In a setting such as a hospital, many leading hospitals have adopted a manufacturing-based model borrowed from Toyota. However, with chronic disease, a service-based approach is necessary to effect behavioral change. In a manufacturing setting, with enough practice a machine will do what it is intended to do and doesn’t have a mind of its own. However, as anyone who has been in a service-based business knows, human interaction and a partnership-oriented approach leads to the best outcomes.

 In effect, this means that IT and related processes will need to be more iterative and adjust to the experience and outcomes of patients, rather than assuming standard outcomes. Conclusion:

… to support the array of new demands, systems will need to be nimble, affordable and person-centered. These aren’t the adjectives typically applied to traditional healthIT systems. Just as we have observed the military frequently spending money on capital built for the last war such as aircraft carriers and other slow moving military tools. Over time, the military learned that it was as much or more important to focus on the hearts and minds of those they were trying to work with and that remote intelligence tools have been highly effective at winning battles. When it comes to managing chronic disease, winning the “hearts and minds” of patients and remotely monitoring health are similar skills not factored into systems developed for the legacy reimbursement model.

Doubting the cost savings of health information technology

A post indicating the results of a study that showed that imaging orders increased with computerized health systems, with increased duplication and costs. Concluding quote:

Perhaps it is not enough just to have a health IT system but rather it is the quality of connectivity between health IT systems (coupled with a less litigious environment) that produces the anticipated cost-saving advantages of health IT and the true effects on physician behavior?

 Another illustration of the complexity of health care and its related systems and habits.

Doubting the cost savings of health information technology.