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Hacking Health in Hamilton Ontario - Let's hear that pitch!

What compelled me to register for a weekend Health Hackathon? Anyway, I could soon be up to my ears in it. A pubmed search on Health Hack...

Monday, July 30, 2012

Online Journal Articles and Social Media

http://www.mdpi.com/1660-4601/6/2/492

The academic study of Health Informatics requires a lot of researching of journal articles, mostly online versions through a university electronic subscription. The work of librarians is constantly changing because of digital technology, and journal articles are framed in the context of relevance, statistics, interrelationship.  Of course, one needs to know how to read a journal article, and in my courses at McMaster, we learned how to read journal articles along the principles of evidence based medicine.  Evidence based medicine was started at McMaster, and one of my tutorial leaders, Dr. Brian Haynes, was one of the original founders of this approach.

But if you look at the journal article link above "Emerging Patient-Driven Health Care Models: An Examination of Health Social Networks, Consumer Personalized Medicine and Quantified Self-Tracking", there are many ways to make the data in the article organizable, searchable, and ultimately understandable.  One of those is the link to Connotea, which  reminded me that I setup a Connotea account but haven't used it in several years.  There are so many ways to slice and dice a journal article as a research object, which is why it makes sense to approach research looking for the "nano-slice of the pie of science".

My favourite way of organizing journal articles was through Refworks.  There are three main reasons way Refworks really rocks:
1) you can search the Pubmed or other library catalogues and import articles quickly
2) you can create footnotes and references exported into Word documents easily
3) you can share, add, edit and delete your references with others on the academic team




Tetherless World Constellation

http://tw.rpi.edu/web/

This educational and research program at Rensselaer University is fascinating.  The name of the program - Tetherless World Constellation - itself is intriguing. Yes, the WWW is anything but tethered. There are health informatics programs of study here, though it is just one of the X in what they call Xinformatics - general areas of informatics study.   I notice that the template for the website is the garland theme in Drupal, one I used to use, and I like the way they have designed the navigation.

Thursday, July 19, 2012

HL7 Working Group on Personal Health Records

There is an HL7 Working Group on Personal Health Records.  They have weekly teleconferences. I have listened in for a few of them.  I just joined one of the HL7 listservs to get involved. It appears to be mostly a voluntary organization run by people in the industry, with oversight from the HL7 organization. Highly recommended for those who want to become more involved in this development.

Friday, July 13, 2012

UK unveils patient-centred electronic health strategy

I am reposting this CMAJ article that some of my eHealth friends had posted on a forum.  Seems like UK eHealth has a different framework strategy, that is more distributed and locally agile in response to the crashing failure of the previous centralized all encompassing waterfall approach. Give local systems room to breath, and they will all mesh naturally in future. 

Thursday, July 12, 2012

The Health and Wellness Companion Personal Health Record

I just found out through my online life insurance company (employer's benefits) that I can access a Practice Solution Personal Health Record.  I am about to apply for online access but I found the user agreement quite interesting, so I am posting it here:




End User Terms of Use (last revised September 15, 2009)
The following Terms of Use constitute an agreement between you and MD Physician Services, a Canadian Medical Association company ("we" or "us" or "MD Physician Services") with respect to your use of the Health & Wellness Companion (the "Service"). By using the Service you agree to the following Terms of Use. If you do not agree to these Terms of Use, please do not use the Service. We may revise this document from time to time. If you disagree with the changes discontinue your use of the Service. Your ongoing use of the Service after the changes take effect signifies your agreement to the new terms. We encourage you to review these terms and conditions regularly.

  1. About The Service
    The Health & Wellness Companion is a web-based interactive health information service comprised of a number of tools and content sources provided by MD Physician Services to you through your employer and/or corporate insurance provider ("Provider") to help you better manage your health:

    1. Assessments are interactive questionnaires that evaluate your family history and lifestyle habits, identify areas of risk, and recommend personalized action plans. The Questionnaires provide an assessment of risk and suggestions for behavioral change. There is no guarantee that following the recommendations will prevent the onset of disease.
    2. Personal Health Record (PHR) is a confidential, secure online location where you can store important medical data such as family and individual health information. You are solely responsible for the accuracy and completeness of the health information that you enter into your PHR.
    3. Health Library is a comprehensive library of accurate, quality-assured health information on medical conditions and/or diseases (causes, symptoms and treatments) as well as a searchable database of information about prescription drugs. The content is provided for information purposes only and is not intended for diagnostic purposes. If you have specific health concerns we recommend that you see the advice of a physician.

    While we have made every effort to provide a reliable and accurate information source you understand that the Service is provided AS IS and without warranties.

    We may from time to time add new features to the Service, substitute a new feature for an existing feature, or discontinue an existing feature. Information about new features will be provided to you by your Provider. The use of any new features will be governed by these Terms of Use.


  2. Ownership
    We own the Service and it is made available to you by your Provider under a contractual arrangement. All content and materials available on the Service is owned by us, our suppliers or your Provider as the case may be and is protected by copyright, trade-mark, service mark, patent, trade secret, or other proprietary rights and laws. You may not copy, modify, alter, revise, paraphrase, omit, change, display, store, timeshare, rent, lease, sublicense, publish, distribute, transmit, transfer, assign, sell, or commercially exploit in any manner the Service, or any software or content contained on the Service. You may however, print or download one copy of the materials or content on this site on any single computer for your personal non-commercial use, provided you keep intact all copyright and other proprietary notices. Use of content or materials for any purpose not expressly permitted in these Terms of Use is prohibited. No part of any content, form or document may be reproduced in any form or incorporated into any information retrieval system, electronic or mechanical, other than for your personal use (but not for resale or redistribution).


  3. Disclaimer of Warranty of Text
    The medical information, consultation features and other resources contained in this Service are for informational purposes only and in no way are intended to substitute for professional medical care or attention by a qualified practitioner. No representations or warranties of any kind whatsoever regarding any treatment, action or medication or preparation by any person with respect to the information, consultation features, possibilities or conclusions, or other resources offered or provided within or through the Service are made by MD Physician Services, its suppliers or your Provider. You agree that MD Physician Services, its suppliers and your Provider are not responsible for the results of your decisions resulting from the use of any content or software on the Service including, but not limited to, your choosing to seek or not to seek professional medical care, or your choosing or not choosing specific treatment based on the text.

    Note to users accessing the Health & Wellness Companion from outside Canada
    The assessments and the content of the Health Library have been developed in accordance with relevant Canadian clinical guidelines. If you require advice for your specific circumstances, please contact a health professional in your country of residence.

    Links to various other Web sites from the Service are provided for your convenience only and do not constitute or imply endorsement by MD Physician Services, its suppliers or your Provider of these sites, or any benefits, products or services described on these sites, or of any other material contained on them. Practices Solutions, its suppliers and your Provider disclaim any responsibility for their content and accuracy.


  4. Disclaimer of Warranty of Software
    You agree that use of the Service is at your sole risk. The Service and the software are licensed "As Is". MD Physician Services, its suppliers and your Provider disclaim all warranties, expressed or implied, including, without limitation, any implied warranties of merchantability of fitness for a particular purpose. No warranty is provided that the functions contained in the Service will meet your requirements or that the operation of the Service will be uninterrupted or error-free, or that defects in the Service will be corrected. To the extent possible, MD Physician Services has provided a reliable and accurate information source however we cannot guarantee that information contained in the Service will always include the most recent developments with respect to a particular item. Unless otherwise agreed to in writing, MD Physician Services and its suppliers do not warrant or make any representations regarding the use or the results of using the Service including, but not limited to its correctness, accuracy or reliability.


  5. Limitation of Liability
    We and our suppliers are not responsible in any manner for direct, indirect, special or consequential damages howsoever caused arising out of the use of this Service, even if advised of the possibility of same. This disclaimer of liability applies to any damages or injury caused by any failure of performance, error, omission, interruption, delay in operation or transmission, communication line failure, alteration of information on the Service, or inability to gain access to or use your Personal Health Record. We disclaim all responsibility or liability for any damages caused by viruses contained within any electronic file containing a form or document. Your sole and exclusive remedy for any dispute with us or our suppliers is the cancellation of your registration for the Service.


  6. Your responsibilities
    You are responsible for keeping your password confidential and for notifying us if you suspect that your password has been hacked or stolen. Please contact us at support@wellnesscompanion.com. You are solely responsible for the accuracy and completeness of health or health-related information that you enter (for example in response to a HRA questionnaire or in the PHR).


  7. No Endorsement
    We do not endorse any information, products or services unless such information, product or service is clearly marked as endorsed.


  8. Content Providers
    Content on the Service is provided by third party suppliers, Clinemetrica, Healthwise Inc. and MediResource®.
    About Clinemetrica

    Founded in 1989 by faculty and research staff from the Division of Clinical Epidemiology, the Montreal General Hospital and McGill University, Clinemetrica is a fully bilingual Contract Research and Corporate Health Organization applying the highest academic standards. Members of the Clinemetrica editorial board also have clinical positions with the McGill Cardiovascular Health Improvement Program. Clinemetrica editorial board includes:
    • Steven Grover, MD, MPA, FRCPC
      Dr. Steven A. Grover is the Director for the Analysis of Cost-Effective Care and the Division of Clinical Epidemiology at The Montreal General Hospital and a Professor in the Departments of Medicine and of Epidemiology and Biostatistics at McGill University. After graduating with a medical degree at McGill University, he completed his post-graduate education at the University of California at Los Angeles, McGill University, and Harvard Medical School. He then received his research training at the Brigham & Women's Hospital while completing a Master's of Public Administration at the Kennedy School of Government, Harvard University. Dr. Grover's research team developed the validated and published disease simulation models that are used on the Practice Solution's website.
    • Ilka Lowensteyn, PhD
      Dr. Ilka Lowensteyn is a Medical Scientist at the Centre for Cardiovascular Risk Assessment at the McGill University Health Centre and an adjust assistant professor in the department of Medicine at McGill University Health Centre. She is also the Director of Clinical Research for the Cardiovascular Health Improvement Program (CHIP), which is a cardiac rehabilitation program for the McGill teaching hospitals. After graduating with a doctoral degree in Exercise Physiology from the University of Miami, she completed an NHRDP post-doctoral fellowship at McGill University.
    • Sylvie Marchand, RN
      Sylvie Marchand is a registered nurse with 25 years of clinical and research experience. Her main areas of practice are cardio-metabolic disease and lifestyle change.
    About First DataBank

    Each First DataBank product module is supported by a comprehensive editorial policy that has been internally peer-reviewed. In the execution of those policies and the development of the NDDF Plus database, First DataBank’s staff of more than sixty pharmacists and research associates use a variety of reference sources including, but not limited to, primary medical literature (e.g., published journal articles), medical reference texts, published expert treatment guidelines, and manufacturer product package inserts. To ensure the quality of this data, First DataBank employs the following procedures:
    • The development of detailed process map sets for core processes to enhance their consistency and accuracy. These process map sets include box diagrams that identify all steps in a work flow, responsibility matrices that designate the parties responsible for performing tasks, control plans that serve to manage risk, and precise work instructions.
    • The application to modules of data audits designed to prevent patient safety issues. Data is regularly reviewed to ensure that it is in accordance with editorial policies in material respects. These audits run prior to delivery to customers and are designed to identify problem issues in advance. Six Sigma statistics are also calculated for each First DataBank module.
    • Data validation at the point of entry to optimize quality and performance. Data validations are incorporated into maintenance system forms to reduce issues at the point of entry.
    • Maintenance system quality checks to support data integrity. Second quality checks are performed for many data elements by a pharmacist or research associate who did not participate in the original entry of the data, and who is required to check the data against original reference sources.
    • Formal methodology for testing that begins at design and extends through delivery. First DataBank clinical pharmacists use automated software tools to test output information across multiple platforms and databases. Dedicated teams execute both clinical and functional tests to ensure that database, software and forms return correct results. Suites of test cases have been developed for every module and requirements traceability and cross reference test cases are performed to ensure compliance with requirements.
    • Root cause analysis to ensure problem understanding and prompt resolution. When issue do occur event investigation are conducted so that problems are diagnosed and corrective actions implemented to prevent their reoccurrence.
    About Healthwise

    The Medical Review Board is directed by our chief medical officer, Dr. Steven L. Schneider, and our medical directors, Dr. Adam C. Husney and Dr. Martin J. Gabica; all three are board-certified family medicine physicians. Dr. Catherine Serio provides leadership on behavioral health issues for all Healthwise products. There are nine board-certified associate medical directors. Together, these thirteen physicians conduct initial and final reviews of all Healthwise® Knowledgebase topics written by Healthwise, and they are involved in the planning and updating of all Healthwise publications and products.
    • Chief Medical Officer - Steven L. Schneider, MD, Family Medicine, Boise, ID
    • Medical Director - Adam C. Husney, MD, Family Medicine; Physician, Boise Minor Emergency Center, PA, Boise, ID
    • Medical Director - Martin J. Gabica, MD, Family Medicine; Boise, ID
    • Behavioral Health Specialist - Catherine Serio, PhD, Psychology, Boise, ID
    • Associate Medical Directors
      • Patrice Burgess, MD, Family Medicine; Assistant Clinical Professor, University of Washington, Family Practice Residency of Idaho, and Medical Director of Physician Relations at Saint Alphonsus Regional Medical Center, Boise, ID
      • William M. Green, MD, Emergency Medicine; Medical Director, Sexual Assault Forensic Evaluation Team and Clinical Professor, Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA
      • Sarah Marshall, MD, Family Medicine; Assistant Clinical Professor, Department of Family and Community Medicine, University of California, Davis, Sacramento, CA
      • Joy Melnikow, MD, MPH, Family Medicine; Professor, Department of Family Practice, University of California, Davis, Sacramento, CA
      • Anne C. Poinier, MD, Internal Medicine; Physician, St. Luke's Internal Medicine, Boise, ID
      • Caroline S. Rhoads, MD, Internal Medicine; Associate Professor of Medicine, University of Washington, Seattle, WA
      • Kathleen Romito, MD, Family Medicine; Physician, Primary Health Wellness Center, Boise, ID
      • Michael J. Sexton, MD, Pediatrics; Medical Director, CARES Program, St. Luke's Children's Hospital, Boise, ID; Associate Clinical Professor, Family Medicine, University of Washington, Seattle, WA
      • E. Gregory Thompson, MD, Internal Medicine; Physician, St. Luke's Internal Medicine, Boise, ID
    Other members of the Medical Review Board review Knowledgebase topics from the specialist's point of view. With the input of these specialists, Healthwise medical writers develop topics based on scientific evidence and current clinical practice.
    Members of the Medical Review Board are experts in their specialty area. Their credentials include board certification, academic appointments at the nation's leading medical schools, active involvement in research, and publication in peer-reviewed journals and medical textbooks. Most important, they share the Healthwise commitment to empowering patients with reliable health information and building strong patient-provider relationships; this encourages partnerships in the decision-making process.
    About Mediresource
    The MediResource Clinical Team includes a dedicated staff of in-house health care professionals, editors, and medical writers, along with a team of medical advisors and freelance medical writers. All have extensive experience in their medical specialty and in producing medical information for the public that is relevant, timely and accurate.
    All MediResource health content is clinically reviewed by a health care professional. Authors of health content are always qualified medical writers. Clinical reviewers are health care professionals selected for their experience and expertise in the topic. All articles are edited by two medical editors experienced in the production of medical information for the public.
    • Medical editors
      • James Harbeck, PhD
      • Nicolette Blase
      • Joanne Lee, BSc
      • Angela L. McOrmond
    • Healthcare professional consultants
      • Pharmacist consultants
        • Ruth Ackerman, BScPhm, RPh, MBA
        • Jennifer Ahn, BScPhm, RPh
        • Daniella Gallo, BScPhm, PharmD
        • Andrea Hudson, BA Psych, BScPhm, PharmD, RPh
        • Daniel Kim, Hon. BSc (Tox), BScPhm, RPh
        • Samantha Moe, BSc Phm, ACPR, PharmD
        • Cathy Nguyen, BScPhm, RPh
        • Trish Rawn, BScPhm, PharmD, RPh
        • Tom Smiley, BScPhm, PharmD
        • Kathy Tam, BScPhm, RPh
        • Amanda Ung, Hon. BSc, BScPhm, RPh, ACPR
      • Medical writers
        • Sharon Aschaiek, Hon. BA
        • Lisa Bendall, Hon. BSc (Psychology)
        • Gisèle Grant, BSc
        • Jaclyn Law, Hon. BA (English)
        • Amy Toffelmire, BA
        • Marijke Vroomen-Durning, RN
      • Medical advisors
        • Emergency medicine - Ernie Murakami, MD, Alan Kaplan, MD
        • Gastroenterology - Paul Moayyedi, MB, ChB, PhD, MPH, FRCP (London) FRCPC
        • Hematology - Darrell J. White, MD, MSc, FRCPC
        • Infectious diseases - Lorne A. Babiuk, OC, SOM, PhD, DSc, FRSC, R. Reynolds, MD
        • Internal medicine - R. Reynolds, MD
        • Neurology -Jack Schneiderman, MD, FRCPC
        • Otolaryngology -Robert Irvine, MD
        • Pediatrics -Jeremy Friedman, MB ChB, FRCPC, Sanjay Mehta, MD, MEd, FRCPC, FAAP, FACEP, Dennis Scolnik, MSc, MB, ChB, DCH, FRCP
        • Psychiatry -Ronald A Remick, MD, FRCPC
        • Rheumatology -Katherine Siminovitch, MD
        • Sports medicine - E. Laura Cruz, MSc, MD, CCFP, Dip Sport Med
      Note about content suppliers
      Each content supplier has its own terms and conditions and licence agreement which are incorporated by reference into these Terms of Use. By accessing and using this material you agree to comply with these additional terms and conditions. For more information please read Healthwise Knowledgebase Licensing Agreement and Terms and Conditions.
      You are required to acknowledge the MediResource Conditions of Use each time you access their service.
  9. Advertising policy
    Our Website does not host any form of advertisement.
  10. Privacy
    In order to provide you the Service we need to collect certain information from you. Please read about our information handling practices in our privacy policy
  11. Transparency
    The Health and Wellness Companion is certified by the Health on the Net Foundation as compliant with the HONcode. As part of the certification process MD Physician Services must disclose its sources of funding as well as any conflicts of interest. The provision of the Health and Wellness Companion and the development of enhancements are financed in part by fees paid to MD Physician Services by employers and/or corporate insurance providers. There are no conflicts of interest to be declared. Health information found on the Health and Wellness Companion is provided by independent third party content providers.
  12. Termination of Access
    We reserve the right, in its sole discretion, to terminate your access to the Service. In the event of such termination we will notify you and you are advised to transfer any medical records or other information stored on the Service. If the Service is terminated by your Provider, your Provider may arrange for a replacement service to be made available to you. You consent to the transfer of any personal health information you have supplied to us when using this Service to such replacement supplier. Any such transfer will occur only on the instructions of your Provider. In the event that we do not receive instructions to transfer your information, we will retain your information for a minimum of 60 days after the date of termination after which time it will be destroyed.
  13. Governing Law
    This Agreement is governed by and shall be construed in accordance with the laws of the jurisdiction in which the end user resides and the laws of Canada applicable in that jurisdiction without regard to their conflict of law provisions.

Wednesday, July 4, 2012

Privacy and Security for Patient Portals: 2012 Guidelines for the Protection of Health Information Special Edition

COACH special edition on patient portals
The COACH 2012 Special Edition "Privacy and Security for Patient Portals 2012 Guidelines for the Protection of Health Information Special Edition", has just been released. I got my web version copy in advance last week because I was a member of the Expert Group who initially drafted it.  The final product looks really good, and presents the hard work of the volunteer group really well. Highly recommended reading if you are at all thinking of implementing or using patient portals, otherwise known as electronic Personal Health Records.

Tuesday, July 3, 2012

Australia's Personally Controlled E-Health Record system starts

I have been interested in following the development of this.  It is a national architecture for an electronically personally controlled health record system.  The recent demise of the UK system suggests that large national architectures don't always do well.  To my knowledge Canada does not have nor is planning such an architecture.  Alberta has the backbone infrastructure to use one, through their Myhealth system. I am not at all sure about eHealth Ontario.


The PCEHR, accessed by the patient and his or her authorised healthcare providers, is a electronic record of patient’s medical history, stored and shared in a network of connected systems.
Managed by the National E-Health Transition Authority (NEHTA) on behalf of the Department of Health and Ageing, the PCEHR reform agenda will save the Australian government and related agencies US$11.5 billion over 15 years.
These saving stem from expanded use of health information management systems, on-line registration capabilies, improved information-sharing between healthcare providers, and consolidated patient record-keeping programmes.
Initially, consumers can register for the e-Health system using a dedicated 1800 number.
An on-line registration website is being finalised by the Australian Department of Health and Ageing, enabling citizens to register on-line through a dedicated portal.
The PCEHR offers an opt-in system, however it is still unclear how this opt-in system will work.
The PCEHR legislation clarifies guidelines about who can enter health information and who can read or change this information. Among these guidelines, patients can access their own e-Health record. They can also track who else has accessed their record.
Patients can upgrade their privacy settings to suit personal needs. But only doctors, or other health professionals, will be alllowed to create medical notes on a patient’s file.
Users who sign up for an eHealth record will no longer have to repeat their medical history each time they see a different GP or other healthcare professional.