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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...

Wednesday, August 29, 2012

Would you use Skype for a doctor's appointment?

This article is a little breezy but it asked the question to the public if they would be willing to use Skype for a doctor's appointment.  A few citizens have replied with comments.
http://www.cbc.ca/news/yourcommunity/2012/08/would-you-use-skype-for-a-doctors-appointment.html?cmp=rss
I heard a Nurse at an eHealth conference in Toronto talk about how Skype was being used for remote villages in Newfoundland.  A lot of education and training is being done by web conferencing these days - saving on travel expense.  A Skype interaction between patient and physician is a no brainer in my opinion, as soon as physicians can work out how to bill for Skype calls.  It is in a way a return to the home visit tradition.  Dedicated telemedicine centers like Ontario Telemedicine Network are more robust versions of this, but the convenience and common sense of the Skype appointment needs more implementation.  I am not sure about the privacy and security of a Skype call, nor Skype's ownership by Microsoft, but I expect those are technological problems that can be worked through.  A quick search on "Skype" in Pubmed brought up some interesting research < here > articles.

Thursday, August 23, 2012

Progress on Plone 4.0 & Python Programming & the Postdam Institute

I had set myself the task of learning Python programming so I could better understand the Plone content management system, but I have not progressed that much. I installed Plone 4.0 on my Ubuntu machine and things are going well, but I have not given much time to it.  I did learn something about Plone 4.0 that fascinated me - the website for the Postdam Institute for Climate Impact Research. This website had a database that was over 16 gigabytes of data and files. Now that is astronomically larger than anything I have used. It make me think of the MyOscar Personal Health Record, parts of which was programmed using Plone. Being able to handle databases with that "memory footprint" is beautiful.  I'll just paste in here some of the data about the Plone 4.0 capacity to handle large databases:


Real-world numbers

But enough talk, how does this actually affect your site in real life? Let's take a look at a recent, real-world example from a large Plone site:
Potsdam Institute For Climate Impact Research had a 16.5 GB database containing documents and other media:
  • Upgrading the entire site to the new, filesystem-based storage: 51 minutes.
  • Plone database size: reduced from 16.5 GB to 3.0 GB.
  • Memory footprint on the heavily cached server:  reduced from 10 GB to 3 GB.
  • Load on the site while in heavy use: reduced to 10-20% of the previous CPU usage, with no intermittent massive spikes, as had been the case with Plone 3.
  • File transfers were faster, with no discernable increase in memory usage while large documents were being downloaded.
Plone 4's new large files implementation has been field tested on large production installations during the beta process, and we're confident you'll find that Plone 4 delivers massive performance and resource usage improvements on sites with multi-gigabyte data stores.

Thursday, August 16, 2012

Health IT Success - A Matter of Psychology and Personalities?

John Halamka posted recently about the good working relationships among CIOs and key stakeholders in Massachusetts HIE, and attributes their many successes to personality and psychology.  eHealth and IT projects in general have high failure rates (I have read up to 70%), and not just because of policy and technology.
I've long believed that HIE is more about psychology and personality than policy and technology.   You need the trust of the community and passionate people to make it happen.
You can see the post < here >.  It made me think of a recent story in the news in Ontario (probably a bit larger than Mass.) where the CIO of eHealth Ontario declined to accept his $80,000 bonus, for the second year in a row.  If you haven't read that story,< here > is a link to it.  eHealth Ontario has had numerous scandals and IT failures, but not because of Greg Reed, I think. The beleaguered CIO of eHealth Ontario is carrying on because he believes in what he is doing, not for the financial reward.  Forget that the politics of governing something like an arms-length organization like eHealth Ontario is, well, just politics. I think Greg Reid is probably like one of the personalities John Halamka refers to:
Manu Tandon is a unique public servant  He's the CIO of the Executive Office of Health and Human Services (EOHHS) and is more interested in making a difference than fame or fortune.   He's had a distinguished career in industry but chooses to serve the state government because he believes in the mission.   He works tirelessly, sending emails at all hours of day and night.   He's always connected and communicating with all our stakeholders inside and outside of government.   He's that rare public servant who combines political savvy, transparency, and competency. Every stakeholder in the community trusts him and his position in government enables him to move projects forward rapidly.
At least one hopes....because I don't know very much about the machinations of eHealth Ontario. 

Monday, August 13, 2012

Public Health Syndromic Surveillance at the London 2012 Olympics

In my M.Sc. eHealth degree I took a course where I dipped my toes into the murky depths of public health informatics.  This article on syndromic surveillance at the London 2012 Olympics just touches on the panoply of data sources now available to track and predict disease outbreaks:
http://www.popsci.com/science/article/2012-07/how-it-works-worlds-largest-health-surveillance-system


How The Largest Health Surveillance System Ever Created Is Preventing An Olympic-Size Pandemic

How do you tell if a flu is dangerous enough to bring down the Olympics? Map diseases in real-time, throughout the entire country

From a Public Health Perspective, the Olympics Can Be a Dangerous Place Athlete's at the 2009 Mexican National Olympics wear masks to protect themselves from an outbreak of swine flu.

Right now in London and various sites around the UK, more than half a million international travelers are sharing stories, beers, doner kebabs, close living quarters and--let’s be frank--the occasional mattress. Roughly 17,000 athletes and officials from hundreds of countries are packed into the Olympic Village alone, and that doesn’t take into account the spectators--more than 8 million tickets will be punched at the Games--who have piled on top of greater London’s nearly 8 million inhabitants. Culturally speaking, it’s a marvel that we can do this and all get well enough along. Epidemiologically speaking, it’s a nightmare scenario.

An international gateway city like London is certainly no stranger to the comings and goings of large numbers of people, but when this many people settle into close proximity over an extended period--eating the same things and sharing the same spaces for several days or weeks at a time--it’s the perfect recipe for pathogen outbreaks. A microorganism that might be fairly benign in one part of the world can blossom among a population with low immune resistance. Food-borne illnesses threaten at every food stall. Something flu-like, that spreads through normal human contact, could potentially clean house.

The key to maintaining the public health during something as massive as the Olympic Games isn’t battling every individual bug but quickly containing any pathogen that does get loose in the population, and to do this the UK’s Health Protection Agency (HPA) has developed what is being billed as “the world’s largest health surveillance system.” By rapidly meshing many different streams of information pouring in from hospitals, general practitioners, clinics, infirmaries, and health care hotlines across the UK, the HPA has developed a way to measure and monitor the public health in near-realtime, ensuring that any pathogen outbreak is quickly identified, diagnosed, and contained before the whole of London comes down with the sniffles--or worse.

While the HPA’s system is imperfect, stitched together from a mash-up of pre-existing information channels (reports emailed and phoned in to regional health authorities), and newer, digital data streams (online systems that beam anonymized patient data from hospital databases to authorities automatically), it's likely the most ambitious public health monitoring system ever deployed. It’s not just a model for future Olympic Games, but for the future in general; as global populations continue to swell and our urban centers become both larger and more connected, systems like this will help cities and states keep vigilant watch on their people's collective health. Here’s how it works.

SYNDROMIC SURVEILLANCE

"In this kind of epidemiology, timeliness trumps complete data sets. The threat picture is constantly evolving."The HPA has collected certain kinds of data from hospitals, clinicians, and general practitioners for some time now, but to be truly useful the data needs to be centralized as quickly as possible. To that end, the HPA has automated as much of the data flow as was feasible for the 2012 games. Anonymized diagnostic data now pours in from emergency rooms and hospital labs in realtime via automated systems--when nurses and doctors enter a patient’s information into their in-house computer systems, an anonymized report is automatically generated and sent to the HPA immediately. The HPA has also asked doctors around the country to include a notation in such reports for Olympics links, designating the patient as an athlete or coach, a staffer, a spectator, or someone who has otherwise been in or around an Olympic venue. Even in cases where doctors cannot diagnose an infectious illness, the HPA has created a means of cataloging the symptoms and defining as much as possible the condition, allowing it to identify new or emerging infectious diseases that haven't been seen before.

This near-realtime clinical data builds the foundation of what becomes an evolving threat picture. The HPA models include data from hospital labs as it streams in over the Web via a secure system called CoSurv, but the models don't wait for lab work (which can take hours or days to process) to begin painting that picture. Clinicians have been put on alert for a spcific list of infectious diseases (authorities are actually particularly concerned about food borne illnesses, as stomach bugs can spread with impunity in close quarters like the Olympic village--just look at historical examples of cruise ship outbreaks for an example of this) as well as symptoms of chemical contamination. When they see symptoms of any of these they report them to the HPA immediately based on clinical (rather than lab) diagnosis. In this kind of epidemiology, timeliness trumps complete data sets. The threat picture is constantly evolving as more and better data comes in (from the lab, for instance), but that the HPA is always working from the most immediate information it can get.

For the HPA, that paints a pretty decent picture of what’s happening in hospital wards, but to fill in the holes in their canvas officials there wanted more data from alternative sources--general practitioners, walk-in clinics, or people calling into national health hotlines--that aren’t plugged into the same system. This data isn’t quite so automated--generally doctors or hotline operators have to phone or email it in to the HPA--but it adds another layer geographically-relevant symptomatic data to the HPA’s ongoing assessment.

IF THERE'S AN OUTBREAK


Say a clinic in East London begins showing a spike in incidences of extreme stomach pain and nausea that is considered above normal levels for this kind of illness. This symptom data passes through the HPA's regional office first, and a flag goes up. Perhaps it's an anomaly, but now it's on the authorities' radar. This data travels on to the HPA's West Midlands office where it is fed into an algorithm-based computing system that quickly extrapolates the overall public health picture of the UK at that moment. Here, the system notes that a spike in similar symptoms has been reported at Weymouth and Portland on the South Coast, where the sailing events are held. The system makes connections between the two; a potential outbreak of some kind of stomach-pain inducing pathogen is brewing. Health authorities are now on alert.

As one day turns over to the next, more data comes streaming in from both regions. In East London, it turns out several members of a large tour group dining at the hotel restaurant got ahold of some salmonella. On the south coast, a bout of stomach flu is circulating among some locals unrelated to the Olympics--a blessing, since Olympic athletes, staff, and spectators are doing a lot of traveling around. The cases are unrelated and crisis is averted, but the important thing is that the HPA and other health authorities were able to connect the dots almost immediately and take precautions. By centralizing symptom and diagnostic data and running it through these algorithms, the HPA can not only monitor the entire UK at once, but can identify trends, outliers, and abnormalities in the public well being with unprecedented speed.

Computationally speaking, this is tough work. A very small and mostly harmless incidence of a rare pathogen might raise an immediate statistical flag while a potentially hazardous symptomatic change in a known pathogen might fall within the statistical “safe zone” while actually representing the greater threat. The algorithms try to mitigate for these kinds of statistical problems, and as algorithms do, they will get better via time and testing. For now, they provide the best rolling picture of an entire nation’s realtime health that authorities have ever seen.


The Health Protection Agency is Monitoring the UK's Health Around the Clock for the Olympics:  Courtesy Health Protection Agency

BETTER DATA, BETTER HEALTH


While the HPA’s system is far from flawless--relying on general physicians and nurses to phone in symptom reports not only opens the door to under-reporting but also pulls them away from their primary jobs--it is an ambitious attempt to leverage the power of Big Data into better public health. It’s a fairly strong argument for the digitization of the medical field in general, and with more information fed automatically into the loop, future systems built on this model could be powerful tools for threat prediction and preventative care.

A system where nationwide, anonymized symptom data flowed freely and automatically to centralized computing centers like that at the HPA’s West Midlands office could revolutionize the ability of authorities to rapidly respond to emerging threats. But the HPA isn’t even tapping some of the richest data streams available--those provided freely by citizens themselves. We’ve seen how systems like Google Flu Trends can accurately predict incidences of flu outbreak in a given area simply by trolling search terms for indicators of flu activity. And just this week we learned about an algorithm that scanned geotagged tweets in NYC to accurately predict which users were about to get sick up to eight days before they even showed symptoms. That kind of data is everywhere, and it’s ideal for taking the pulse of large groups of people--the same kind of large groups currently tweeting so much from London that Olympic organizers have asked them to tone it down (it’s disrupting television coverage apparently). That’s why the UK plans to leave large parts of its health surveillance system in place after the Games are overwith (it will likely scale back the frequency of some kinds of reporting, though it will keep the technology in place to ramp it back up during an emergency). As global populations continue to swell and our metropolises become bigger, denser, more diverse, and better connected, epidemiological situations like that presented by the Olympics will become less the exception and more the norm. The ability to quickly crunch disparate data streams into a perfect picture of public health will be the difference between staying out in front of emerging biological threats and constantly trying to chase them down from behind.

Australian Personal Health Record System - not doing well

http://www.theage.com.au/it-pro/government-it/patients-reject-ehealth-system-20120811-24179.html

Very low update of a very expensive personal health record system. Lots to learn from this, for example, healthy people don't need personal health records.

Tuesday, August 7, 2012

ehealth Saskatchewan public survey on personal health records

Saw this news story:
http://www.canhealth.com/
News2029.html
"eHealth Saskatchewan is polling the public on its website, www.ehealth-sk.ca, to discover whether the residents of the province would like to see development of a Personal Health Record, and if so, what they would like to see in it."

eHealth Saskatchewan Public Message from eHealth Saskatchewan on Vimeo.


This to me is a credible thing to do.  Most surveys of the public attitudes towards electronic health records show a great interest in them.  An equally high percentage are concerned with the privacy and security of their health records. Sounds like Saskatchewan is sizing up the feasibility of a provincial architecture for the personal health record.  I would like to see the results of the survey.  

Saturday, August 4, 2012

Automatic Tape-collecting Lathe Ultramicrotome (ATLUM) device - In search of Immortality

I have always thought that one of the goals of ehealth was towards life extension, and this research article is indicative of the advances being made towards immortality, specifically - mind uploading - and a new word that I wonder might make head way in the English language lexicon - connectomics!


The strange neuroscience of immortality

July 30, 2012
[+]ken-hayworth
Kenneth Hayworth with his Automatic Tape-collecting Lathe Ultramicrotome (ATLUM) device (credit: Kenneth Hayworth)
Neuroscientist Kenneth Hayworth believes that he can live forever, the Chronicle of Higher Education reports. But first he has to die.
“The human race is on a beeline to mind uploading: We will preserve a brain, slice it up, simulate it on a computer, and hook it up to a robot body,” he says.
He wants that brain to be his brain. He wants his 100 billion neurons and more than 100 trillion synapses to be encased in a block of transparent, amber-colored resin — before he dies of natural causes.
The connectome grand theory
To understand why Hayworth wants to plastinate his own brain you have to understand his field — connectomics, a new branch of neuroscience. A connectome is a complete map of a brain’s neural circuitry. Hayworth looks at the growth of connectomics — especially advances in brain preservation, tissue imaging, and computer simulations of neural networks — and sees a cure for death.
Among some connectomics scholars, there is a grand theory: We are our connectomes. Our unique selves — the way we think, act, feel — is etched into the wiring of our brains. Unlike genomes, which never change, connectomes are forever being molded and remolded by life experience.
A human connectome would be the most complicated map the world has ever seen. Yet it could be a reality before the end of the century, if not sooner, thanks to new technologies that “automate the process of seeing smaller,” as Sebastian Seung puts it in his new book, Connectome: How The Brain’s Wiring Makes Us Who We Are.
Hayworth looks at the growth of connectomics — especially advances in brain preservation, tissue imaging, and computer simulations of neural networks — and sees something else: a cure for death. In a new paper in the International Journal of Machine Consciousness, he argues that mind uploading is an “enormous engineering challenge” but one that can be accomplished without “radically new science and technologies.”
Hayworth has founded the Brain Preservation Foundation, which offer a cash prize for the first individual or team to preserve the connectome of a large mammal. A dependable brain-preservation protocol is possible within five years, Hayworth says. “We might have a whole mouse brain preserved very soon.”
The foundation has published a Brain Preservation Bill of Rights on its Web site. ”It is our individual unalienable right to choose death, or to choose the possibility of further life for our memories or identity, as desired,” the document declares.
Hayworth’s brain-preservation and mind-uploading protocol
Before becoming “very sick or very old,” he’ll opt for an “early ‘retirement’ to the future,” he writes. There will be a send-off party with friends and family, followed by a trip to the hospital. After Hayworth is placed under anesthesia, a cocktail of toxic chemicals will be perfused through his still-functioning vascular system, fixing every protein and lipid in his brain into place, preventing decay, and killing him instantly.
[+]
Preserved in amber resin (Credit: Bad Robot/Fringe)
Then he will be injected with heavy-metal staining solutions to make his cell membranes visible under a microscope. All of the water will then be drained from his brain and spinal cord, replaced by pure plastic resin.
Every neuron and synapse in his central nervous system will be protected down to the nanometer level, Hayworth says, “the most perfectly preserved fossil imaginable.”
Using a ultramicrotome (like one developed by Hayworth, with a grant by the McKnight Endowment Fund for Neuroscience), his plastic-embedded preserved brain will eventually be cut into strips, and then imaged in an electron microscope. The physical brain will be destroyed, but in its place will be a precise map of his connectome.
In 100 years or so, Hayworth says, scientists will be able to determine the function of each neuron and synapse and build a computer simulation of the mind. And because the plastination process will have preserved his spinal nerves, the computer-generated mind can be connected to a robot body.
“This isn’t cryonics, where maybe you have a .001 percent chance of surviving,” he said. “We’ve got a good scientific case for brain preservation and mind uploading.”