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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, May 29, 2013

Coldfusion progamming FLOAT IsNumerc date comparison SQL

One of the systems I developed was done in the Coldfusion programming language. As I have developed and learned more about Coldfusion over the past 9 years or so, the more I realize it depends a lot on SQL. I learned how to do a lot of Coldfusion from another learner in the beginning, but after that, internet searching for code solutions is mostly what I do, as I imagine many programmers and code seekers do as well for answers. Since Coldfusion runs on a proprietary software platform and is not open source like PHP or MySQL, it is more difficult to find Coldfusion programmers to share ideas.

Recently I found the answer for a puzzle that had long baffled me, how to compare two dates then output data fields on a query for them. I knew how to do the SQL to output data from a month, day or year in the past, something like this:

<CFQUERY NAME="GetRecords" datasource="myAccessDB" >
      SELECT COUNT(id)as number_total FROM tblMyTableName Where  Month(DateReceived) Like '1' and DateReceived Like '%2010%' </cfquery>
      <cfoutput query="GetRecords">#number_total#</cfoutput><br>

In order to compare two dates in one year, I found a Coldfusion developer site that suggested using FLOAT, and here is how this is done:

   <CFQUERY NAME="GetMREBRecords" DATASOURCE="myAccessDB">
        SELECT *
        FROM tblMyTableName
          Where DateReceived BETWEEN 40358 AND 40722
        ORDER BY ID
        DESC
        </CFQUERY>

The FLOAT values in this example are actually dates. 40358 is June 30, 2010 and 40722 is July 1, 2011 (maybe give or take a day?). I have yet to find an actual table with FLOAT date equivalents. I am not even sure if this means "Floating point", a term or process used in computational data computing. All I know is, that it works for my system really well, and solved a big problem we had.

Actually, these FLOAT values have no known standard dates(times) that I can find, and are not accurate for leap years and other variables.  Thankfully, I kept searching the internet for some code that would work and finally found this:

<CFSET start_date = #CREATEODBCDATETIME("7/1/2012")#>
 <CFSET end_date = #CREATEODBCDATETIME("6/30/2013")#>

        <CFQUERY NAME="GetRecords" datasource="myAccessDB" >
      SELECT COUNT(id)as number_outstanding FROM MyTable 
   Where DateOfReceipt  Between #start_date# And #end_date# </cfquery>
          Number of 2012-2013 Records 
          = <cfoutput query="GetRecords">#number_outstanding#</cfoutput>

Wednesday, May 22, 2013

Programmableweb Healthcare API List

I have been having problems recently trying to understand "integration engines" or "Application Program Interface - API". This is list of Healthcare APIs helps shed some light on what I am thinking about - from the programmableweb site. I knew that Google Health, when it was active, had an excellent API system for those living in the United States who could use a variety of health services. Joining up databases in the cloud is technologically doable. In healthcare, it would seem to me that live, real time in-sync linkage of databases would be critical - something I think you might call data driven architecture (which I blogged about before). Anyhoo, still trying to understand better such things as WSDL, SOAP, REST, and web services in general. Interoperability is one of the most difficult problems in health informatics.

37 Health APIs: Google Health, Avvo and Fitbit

Wendell Santos, March 21st, 2012
AvvoOur API directory now includes 37 health APIs. The newest is the DailyMed API. The most popular, in terms of mashups, is the Avvo API. We list 2 Avvo mashups. Below you’ll find some more stats from the directory, including the entire list of health APIs.
In terms of the technical details, REST and XML lead the way. There are 29 health REST APIs and5 health SOAP APIs. Our directory lists 30 health XML APIs and 16 health JSON APIs.
The most common tags within health are 17 medical health APIs8 reference health APIs and 6 sports health APIs
On the mashup side, we list 40 health mashups. We named Hello Vaccine as mashup of the day in August.
For reference, here is a list of all 37 health APIs.
  AIDSinfo API: Government info on HIV/AIDS treatment
  AT&T mHealth Platform API: Health system backend
  Avvo API: Lawyer and doctor directory service
  BigOven Recipe API: Recipes, grocery list, and nutrition API
  BioLabeler API: Library of Medicine text extractor and indexing engine
  BodyMedia API: Fitness tracking service
  CDC Wonder API: CDC health statistics retrieval service
  Centers for Disease Control (CDC) Content Syndication API: Health information content syndication service
  DailyMed API: Marketed drugs information service
  Data.Medicare.Gov API: Medicare information and datasets
  Deepdyve API: Scientific and medical journals
  DeepFitness API: Fitness and nutrition article service
  Diabetic Complications Consortium API: Diabetes and health care information service
  Dossia API: Health information aggregation service
  FatSecret API: Food, nutrition and recipe database and diet tools
  Fitbit API: Fitness Tracking Tools
  GoodGuide API: Green healthy product ratings
  Google Health API: Health data service
  Health 2.0 API: Directory of health-related APIs
  Health Indicators Warehouse API: Health indicators database
  HealthTap API: Online health network service
  Indivo Health API: Health record manipulation services
  MapMyFitness API: Fitness tracking service
  MedlinePlus API: Health information service
  MedlinePlus Connect API: Health information service
  Microsoft HealthVault API: Health-related data storage, security, and records
  NHS API: UK National Health Service
  Patient Opinion API: UK health ratings service
  PHIN VADS API: Public health terminology service
  Pizza-Rat Restaurant Health API: Restaurant health inspection scores
  RunKeeper Health Graph API: Health & fitness tracking service
  SimpleUPC API: Product information database
  Skinnyr API: Weight loss tracking service
  SweetSpot API: Diabetes management service
  Thomson Reuters Pharma API: Investigational drugs data
  Walker Tracker API: Step tracking service
  Withings API: Connected health devices

10 mistakes made implementing IT systems in Healthcare

IT systems tend to fail at high rates. Studying EHR systems that users in hospitals hate using is one of the classics in Health Informatics. I found this piece on the Kevin Pho newsletter and thought it was a very good precautionary guide. We should all know better, right?

10 mistakes practices make in implementing information technology

What is the measure of successful technology adoption? Is it never having to hunt for a missing chart? Is it a reduction in specific operating cost line items? Is it about access to clinical information when you need it and where you need it?
Technology implementation has a significant effect on profitability. The Medical Group Management Association Cost Survey Report beginning with 2010 data shows that total medical revenue after operating and nonphysician provider costs per FTE physician actually increased as total IT expense per FTE physician increased. For multispecialty groups, for instance, among groups that invested less than $10,000 per FTE physician in IT revenue was $230,968; it was $313,900 in groups that spent between $10,000 and 20,000.
But simply acquiring technology is not enough; it is essential to implement the technology effectively to achieve those types of results.
Here, then, are the top 10 mistakes practices make in implementing information technology — and how to avoid making them.
10. Selecting a system based primarily on a demonstration session. Better to be thorough than fast in the practice management/EHR selection process.
  • Apply structure to the process.
  • Incorporate your workflow into the vendor’s application by defining a sample patient case in advance.
  • Don’t sign a contract without a reference site visit — no matter how busy the physician claims to be in order to avoid the visit!
9. Going live with your EHR without a lab interface. Viewing lab results via PDF is cumbersome for providers and trending a patient’s labs without a lab interface requires staff to enter test result values as discrete data, which is problematic and too labor intensive to be cost effective.
Identify the lab that provides the most results to your practice and test the interface with that lab prior to a go-live implementation.
8. Waiting to implement the patient portal. Implement the patient portal first, even before you convert your practice management system or go live with your EHR.
  • Save staff data entry time and effort by encouraging patients to self-register.
  • The patient’s past medical, social, and family history can be captured in the portal and “accepted” or imported into the PM/EHR system.
Getting information into the system will also save the patient time by reducing time in the waiting room. Patients are also usually more accurate and comprehensive when using the portal than they are with paper and pen.
7. Accepting the vendor’s “train the trainer” plan. Your trainer must understand the application of the system, not just which screens to go to to perform which function. Your own standards and processes are critical to how to use the new technology in your practice workflow.
6. Allowing physicians access without training. Don’t issue any physician a login/password without completing the required training. Provide test-out options to the physicians that demonstrate adequate system knowledge to prevent the dissatisfaction that will ultimately arise from not having sufficient training.
  • Provide one-on-two sessions specific to nurse/physician workflow.
  • Include procedural training along with the system know-how training. Answer the question “How does this apply to what we do?”
5. Assigning the project to the wrong person. Do not assign responsibilities for implementation based on seniority or loyalty or because you have no other position available for a long-term employee. The clinical application project manager must have some clinical background or understanding. He or she must understand what a provider sees (and grasps) when they open a chart.
Characteristics necessary for successful project management:
  • Commands authority and respect
  • Able to delegate tasks and lead others
  • Creative problem-solver and analytical thinker
  • Has high level of energy and self-direction.
4. Not including nursing in the selection process. Nurses touch the chart more than physicians do. Messaging and nurse workflow are critical to the successful use by physicians (nurses must do more of it so that physicians do less of it).
Nurses can facilitate the implementation or create barriers to the implementation; get them involved to get the best result.
3. Not elevating the EHR project in the organization. The EHR Project Manager/Director should report directly to the CEO/COO and work in conjunction with the physician champion(s). The manager should participate in the EHR governing body to establish standards and policies and procedures.
2. Making the EHR implementation an IT project. The implementation is about clinical operations and workflow changes. It is about improving operations with the use of a new tool. The EHR is no more IT than the front desk reception is. IT supports the infrastructure, just like the telephone infrastructure.
1. Not investing in ongoing optimization. Technology implementation is not a once-and-done project; it is an evolutionary process. Technology changes what is feasible. Technology adoption is iterative. Static templates will not satisfy changing needs of the end-users.
Implement a formal rounding plan to observe users and to prioritize ongoing development, training, and required modifications.
The initial goal of an implementation should be to acquire enough knowledge to get through the day. Users don’t know what they don’t know and need support as their use of the technology becomes routine.
Remember: Optimize your technology adoption and improve your profitability.
Rosemarie Nelson is principal, MGMA Health Care Consulting Group and blogs at Practice Pointers.

Wednesday, May 15, 2013

Epic vs. Meditech

John Halamka had an interesting post on how Meditech is changing it's EHR/EMR architecture to meet the current demands of the market for "cloud hosted, standards-based, web-centric and mobile enabled hospital information systems". The Epic systems already do that (as well as having a widely used MyChart personal health record system - which is not to be confused with MyChart developed by Sunnybrook Hospital in Toronto and now owned by Canadian mobile communications company Telus). I have been hearing a lot from people in the industry about Epic (no wonder that they probably don't advertise) and it all sounds good. (Their website design looks to my eye as being very "mobile oriented"). There is also another interesting post on the CIO Healthcare blog by a guest on personal health records for adolescents.

Thursday, May 9, 2013

Consumer health information discoveries

I have been finding a lot of consumer health information websites, both local and international - a whole bunch of them - and I think it all started when I went to the announcement yesterday for the CISCO/McMaster University Professorship in Integrated Health Biosystems, as well as a Research Chair in Bioinformatics. This doesn't have a consumer health informatics label on it, but should have a Big Data one and be a separate post. Patients come into it when data from clinical trials will finally not go to waste but will be cross-linked with research databases to be put to use for medical research. If personal health records ever catch on, and patients consent to have data (whether de-identified or not - but probably de-identified) used for research, this would also be a mine of information as the original vision for PHR was to include genomic records, the intent being the development and perfection of personalized medicine.

This made me think of Dr. Danny Sands who teaches Medical Informatics at Harvard and is working for CISCO. He had a presentation at a conference (AHIC) where I was also delivering my first student paper presentation. Anyway, I read Danny's bio at CISCO which lead me to a blog he participates in called e-patients.net. It has interesting links to the Society for Participatory Medicine, and the Journal of same.

Impressed with that find, I came across by happenstance the meforyou.org website - a website that can cure you. For some reason this site reminded me about some research and journal articles I read, on how intercessory prayer doesn't work scientifically speaking.  It is a website inspired by Facebook new media but created by U of San Francisco:

UC San Francisco is the only university exclusively focused on human health. For 150 years, we've tackled the world's most vexing health issues, from diabetes and malaria to AIDS and cancer. We are driven by the idea that when the best minds come together, united by a common cause, great breakthroughs can be achieved. Because we believe it is perhaps the greatest single breakthrough that can be achieved, we have committed ourselves thoroughly to the realization of precision medicine. We began this movement knowing that we could not do it alone, and continue assured that we will do it together. Join us.

And then I found this surprising and local "searchless" health information website - hi - consumerhealthinfo.ca (a URL I wished I could have claimed). You can't not appreciate the layout, and user interface (think old people with no time to read extensively.) I think Dr. Mike Evans  ( Dr. Mike Evans curates the best health information found online. ) contributes to this site which lead me to his blog and website, which is simply brilliant, and this viral video!




And finally after this amazing journey just seemed to be beginning, Dr. Evans recommended the ultimate consumer health informatics website NHS.UK  I had recently read on a Yahoo website the UK's National Health Service was in the top ten biggest employers in the world! Well, a lot of them were busy preparing this website, and I relish reading their entire medical encyclopedia someday.

Tuesday, May 7, 2013

australia's personal health record system falls behind

I have blogged before about Australia's national architecture approach to personal health records for every citizen and it would appear the expensive mega-project is still slow to attract clients:
http://www.crn.com.au/News/340617,feds-fall-behind-on-e-health-sign-ups.aspx
My opinion from my research is that physicians should prescribe personal health records to patients where it is clinical sound to do so. Most healthy people don't need to use them. They should be integrated locally but with the potential to be mobile and transferrable anywhere. A tall order? Maybe, my own family doesn't have this yet.


Feds fall behind on e-health sign-ups

By Charis Palmer on Apr 22, 2013 12:28 PM
Filed under Services

Data already delivering insights.

The Government will likely struggle to meet its target of 500,000 registrants for the personally controlled electronic health record (PCEHR) by June, after it was revealed only 109,000 Australians had registered in the last nine months.
The system, launched last July, has been plagued with issues, including with its online registration system and availability for general practitioners.
Speaking today at a conference on big data in health, Department of Health & Ageing chief information and knowledge officer Paul Madden encouraged attendees to sign up to the program.
He said the $628 million e-health records project had the ability to change the game for health, with significant flow-through data from the records already being gathered.
So far, Madden said, the e-health records of the 109,000 people already registered had delivered 5.4 million Medicare records, 2.9 million pharmaceutical benefits claims, 16,600 immunisation registrations for children over the age of seven, and 23,000 organ donor records.
Only two hospitals are currently uploading discharge summaries to the system. All public hospitals were expected to be doing so by July, Madden said.
Based on the information gleaned from the electronics records, the average Australia visited the GP four times a year, ordered 12 pharmacy prescriptions, visited a specialist three teams, went twice to allied health care workers and once to the dentist.
He said 2000 health care practitioners now had access to the system, and 90 percent of GPs had access to the software deployed by the National E-Health Transmission Authority.
He called the PCEHR a "leap forward in health”.
“The way that we use, maintain and manage health care delivery throughout Australia will start to change as a result of the information we are able to put together which we’ve never had access to before in the way we do now."

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