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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...

Showing posts with label Economics. Show all posts
Showing posts with label Economics. Show all posts

Sunday, April 23, 2017

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 Hackathons...https://www.ncbi.nlm.nih.gov/pubmed/28250965 came up with a research article that shows that Hacking Health does have very useful benefits. I am intrigue and would even like to do my own research on this.

I attended a pitch workshop and learned that intellectual property on ideas is not what it appears to be. From that perspective, and in the interests of ehealth promotion:

1. Medical School ePortfolio - So you want be a Doctor eh? [app, educational]
Problem:
Getting into medical school is like a lottery. Or is it? How can students best prepare so they don't become disappointed or feel like they are gambling getting in, or getting in and realizing it is not their ideal career choice?

Solution:
This app will be for students who want to be physicians. Maybe it could even be aimed at three levels; elementary, high school, and university. It would allow students to track their interest in a career in medicine from early days. Students are also getting into medical school after high school these days at Queens University. It could have tests and quizzes, links to schools, CV prep, volunteer opportunity suggestions, how to apply, what's involved in the actual application process at very schools. The book "So you want to be Doctor eh?" by Anne Berdl is an excellent resource to model this on. Also, many universities have learning portfolios and that is also a model. Possible mentor relationships or chats or talks with professionals in the field. By tests and quizzes, it could also have an educational role to survey student empathy, compassion training, aptitude, in addition to preparation for MCAT and other formal tests.

2.Smart Forms Builder for Healthcare [ app, software]
Problem:
Hospitals were faced with a crisis in screening patients and visitors for SARS at Ontario hospitals in 2003. The paper system they had was bogging down entry to the hospital. A LAMP (Linux, Apache, MySQL, PHP) online screening system was eventually created to streamline the process. Healthcare administrators and even IT need to develop online forms quickly without programming skills as well as have access to useful data.

Solution:
There are smartform software systems like Google docs and commercial ones like Jotform, but they are not private and secure for personal health information. As well, smart forms need to be smart enough so people without programming experience can quickly develop an application. These kind of systems are evolving, but they just need something more akin to artificial intelligence to make them really smart and inexpensive to setup. API, mobile and REST applications would also be good integration components.

3. eHealth enabled browser [ browser, app, big data]
Problem:
Personal Health Records come in many different types, tethered, stand alone, and integrated. The  people who benefit most are those who need to monitor and access a lot of medical records and visits. However, tracking health, IOT, and fitness device data can be integrated into Personal Health Records to create an overall digital health snapshot. Not everyone likes to login to a portal and track their health data.

Solution:
The idea here is to integrate Watson IBM analytics, or google alpha Go search engine analytics built into a dedicated open source browser built on chrome (or chromium). While this might sound just like an app running on a smartphone, the idea is to build a Firefox, Chrome or Safari browser that is actually a dedicated health analytics and digital health single sign on personal health record browser. What you search and read in every day life is all fodder for personal health anlaytics. This is digital "google flu" writ larger for an individual. In a way, think of it is a browser add on or extension that is a personal health record data collector, storage, and dashboard, but it is actually the browser itself.

4. Universal Healthcare Observatory [Big Data app]
Problem:

The problem is that not everyone has access to free healthcare. Statistically, millions of people are rising out of poverty every year, according to the late Global Health researcher Hans Rosling. Access to free or affordable healthcare should be a basic human right.

Solution:
The purpose of the project is based on the scientific based belief of evidence based medicine that "for profit healthcare is hazardous to your health". The United Nations and even the WHO have many observatories, and this one would be similar to the European Observatory of Health Systems and Policies. It will be a big data app that pulls data and statistics from disparate sources to monitor the global healthcare systems in the world and promote any trends towards universal healthcare. It might be able to use the Trendalyzer software. The bold target would be to achieve universal access to free or affordable healthcare for everyone on the planet by 2050.

5. eHealth Garage [ infrastructure, service]
Problem:
In my neighbourhood there are two former automobile/gas stations that are now a Vietnamese restaurant and a Holistic Health Clinic. Gas stations used be found on almost every block in every neighbourhood in every city and town. Cars no longer break down because the technology is better and gas monopolies are pushing gas stations out of neighbourhoods. Needless to say, electric cars are moving in soon. Also in my neighbourhood is a legal Medical Marijuana Clinic. Why not an eHealth Garage?

Solution:
With an aging population living longer and a coming generations that might may well live easily way over 100 years of age because of advances in exponential medicine, preventive medicine and holistic health services need to be accessible with digital health services in the community. This is also a way to deconstruct medicine.The eHealth Garage could be a component of a Family Health Team but they might call it an eHealth clinic. I see the Garage being full of healthcare technology: x-ray machines, ultrasound, MRI, fitbits, resistance training gym machines, Transcranial Magnetic Stimluation (TMS) - almost any health technology that can be coupled with a digital health technology or record. DIY healthcare, though with options for professional healthcare oversight.



Friday, January 3, 2014

Research Ethics Board Decision Making Maximers or Satificers

A fellow McMaster eHealth M.Sc. graduate, Yervant Terzian, has an interesting post on his blog "Yervant's Musings: Healthcare Through a Patient's Lens". He sent me an email asking what I thought because I attended the same conference of research ethics board professionals - the Canadian Association of Research Ethics Boards (CAREB). Yervant is now a community member of a research ethics board and I would like to welcome him to my world! I have been a research ethics board administrative professional for coming up to 14 continuous years.

Here is the link to Yervant's post:
http://yterzian.wordpress.com/2013/12/23/are-reb-members-maximizers-or-satisficers-ethics/

The talk given by Dr. Ivor Pritchard was aimed at REB professionals. Dr. Pritchord is well known in US bioethics and research ethics professional organizations (acting director of US Human Health Services Office of Human Research Protections) , but has been invited to speak at Canadian REB conferences before.  I believe that he holds a PhD in Philosophy. His theory revolves around research on decision making aiming to illustrate how REB members make decisions when they review research projects for clearance. I don't believe the basis of the talk was on his own research into this subject though I may be wrong.

Let me first say that I think there needs to be more research on REBs - on all aspects of it. Research by Dr. Will van den Hoonaard on Canadian REBs was very valuable on describing the kinds of REB cultures that exist in Canada, as well as arguing how a biomedical basis formed the basis for the ethics policies - not easily extended to social science and qualitative research. There has been some research by Rachel Zand, current CAREB president, on how to educate, train and retain REB members. My colleague Dr. Brian Detlor and I presented on own research on REB information systems used by Canadian REBs at this very same conference. We have just recently posted the results on our website <here> but this will also be posted to the CAREB website this month I am told.

I agree with Yervant that the Maximizer vs Satisficer notion on REB decision making might not be the best way to describe the behaviour of REB members because it comes from a consumer behaviour model. Members of REBs are mostly volunteers, and some ethics board gurus have argued that unpaid volunteer membership on REBs is the only way to preserve ethical integrity in this work. True though, that REB members need incentives to do the ever increasing work load. True though, that altruism alone ought to be the guiding light for contributing to the integrity of research. True it is, that the behavioural effectiveness of REB members is needed more often than the efficiency of REB systems.

Applying an economic "Rational Choice Theory" to REB metrics is one way to approach an analysis for insight. However, I think the real effectiveness for this line of reasoning is more applicable for the ethics of healthcare resource allocation, which is the subject of extensive bioethical debate. Rational choice, as well as maximizers and satisficers, can be applied there, and the scenarios are very similar. Making decisions for how healthcare resources can be allocated, especially in underdeveloped countries, is heart breaking at the best of times. Should one patient be allowed a million dollar support system for an extremely rare condition when the same money can be allocated to improve the quality of life for thousands of others? Closer to home, why is physiotherapy not covered by Ontario health insurance? Why are dental services not covered? etc.

The scenarios for decision making used in our break out groups at the conference that Dr. Pritchard presented and that Yervant discusses are life and death decision scenarios. Not all REBs review research that involves life or death risks. Mostly it is medical REBs that review clinical trials involving experimental drugs for persons with terminal or chronic illness that need to decide on risks of living or dying. The risks in social science and qualitative or behavioural research are not so overtly black or white or of that nature.

Another way to look at this is that REB members as Maximizers are more likely to engage in "ethics creep" - spending a disproportionate amount of time on the minutiae of a protocol instead of the major issues. On the other hand, it would be good to have Maximizers when there are research proposals that do have major issues. For the 90% of social behavioural research reviewed by social science/qualitiatve/behavioural REBs, being a Satisficer is the way to go, because this 90% will be research that is not greater than minimal risk, or risk experienced by participants in their everyday life. Ethics review can be done on a Satisficers'  "it is good enough" basis, even though it is not desirable to do so for the purposes of maintaining high academic standards of research quality.

Yervant proposes a "Traits" approach to examining how REB Members make decisions in the review of ethics applications. Perhaps that might be interesting, but I am not sure how it would improve the effectiveness of REB review. Would REB administrators start to recruit new members based on certain "traits"?

The book You Are What You Choose by Scott De Marchi and James T. Hamilton introduces the TRAITS model and identifies 6 categories for an individual’s decision-making process: Time, Information, meToo, Altruism, Stickiness, and Risk

Certainly, we don't want REB members who will try to exert their own agendas, biases, etc., or who would otherwise be disruptive at meetings, or totally non-present wrapped in a cocoon of silence.  In fact, REB members are assigned research ethics applications to review based on their disciplinary expertise first of all, and secondly, according to known personal interests or other areas of knowledge that they might possess. A theory of "Expert Systems" might also be applicable here in case REB members are ever replaced with IBM Watson type systems.

Anyway, I could probably write more like this for a while, but the relevance for eHealth is drifting away. Thanks very much Yervant for applying your insights to the work of REBs!









Monday, September 30, 2013

Future Med Conference at Hotel Del Coronado in San Diego


The future med conference this year is at the Hotel Del Coronado in San Diego. The Core Track of the conference is very eHealth relevant:


  • Introduction to Exponentials on the topics of Artificial Intelligence, Robotics, 3D Printing, and IT Data Driven Health 
  • Future of Oncology 
  • Personalized Medicine 
  • Mobile Health & Body Computing 
  • Design Thinking and Tech Integration (i.e. Google Glass in Healthcare) 
  • Future of Intervention 
  • NeuroMedTech 
  • Regenerative Medicine 
  • Future of Pharma & Clinical Trials
  •  Global Health Impact of Technology on the Practice of Medicine 

I had heard that San Diego is a great place for conferences, but what I think is the real star of this conference is the Hotel! The Del Coronado is made of wood - over a hundred years old - and it's on the beach!

Now, this conference is going to set you back $4500 as an ordinary registrant for the four days. The last time I went to a 4 day conference happened to be in Boston. Paid by my institution, it was over $1000. It had stellar presentations and I will never forget the keynote presentation by Dr. Judah Folkman who talked about how the Institutional Review Board at his university (Harvard), instead of doing it's usual rubber stamp bureaucratic handling of a research protocol, made recommendations to the scientist that actually lead to the permanent end of a terminal illness that affected kids. I digress. What I mean is, unless you are paying the VIP price of over $8000 dollars, you might get a valuable experience without feeling like you've been robbed at this conference.

And that VIP experience made me think of a TV program I was watching the other day - more and more digression but this has an eHealth element - CPAC channel actually, which is a dedicated Canadian politics channel, that featured a live broadcast from the United Nations on Maternal Health. On the same panel with our Prime Minister Stephen Harper was Melinda Gates. Melinda spoke about how she personally observed how simple cell phone and text messaging used by women in Kenya/Tanzania was leading to all kinds of health improvements. Exactly! It is Communications Technology that is needed, as well as the vaccines and the mosquito nets. There is your eHealth element.

But what this made me also think about - and there is no eHealth dimension to this really (except maybe the Science fiction movie Elysium again - is the book I am reading "Plutocrats: The Rise of the New Global Super-Rich and the Fall of Eveyrone Else" by Chrystia Freeland. Maybe I thought, the Future Med conference is one of those Davos / TED / Gilded Age kind of meeting places on the Global circuit. Perhaps not, but digression will now cease.


Thursday, December 13, 2012

Another McMaster Study about Health IT: The Renaissance Version!

So, I enjoy reading posts on the Kevin Pho MD newsletter, and I am not even an MD. The ehealth stories are often very interesting, like the one I am posting here. Now this article has 3 main characters:

1. The article by James Salwitz entitled "Why IT is the core of the healthcare renaissance".
2. An article mentioned by Dr. Salwitz by Stephen Soumeri and Ross Koppel on the online Wall Street Journal called "A Major Glitch for Digitized Health-care Reform".
3. A paper by McMaster University researchers entitled "The economics of health information technology in medication management: a systematic review of economic evaluations".

Please draw your own conclusions! My conclusion would be that the McMaster researchers uncovered a need for better economic assessments of healthcare technology, in order to really make a realistic appraisal. And I agree with Dr. Salwitz that looking back 5 decades is too long.

And this isn't the only research that has cast aspersions on the benefits of eHealth technology. A study on PLOS last year, that was almost polemical in tone, blew the doors off of that "The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview"
"http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000387



Why IT is the core of the healthcare renaissance


Why IT is the core of the healthcare renaissance
Warning!  I am a practicing doctor who sees real patients using an electronic medical record (EMR).  My sole agenda is to provide the best patient care.  I have no financial stake in information technology (IT).  However, unlike the editorial board at the Wall Street Journal, Mr. Stephen Soumerai of Harvard or Mr. Ross Koppel of the University of Pennsylvania, I have actually used digital patient records for over a decade and I have news for them;  EMRs work.
In a reactionary opinion in the WSJ entitled “A Major Glitch for Digitized Health-Care Records,” the authors expanded to the point of silliness the conclusions of a review of healthcare IT by McMaster University.  The McMaster analysis abstracts data from 36000 studies over five decades of healthcare IT and concludes that computerization has yet to save dollars nor improve health care.  WSJ editorialists proposed that the concept of a common medical database has “already failed” as is “common knowledge.”  While they portend to “fully share the hope” in the success of a computerized healthcare system they express doubt as to “why are we pushing ahead to digitalize.”
The question is so ridiculous as to barely require an answer.  We are pushing ahead to digitalize because the healthcare industry, which is 18% of our GDP, is the last major industry to go electronic.  Despite how critical medicine is to our citizen and nation’s vitality, health care is most often documented with paper and ink.  Can you imagine any other industry where this would be acceptable?  Would you go to a bank where they use a hand-written ledger?  Travel on an airplane without GPS, fly by wire technology or a minimum of three computers?  Do you yearn for rotary phones?  Credit cards left paper money behind decades ago and will soon move on to the next phase, pay by smart-phone. The world is digital and one of the core problems with medical care is its failure to follow.
The average doctor writes his notes on parchment and scribbles orders on contact paper.  He wastes time writing prescriptions by hand that cannot be read and will produce unneeded drug interactions and side effects.  The data on billions of health care events cannot be mined, monitored, analyzed or improved, because it is not digital.   Millions of hours are wasted, billions of dollars vanish and tens of thousands die because of preventable medical complications, the result of massive variation in quality and safety.  We are doomed because we cannot access or evaluate most medical care data; “If you can not measure it, you can not manage it.”
Taking health digital is key to fixing and affording care.  Standard, unified medical records will significantly decrease the risk of providing unneeded or dangerous medical care.  Massive efficiencies will result by reducing duplication, speeding communication and reduction in waste (and fraud).  Critical improvements will follow the use of guidelines to study clinical databases and drive quality. This means that whether one lives in Manhattan, in the mountains of Tennessee or potentially deep in Africa, the finest care will be possible.
How do I know this to be true?  Our practice of seven doctors and three nurse practitioners was an early EMR adapter.  We put in our first basic system in 2000, upgraded three times and have been fully electronic for four years.  This has resulted in marked efficiencies and obvious quality improvement. Encrypted electronic records cannot be lost, are unlikely to be stolen and are always available from anywhere.  Ordering tests is instantaneous, as is reviewing results, organizing treatments, scheduling appointments or communication with outside health providers. On the cost side we reduced non-clinical staff by more than 50% and in an account receivable analysis our billing cycle dropped more than 60% and bad debt fell to low single digits.
Today in the office, I saw four new patients.  Without assistance of clerical staff and without leaving my desk I reviewed their entire surgical, laboratory, pathological, and radiologic records.  By the time, I entered the room to meet each of them a significant part of their medical history was entered into our EMR, based on outside records, so that the care and observations of previous doctors was not forgotten. Half way through each visit documentation of their history and physical exam was complete, leaving more time to talk with each patient.  Tests were ordered, treatments scheduled, disability letters printed, medications e-scripted, instructions created and follow-up appointments setup.  The patients were given codes to electronically access their records from home.  Letters were sent online to referring doctors, as well as any clinicians we were consulting in that patient’s care.  Billing was complete before each patient got to the parking lot.  Such is the power, efficiency and quality of electronic medical records.
This is just the beginning.  Although EMRs now provide assistance with basic medical care, such as scheduling flu shots, identifying drug interactions, and health screening reminders, future systems will use academic information to assist the doctor in making diagnoses and planning treatments.   Seamless with the EMR will be computer augmentation to create differential diagnoses and recommend treatment alternatives.  In oncology alone there are almost 50,000 articles published each year; Artificial intelligence integration with the clinical EMR will help every doctor penetrate that massive database on a continuous basis as it applies to individual patients.
So, why does the McMaster study not show this obvious benefit? It comes to four factors. The first is the “five decades” of study reviewed by the Canadian authors.  Since most doctors did not start adapting EMRs until 3 years ago, that leaves 57 months of irrelevant data.  Second, we have not reached the critical mass to achieve broad system efficiencies, as hospitals and doctors are still figuring out how to incorporate the technology into their daily practice, and less than 50% of health care providers have converted to EMRs.   Third, we do not yet have a universal common database for medical records. This is a complex technological step, which has been achieved in major industries such as banking, but still must be assembled in medicine.  Finally, as was correctly stated in the WSJ op-ed piece, present EMRs are cumbersome, immature, and several generations short of perfection.  However, these are expected problems when implementing disruptive evolving technology in the complex changing health market. Challenge is a weak argument for giving up and bringing back the fountain pen.
I am not certain what the goal of Sommeri and Koppel was in writing this piece, they offer nothing but “hope.”  The WSJ has been a strong supporter of business technology leading the drive towards quality, and has long recognized the positive contribution of IT to industry.   Those of us in the trenches, putting EMRs in place, ironing out the kinks, know that electronic medical records are now and they are the future.  With IT at the core of the healthcare renaissance we can make medicine cost efficient, producing quality second to none.
James C. Salwitz is an oncologist who blogs at Sunrise Rounds.
Image credit: Shutterstock.com

Sunday, March 18, 2012

Drummond report on Information Technology in Healthcare

Just had a chance to scan through the Drummond report. This is the state of the Ontario economic. It is almost 500 pages, so I don't know when I will ever read it all. This section on information technology in healthcare resonated with me. I agree with it. Not only is it a way to save money, but it is also the right approach to the appropriate use of the technology. They say that the largest civilian software project failire in history was the national health service architecture in the UK for health records. My own research discovered that the best results will come when the patient and physician are working close together, and the electronic medical record is only stored locally. It doesn't mean the data is locked in a silo. The record can be programmed or make accessible through XML, HL7 or other interoperable standards. Standards neeed to start locally though, not from a national architecture. http://www.fin.gov.on.ca/en/reformcommission/chapters/report.pdf
Information technology (IT) is not used enough by physicians and other health care professionals across the system in a way that allows different disciplines and services to integrate their activities. Extensive use of IT is key to pushing the health care system to operate in a co-ordinated fashion. History has shown that huge IT projects are unwieldy. Most gains will come from local and regional records, so electronic record-keeping should begin with FHTs and hospitals; these could then be connected and expanded from this base. It is imperative, of course, that everyone use compatible systems that can communicate with each other.