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Showing posts with label Systematic Reviews. Show all posts
Showing posts with label Systematic Reviews. Show all posts

Wednesday, May 30, 2018

eHealth forever or technology forever?

I have been writing this "ehealth enabled browser" blog on eHealth since after I graduated with a M.Sc. in eHealth in 2012. I will probably be spending a lot less time blogging here. I still enjoy following the various topics and points of interest that I have encountered in digital health.  Recently one of the great health informatics bloggers, Dr. John Halamka - the Geek Doctor - has decided to wind down his blog. Looks like he is taking more to the twitter sphere. I highly recommend you check that out if you are interested in Health Informatics (or life in general).

A little while ago something I read inspired me to think about writing the ebook version of the "ehealth enabled browser" that I have run here on the earthspiritendless URL at blogspot.ca  Turns out I may have received more inspiration than the perspiration necessary to do that. For the time being, I will settle for writing this post. This will try to encapsulate what I think I have learned by following digital health during this blog experience. To start off  - let me try to explain the significance of the title of this post - eHealth forever or technology forever?

I saw a TED talk where I heard that essentially "technology lives forever" (Kevin Kelly - How Technology Evolves). To illustrate this point the presenter used the example of a steel plow, the kind our ancestors not so long ago pulled behind horses or oxen. A schematic or blueprint of this technology would allow anyone with the technology to replicate it - in essence, bringing it back to life. The technology will last many hundreds of years and would still exist in some less than functional form even after the warranty expires. When it is totally broken, you create another one. Maybe the most difficult thing is just preserving the knowledge and information to manufacture it.  Well, biological beings might appear to be in the same category - cloning DNA - but let's face it, we break down more permanently than the technology we have created. Which leads me to the URL name for this blog - earthspiritendless. The final word is going to be that none of this matters and that only the Earth abides. Nothing lasts forever.

I can't remember why I named this blog URL earthspiritendless when it was supposed to be about digital health and the study of health informatics. The title of the blog - "an ehealth enabled browser" - suggests a blog about someone "browsing" or reading about ehealth.  The URL name actually comes from the English translation for a Tibetan name a Tibetan Rinpoche (reincarnated Lama) gave me in Bodhgaya, India. It is not a riff on the sports wear company that makes earthspirit brand running shoes. I always did have some fear that the company would track me down and accuse me of infringing on their brand or something. The fact of the matter is that there is no connection between ehealth and the Tibetan "nom de religion".

Since eHealth has a computer science focus there is always going to be an attraction to future technologies - for as we know - technology evolves. If you want to try to follow where computer technology is going in the future, there would be no better futurologist to consult than Ray Kurzweil, currently Chief Engineer at Google. It was by reading his books and starting this blog that I began to see a convergence in the ideas of transhumanism, the singularity, and health informatics - a future where we need to learn how about the role of the health care system along with life extension concepts and technologies. I also read his weekly Accelerating Intelligence reports on new discoveries in science and technology, and have a link to it on the blog.

In the field of eHealth itself one of my overall impressions is the continual need for research and systematic reviews on the efficacy of eHealth for improving health and quality of life, as well as a return on investment. The latter just means an improvement in the quality of life. This is where the great service of such academic venues as the Journal of Medical Internet Research is focused. If I was to go back 7 years with a serious intent to study eHealth - toward a PhD for example - I would be busy reading, saving and studying journal articles. eHealth is a business, computer science, and health science interdisciplinary work, and it is always important to keep that in mind when reading and assessing journal articles.

I suppose if I was to generalize about what I have reviewed in digital health into categories of most interest to me and this blog, I could come up with something like this:
  1. Careers
  2. Ethics of Technology
  3. Life Extension
  4. Personal Health Records - Toward the Quantified Self
  5. Spiritual machines
Careers

A spiritual master was once asked what is man's greatest need and the answer was "having work to do". Sorry I don't have a reference for that or even if I have reworded that correctly, but it really means that we find no real meaning in life unless we do work.  Health Informatics as an educational program is an applied field where internships are developed, so it is career oriented from the beginning. One reason I studied it was the possibility of making a career change into what I perceived was an exciting field that had many new developments on the horizon. This blog was never going to provide me with an income from the google ads ( I made enough to buy a few cups of coffee so thanks for those clicks!). I once thought of extending it as a possible business and I secured an URL called ehealthenabled.ca with the intent of developing a site/service for ways of empowering people to use ehealth technology.

That ehealthenabled.ca site didn't run for longer than a year, and I used it mostly to explore again web development in the suite of web hosting software one finds in Control Panel. I learned that WordPress is better than blogspot for creating content. My problem was that I didn't really know what kind of content to bring to market. I had a vague sort of idea that what we need for public and preventative health were ehealth technology "garages" in every neighbourhood. When cars were mechanically breaking down all the time, every neighbourhood had a repair garage - all gone now as pumping stations have consolidated and cars no longer break down as frequently.  These self-service or consultant oriented ehealth stations would also have exercise equipment and all kinds of mobile ehealth technology available, including DIY ultrasound, tDCS etc - after working through the health, safety and privacy concerns of course. We know now how important exercise is for health and having access to resistance training equipment -and/or health coaches - is a fundamental health technology.

The other and perhaps most interesting aspect about an eHealth career is the current potential for entrepeneurship, start-ups, and innovation. eHealth is an applied field, an application of ideas and technologies to solve ever changing and challenging problems in healthcare. I have participated in several Health Hackathons and it would have been great to get involved in some of these types of activities a lot earlier. I would also like to turn the clock back a few more years so I wouldn't miss the mobile app programming bus! Knew that one was coming - did nothing much about it.

Ethics of Technology

Since I work professionally in an ethics related career ( university research ethics) I naturally have had an interest in technology and ethics. For many years I was more interested in bioethics generally and have some courses and conferences under my belt (including a conference presentation on RFID privacy and security concerns in Healthcare). In the past several years there has been a strong shift towards just focusing on the ethics of new technologies and I trace this back when Demi Hassabis sold his DeepMind artificial intelligence gaming software company to Google. Forming an ethics technology committee was a condition of the sale to Google. There is relevance to eHealth a lot here because at Google, Deep Mind went on to develop Alpha-Go the AI that defeated the best Go players in the world. Alpha-Go is also being used in Healthcare, much like IBM's Watson.

There is a really comprehensive research group that also has an open source journal called the Institute for Ethics and Emerging Technologies -  https://ieet.org/. It is interesting to follow this group. I once tried to interest them in publishing an essay I wrote about Steve Mann but I ended up posting it on my Linkedin page - a version of it at least.

Life Extension

I think I only seriously became interested in how life extension related to eHealth by reading Ray Kurzweil. Medicine is more and more becoming an information science apparently. I think the corner was turned on that once medical reference libraries went digital. Living forever is a serious science fiction theme but if Ray is right and exponential changes is happening in computer power, discoveries in science are going to accelerate.  The idea that we should be trying to stay healthy to live longer is not new, but the idea that we should seriously try to stay healthy in order to possibly benefit by new life extension technologies that will be available after the singularity - in 2030? - certainly is a new deck of cards.  The movie Elysium, one of probably a thousand or so that explore life extension ideas in science fiction had a credible healthcare technology that could cure any disease.

Is this something I personally want and help strive to attain? Something like this is a foundational and massively transformational (thank you Peter Diamandis for that concept)  movement and revolution in healthcare where the ethics of maintaining quality of life is so vital. What if we as individuals don't have a choice for how long we are going to live if even the dictates of healthcare ethics say we have to be preserved in some form of silicon based artificial intelligence while our biological DNA is being reprogrammed for cellular regeneration. Maybe it will just come down to a duty to care?

Another spiritual master was asked what was the secret to his longevity and health and he replied "Living off the interest of my investments". Sorry - no reference for that anywhere on the Internet at the moment. Maybe I heard that before the internet.

Personal Health Records - Toward the Quantified Self

The ehealth enabled blog explored a lot studies about personal health records. An aspect tangential to that is a concept called the "quantified self". Will collecting a lot of health data in a "do it yourself" sort of way help save us? I found it interesting to read about experiences with fitbit heart rate data, facebook posts on personal health issues, and other such patient lead data collecting activities, that have resulted in some life saving measures.

The really protracted issues that never seem to go away are the problems with data interoperability. It is hard to join an HL7 committee and help advance the work of interoperability (tried that).  Not everyone is cut out to help write standards. New standards then emerge - FHIR for example. Now there is talk about how the blockchain will be used for the "provenance" of information. Who owns my health data, me, my doctor, or the data miners?

My own conclusion here is mostly about usability.  Collecting our own personal health data should be like an ongoing construction or renovation project where the tools are easily accessible.  Are we not building the virtual self? Log ins to health records are cumbersome - so is typing up the data. Just let the healthcare system do it? We have to be able to better track and record our ongoing health concerns - with or without the healthcare system. I also think we need artificial intelligence in the health record in our social media to tell us when to do things, based on our profiles and our precision medicine disposition. Out of nowhere, we should get a suggestion to get a shingles vaccination!

Spiritual Machines

Meditation to me is a form of health technology, and my teachers were like physicians who prescribed the daily practices for my own benefit, and the benefit of all sentient beings. Experimenting with the Muse EEG headband which is designed to induce or teach one how to enter a meditative state was a highlight not only of my blog posting, but of my own meditation experiences. Though I learned meditation in a long, hard, and traditional kind of way, I truly value the potential for technologies like the Muse. Talking AI or virtual doctors aside, exploring our own calm states of mind is going to make us better people in the long run. For then, we will know what we know, and what we don't know.


Saturday, December 19, 2015

Fall Prevention - From the Optimal Aging Portal

I volunteer with McMaster Family Medicine in the Tapestry program. We visit seniors who have volunteered to be in this research study. We bring an iPad and take a health survey. We also ask if they want to sign in to the McMaster Personal Health Record, which is integrated into the OSCAR EMR.  Many of the clients we have met have had falls.

Just saw this article on the McMaster Optimal Aging Portal about fall prevention. Because I have practiced Tai Chi for more several decades, and because I value the work of the Portal and the plain language systematic reviews and evidence based research they present to the public, I will post this here. It would be great if more people, both citizens and health professionals, could subscribe to the Portal.

Steady on your feet: New ways to improve balance and avoid falls


Dec 18, 2015
When it comes to keeping your feet safely on the ground – metaphorically and literally – it’s all about balance. But like many other things we take for granted when we’re young (strength, endurance, bone density, a full head of hair...) our sense of balance declines as we age. That’s one reason why older adults are at greater risk of falling and potentially becoming seriously hurt or even dying as a result (1).

Past research has shown that regular physical activity can help prevent falls, particularly when it includes exercises and movements designed to improve balance (2). Tai Chi for example, is recommended for its various benefits, including improving strength and balance through slow, controlled movements (3,4).

But if Tai Chi isn’t for you, there are other options you many want to consider. One recent systematic review of six studies measured the benefits of Pilates, a mind-body exercise program that has been popular since the early 20thcentury. Like Tai Chi, it involves controlled movements and concentrates on flexibility, strength, posture and breathing (5). Each study included older adult participants who took part in group Pilates sessions. The exercises varied (mat exercises as well as exercises using elastic bands, weights or other equipment), and included at least 2hrs of Pilates each week. The study participants were compared with a control group who kept up their usual daily activities but did not take Pilates.

Another emerging form of balance training that is gaining attention for its novel approach is “perturbation-based balance training” or balance recovery training. It focuses on improving people’s reaction time and helping them better recover from a loss of balance (6). Training can include equipment (such as moving platforms), or manual interference (such as nudges by a therapist) to enhance your ability to react and stop yourself from falling.

A recent systematic review of eight randomized controlled trials examined whether perturbation-based balance training lowers the risk for falls in older adults as well as people with neurological disorders such as Parkinson’s disease (6). More than 400 people between the ages of 50 and 98 took part in perturbation-based balance training and were compared with those in control group who participated in other types of balance enhancing exercises.

What the research tells us

Both Pilates and perturbation-based balance training appear to be promising strategies for helping older adults avoid falls and the resulting serious consequences.

Despite limitations in the quality of the Pilates studies the results suggest that Pilates is a promising way to help improve balance (5). So far the evidence on perturbation-based balance training is also encouraging: participants completing the training reported fewer falls and were less likely to fall, compared with those in the control groups (6). Further research is needed but there is cautious optimism that this approach may help people react and recover their balance more quickly so that a slip or trip doesn’t necessarily have to end in a fall.

Not sure which balance training exercises are best for you? Ask your doctor or physical therapist, or give these activities a try! At the same time, be aware of hazards and take the necessary precautions (e.g. good lighting, clear pathways, secure handrails etc.) so that you remain surefooted and safe as you enjoy an active lifestyle (7).


The Bottom Line

  • Older adults have a greater chance of falling and experiencing serious injury or even death.
  • Exercises aimed at improving balance have been shown to help prevent falls.
  • Initial studies of Pilates exercises (involving controlled movements to build flexibility, strength and posture) suggest it has the potential to improve balance.
  • Balance-recovery training aims to improve reaction time after a loss of balance and also appears to help lower risk of falls.
  • More high quality studies are needed to learn more about the benefits of Pilates and balance-recovery training.

References

  1. Centers for Disease Control and Prevention (CDC). Falls among older adults: an overview. [Internet] 2012. [cited Dec 2015] Available from: http://www.cdc.gov/homeandrecreationsafety/falls/adultfalls.html.
  2. Gillespie LD, Robertson MC, Gillespie WJ et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; 9:CD.007146.
  3. Mat S, Tan MP, Kamaruzzaman SB, et al. Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review. Age Ageing. 2015; 44:16-24.
  4. Leung DP, Chan CK, Tsang HW, et al. Tai chi as an intervention to improve balance and reduce falls in older adults: A systematic and meta-analytical review. Altern Ther Health Med. 2011; 17:40-48.
  5. Barker, AL, Bird M, Talevki J. Effects of Pilates exercise for improving balance in older adults: A systematic review with meta-analysis. Arch Phys Med Rehabil. 2015; 96:715-723.
  6. Mansfield A, Wong JS, Bryce J et al. Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Phys Ther. 2015; 95:700-709.
  7. Public Health Agency of Canada (PHAC). You Can Prevent Falls. Ottawa, Canada. [Internet] 2011. [cited Dec 4, 2015] Available from: http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/prevent-eviter/index-eng.php 



AUTHOR DETAILS

Optimal Aging Portal Blog Team

The latest scientific evidence on this topic was reviewed by the McMaster Optimal Aging team. Blog Posts are written by a professional writer, assessed for accuracy by Dr. Maureen Dobbins, an expert in interpreting and communicating the scientific literature, and edited by a professional editor. There are no conflicts of interest.

Friday, March 8, 2013

Cochrane Reviews for Patients Seeking Health Information?

I heard a story on CBC radio about "Plain Language" summaries available for patients (or healthcare consumers) who need to make decions on health information via Cochrane Reviews. I tried to google to find a textual piece on this story and there was "nada", which means the radio and the internet don't always interface or there is no automatic speech to text translation between the two media. A woman who I believe was also a volunteer with a Cochrane Review was describing how helpful it was for her to search the Plain Language summaries to find exactly the information she was seeking on the new research for her own health condition.

Anyway, it has been a year or two since I have visited the Cochrane Library website and I think there have been some improvements in the website and it's usability. Still, I am not sure how it can become one of the more trusted sources of health information on the net for the general public (like Mayo Clinic, WebMD, Medline) but I fully endorse it as a gold mine of health information. They now have a blog called Evidently Cochrane, and they are starting to use social media a lot more.

In fact, based on one of their reviews for acupuncture for shoulder pain, I have decided to cancel an appointment and rethink future treatment options.


Cochrane Reviews

 How do you know if one treatment will work better than another, or if it will do more harm than good?"

Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. They are published online in The Cochrane Library.
Each systematic review addresses a clearly formulated question; for example: Can antibiotics help in alleviating the symptoms of a sore throat? All the existing primary research on a topic that meets certain criteria is searched for and collated, and then assessed using stringent guidelines, to establish whether or not there is conclusive evidence about a specific treatment. The reviews are updated regularly, ensuring that treatment decisions can be based on the most up-to-date and reliable evidence.
“We care that you care enough to help us provide people all over the world, with a personal or professional interest in health care, with reliable information.”

Sonja Henderson, Managing Editor of the Cochrane Pregnancy and Childbirth Group, Liverpool, UK

Cochrane Reviews are designed to facilitate the choices that practitioners, consumers, policy-makers and others face in health care.  

No other organisation matches the quality, volume, scope and range of healthcare topics addressed by Cochrane Reviews.

As well as covering hundreds of medical conditions and diverse healthcare topics such as injury prevention and natural treatments, Cochrane Reviews have an international appeal through their global coverage of healthcare issues affecting people in all countries and contexts, including resource-poor settings, where it is vital to ensure that funds are used to maximum benefit.

Without Cochrane Reviews, people making decisions are unlikely to be able to access and make full use of existing healthcare research.

“To ensure that the work of The Cochrane Collaboration is relevant to low and middle-income countries it is essential that people from those countries actively participate.”

Jimmy Volmink, Director of the South African Cochrane Centre and Coordinator of the Cochrane Developing Countries Network, Tygerberg, South Africa

Why are Cochrane Reviews different?

Cochrane Reviews enable the practice of evidence-based health care.

Health care decisions can be made based on the best available research, which is systematically assessed and summarised in a Cochrane Review.
Narrative reviews of healthcare research have existed for many decades, but are often not systematic. They may have been written by a recognised expert, but no one individual has the time to try to identify and bring together all relevant studies. Of more concern, an individual or company might actively seek to discuss and combine only the research which supports their opinions, prejudices or commercial interests. In contrast, a Cochrane Review circumvents this by using a predefined, rigorous and explicit methodology.

Users of the medical literature should start paying more attention to the Cochrane Database of Systematic Reviews [the database of Cochrane Reviews in The Cochrane Library], and less attention to some better known competitors."

 Richard Horton, Editor of The Lancet, July 2010 
A Cochrane Review is a scientific investigation in itself, with a pre-planned methods section and an assembly of original studies (predominantly randomised controlled trials and clinical controlled trials, but also sometimes, non-randomised observational studies) as their ‘subjects’. The results of these multiple primary investigations are synthesized by using strategies that limit bias and random error. These strategies include a comprehensive search of all potentially relevant studies and the use of explicit, reproducible criteria in the selection of studies for review. Primary research designs and study characteristics are appraised, data synthesized, and results interpreted.

Each review is prepared by an 'author team' with support from specialist librarians, methodologists, copy and content editors, and peer reviewers, taking hundreds of hours of work from start to finish.

“The Cochrane Collaboration has consistently involved consumers in its editorial processes, in the firm belief that the more consumers are involved, the more health services and research will grow in democracy, and will be tailored to people’s needs.”

Silvana Simi, Consumer Coordinator for the Cochrane Multiple Sclerosis Group, Pisa, Italy
Updated on: March 19, 2012, 13:36

Copyright © The Cochrane Collaboration
Comments for improvement or correction are welcome.
Email: web@cochrane.org

Wednesday, December 19, 2012

p value less than 0.05



I received an email about a Research Integrity conference and checked out the keynote speakers. One of them was Dr. John Ioannidis. This lead to me to what I discovered was one of the most cited research papers out there "Why Most Published Research Findings are False". This article touched off a nerve or two in me, and eventually I will try and read it to at least a level of comprehension, because it is very mathematical. What struck me was the hypothesis that:

Several methodologists have pointed out [9–11] that the high rate of nonreplication (lack of confirmation) of research discoveries is a consequence of the convenient, yet ill-founded strategy of claiming conclusive research findings solely on the basis of a single study assessed by formal statistical significance, typically for a p-value less than 0.05.

I took courses in health research methodology and was taught how to read medical literature and the p value inherent in most of the journal articles always confused me.  I still don't know the significance of the p value, but this I know: it is not good if family doctors, relying on evidence- based medicine to prescribe innovative therapeutic drugs, are relying on these articles' conclusions and p values for their predictive value to help me. They should be relying on the gold standards of medical evidence: systematic reviews and meta-analysis - the highest forms of "unbiased" research. Atlantic magazine has a great article "Lies, Damn Lies, and Medical Science" (in plain English) about Ioannidis and this medical dilemma.

If you want to check out why I might be confused by what a p value is, check out this definition in wikipedia:


In statistical hypothesis testing, the p-value is the probability of obtaining a test statistic at least as extreme as the one that was actually observed, assuming that the null hypothesis is true.[1] One often "rejects the null hypothesis" when the p-value is less than the significance level α (Greek alpha), which is often 0.05 or 0.01.
Although there is often confusion, the p-value is not the probability of the null hypothesis being true, nor is the p-value the same as the Type I error rate.[2] A Type I error in statistics is the incorrect rejection of the null hypothesis. In this case the hypothesis was correct but wrongly rejected. In a Type II error, however, the null hypothesis was not rejected despite being incorrect. This results in the failure of rejection of incorrect assumptions.


The best place to learn about all of this is in one of the classics of evidence-based medicine by one of the authors who coined the term "evidence-based medicine", Dr. Gordon Guyatt, who teaches and does research at McMaster University:

Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice, Second Edition (Jama & Archives Journals) by Gordon Guyatt, Drummond Rennie, Maureen Meade and Deborah Cook (May 21, 2008)



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