Searching for Trusted Health Information - A.D.A.M.

Recently I did a lot of personal searching of health information for a close relation and after many searches, I still think the MedlinePlus A.D.A.M. references were the most useful. Very plain and simply language was what I most remember. Although, sometimes links outside of the encyclopedia were broken. This won't always be the case for everyone and every condition - there is too much out there, but you've got to trust A.D.A.M. and their editorial board and process.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2013, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM Health Solutions.

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

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

Should diabetics eat grapes?

I was listening to an acquaintance of mine talk about her mother who was recently diagnosed with diabetes. She was debating with her whether or not grapes could be part of the diabetic diet. Where to get an answer on that one? Yes, make an appointment with a professional dietician, which is what she recommended to her mother.

But what do most people do? Right, they google. And, what do they find? Research has shown that most people will click on the first five search return links that come up (thus the lucrative power of Search Engine Optimization or SEO). But when searching for health information, which is one, if not the highest usage for internet searching, do most people know if they are getting reliable or trustworthy information? Anyone even heard of Health on the Net?

I just searched on "should diabetics eat grapes?" and I did not see some of the more trustworthy internet health sites out there, like mayoclinic.com or medline. I don't know if Canadians automatically go to their provincial health authority website to seek this information. There is a lot of research on health information seeking behavior, and what patients print off before they visit their family physician.

What I am getting at, is that the trend towards personalized medicine should be able to answer this question in the context of their personal health record system (which ideally has been prescribed or recommended to them by their personal family physician).  You could have a Dr. Watson type search engine answer the question. You could have data crunchers analyzing health information in the health record, comparing to the ocean of health data that could be analyzed. Genetic information could be a factor for grapes, blood type, and insulin levels. Socio-economic factors loom large, for example, what is a grape in a food desert?

But what I think the reality is, most people don't have personal health records or know how to set them up, and the personal health records that do exist, won't be able to automatically answer this type of question, though we all speculate that it should. The family physician should be answering this question, either through a referral to a nutritionist, or a diabetes guidance counsellor. 

And this has made me think that what we need are more self-tracking stations. These would be counselling services where people can go to learn and maybe even procure self-tracking technologies, like fitbit, personal health records, mobile smartphones with blood pressure cuffs, etc.  What if there could even be fMRI, ultrasound, and Transcranial Magnetic Stimulation machines in these stations. This would be one way to deconstruct medicine, and I would like to venture on this idea in a future post on practising medicine without a license. There are so many medical and other devices which can be used to support healthy living. Maybe the model of the York University "Health Coach" would fit this idea, or the Self-Tracking Station counsellor.

The Rapid Approach of the Health Internet of Things

I subscribe to LaBlogga's "Broader Perspectives" blog and this is one of the first posts that directly talks about "ehealth".  Broader Perspectives is interesting to read because most of the time it is kind of a post-modernist advance search party looking for the intersection between technology and society. I also wonder about the subject of the post, referring to "Internet of Things".  Now, if I am not mistaken,  the "Internet of Things" was coined by a guy who ran an IBM sponsored lab at MIT, who envisioned a world networked together through RFID tags - literally every manufactured thing could have an RFID tag and thus be on the internet.  I know RFID is being used in Healthcare, but I am not sure if it will ever be ubiquitous.

Sunday, August 05, 2012

The Rapid Approach of the Health Internet of Things

The efforts of the eHealth movement have been quietly gathering steam for the last five years and are finally fulminating into what could be a significant transformation in the management of health and health care. The most encouraging sign of change is that it consists of not just the usual shiny new technology solutions, but more importantly, structural changes in the public health system:

The 80% slim-down of the doctor’s office visit…

• Telemedicine reimbursement: As of March 2011, only 12 states offered reimbursement for telemedicine services (e.g.; telephone, email, video consultation), and at lower rates than in-office visits. Now more payers and states are starting to approve telemedicine reimbursement, which could be a huge cost savings for the industry as it is estimated that 70% of physician consultations could be handled by phone.

• Majority of diagnosis is straightforward: It is estimated that in 18/20 cases (per Singularity University FutureMed), diagnosis is straightforward, and could be accomplished via telemedicine.

• Trend to higher deductible plans: many programs are underway to transfer employees to higher-deductible plans which both reduces costs and puts more of an emphasis on preventive medicine.

Significant progress could be made with these structural changes acting in concert with the new generation of healthtech tools in areas such as:

• Health sensors, examples: continuous glucose monitoring patches, EEG sensors, ambient assisted living

• Quantified self-tracking devices, examples: Fitbit, Zeo sleep tracking, Body Media, Pebble Watch, Nike Fuel Band, Basis Watch

• mHealth (mobile health) apps, examples: The Eatery, MoodPanda, Map My Run, Cardio Trainer

Posted by LaBlogga at 9:45 AM   ShareThis

Virtual-reality simulator helps teach surgery for brain cancer

This article, which I found on the Kuzweil site, is an education and training simulation system built in Canada and now used in Canadian medical centres for teaching.  I don't know if this kind of health technology is classified as eHealth, but I thought the area of medical professional and student training in health technology a real part of health informatics.  Health Technology Assessment is almost a branch of science itself.  It is kind of the clinical trial process for health technology, before it comes to market, safe for human consumption.

Virtual-reality simulator helps teach surgery for brain cancer

NeuroTouch system provides 3D graphics and tactile feedback during simulated brain surgery

September 24, 2012

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NeuroTouch (credit: National Research Council Canada)

A new virtual-reality simulator — including sophisticated 3D graphics and tactile feedback — provides allows neurosurgery trainees to practice essential skills and techniques for brain cancer surgery.

The prototype system, called “NeuroTouch,” uses 3D graphics and haptic (sense of touch) technology to provide a realistic look and feel for practice in performing common tasks in brain cancer surgery. Lead author Sébastien Delorme, PhD, of the National Research Council Canada and colleagues believe the NeuroTouch system could enhance “acquisition and assessment of technical skills” for neurosurgeons in training.

The NeuroTouch software simulates what the neurosurgeon sees through the operating microscope during surgery — including detailed, lifelike renderings of brain tissue, blood vessels, and tumors. The system also includes haptic tool manipulators, providing tactile feedback similar to what the surgeon would feel during surgery. The simulator runs on computers that are similar to those used to run popular games.

The surgical tasks were developed using 3D reconstructions of MRI scan data from actual patients. With further development, the system could also allow neurosurgeons to simulate and practice actual operations, based on the patient’s own MRI scan.

During the development process, the researchers received feedback through an advisory network of teaching hospitals. The 3-D visual graphics received high praise, although the tactile feedback system came in for more criticism. Surgeons testing the system also suggested improvements to the ergonomics of using the simulator.

Neurosurgical residency training programs are challenged to make the most of their resources while maximizing training opportunities for residents. About 90 percent of surgical training is received in the operating room, where residents learn procedures by assisting surgeons with hundreds of operations.

Medical simulators — similar to those used to train airline pilots — are increasingly viewed as a cost-effective complement to traditional surgical training. For example, a commercially available simulator has proven effective in helping trainees perform minimally invasive gallbladder surgery more rapidly, with a lower risk of patient injury.

The NeuroTouch system appears to be a promising tool for extending virtual reality technology to teaching common and important neurosurgery techniques. While it is not the first neurosurgical simulator, it provides key advances over previous systems, particularly in terms of providing real-time graphics and tactile feedback.

The next step will be to evaluate the new system in actual neurosurgical training programs. “First generation NeuroTouch prototypes have been set up in 7 teaching hospitals across Canada, to be used for beta testing and validation and evaluated for integration in a neurosurgery training curriculum,” according to Dr. Delorme and colleagues, and a new generation of NeuroTouch simulators is currently being deployed worldwide.

REFERENCES:

• Delorme, Sébastien, Laroche, Denis, DiRaddo, Robert, F. Del Maestro, Rolando, NeuroTouch: A Physics-Based Virtual Simulator for Cranial Microneurosurgery Training, Neurosurgery, 2012, DOI: 10.1227/NEU.0b013e318249c744

Topics: Biomed/Longevity | Cognitive Science/Neuroscience | VR/Augmented Reality/Computer Graphics

McMaster Developed OSCAR/MyOSCAR Personal Health Record gets over 5 million from Federal Government

This story is the highlight of my year.  Not only is it another McMaster story, it is one involving the OSCAR EMR and the  MyOSCAR personal health record (PHR) that most M.Sc. eHealth students at McMaster know about.  I used MyOSCAR in an exercise to design a clinical trial for type II diabetes self-managment, a procurement solution for mobile eHealth (again with Diabetes in mind), and as an example of a tethered system.  Tethered no longer by the looks of it!  It looks like it will be developed for an integrated if not interoperable solution for the general public, instead of just the trial projects at Stonechurch Family Medicine in Hamilton, where the McMaster developers work.  Certainly, the clinical utility, effectiveness, etc. has been through many tests.  How exciting for McMaster, and for the general public, to have this service available for them.

This story is big ehealth news, in my mind, and here are some of the links to it, just to get started:

A) The story on the McMaster University Daily News.
B) The Hamilton Spectator.
C) The Federal Economic Development Agency for Southern Ontario (which provided funding)

From news source C) above:

The following is the complete list of partners in this project:

Private sector partners

Post-secondary institute partners

Not-for-profit research partners

• NexJ Systems Inc.
• OSCARService Inc.
• PryLynx Corporation
• Rogers Health Care
• Research In Motion
• Trivaris
• Tyze Personal Networks
• Beth Israel Deaconess Medical Center (an affiliate of Harvard Medical School)

• York University
• McMaster University
• Centennial College
• George Brown College
• Seneca College

• Centre for Global eHealth Innovation (University Health Network)
• North York General Hospital
• Southlake Regional Health Centre

For more details on the project and its partners, please visit: www.chwp.org.

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

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

The Power of Personal Health Records?

I have written and researched about Personal Health Records - and had a Google Health account until the project was closed - but I am not sure about the future for PHR anymore.  I joined a few teleconferences for the HL7 standards group on PHR and know how much work they are doing trying to define them in terms of HL7 and interoperability. Here is an article they recommend < HIMSS blog >.  The research has shown more doctors need to adopt EMR before PHR become viable.  And it just maybe more of us need to be chronically ill to speed up their adoption - healthy people don't need to use them!  Be that as it may, time will tell what the future has in store.  My hope will be that the PHR will gain more clinical efficacy and effectiveness for physicians to place them in the trust of their patients.  I have no doubt that a great many people will be using PHR or equivalents to track their wellness in novel ways, without their physicians.  

Tricorder Project

The X Prize Foundation announced a Tricorder competition not long ago, but a McMaster graduate and  researcher has been working on one for quite some time. See Jansen Tricorder Project. I say just add a geiger counter feature and this will fly off the shelves the next time there is a nuclear error. Hat tip to the Hamilton Spectator for publishing this.

The dire need to improve healthcare and health in the U.S. is a problem whose solution has evaded the brightest minds. The Qualcomm Tricorder
X PRIZE is a $10 million competition to stimulate innovation and integration of precision diagnostic technologies, making definitive health assessment available directly to “health consumers.” These technologies on a consumer’s mobile device will be presented in an appealing, engaging way that brings a desire to be incorporated into daily life. Advances in fields such as artificial intelligence, wireless sensing, imaging diagnostics, lab-on-a-chip, and molecular biology will enable better choices in when, where, and how individuals receive care, thus making healthcare more convenient, affordable, and accessible. The winner will be the team that most accurately diagnoses a set of diseases independent of a healthcare professional or facility and that provides the best consumer user experience. Visit the competition website to learn more.

This prize is made possible by a generous grant from the Qualcomm Foundation.

TRICORDER is a trademark of CBS Studios, Inc. Used under license.

The Guardian Informatics Section

It would appear that the UK Guardian has a section on Health Informatics.  Quite interesting that this should be a "normal" section of one's daily reading.  Perusing the articles, you come across a series by the Patient from Hell - Dick Vinegar, who writes articles on EMR implementations, public health, the NHS, etc.

Fitbit

Fitbit is quite a useful and potentially revolutionary device. When I was doing research for a computer science and software engineering paper, I was wondering how data from the fitbit could be wirelessly transmitted into personal health records, and stored in the HL7 standard. The problem is, there is a lot of data, so only certain trends need to be recorded. The other problem is how to program an XML or HL7 standard self-journalling area in the personal health record. I know the HL7 standards group is working on PHRs now, because I participated in one of their lunchtime teleconferences. I am not sure how this particular problem was addressed. This is one device the people in the self-tracking movement cannot afford to be without. In fact, they have latched on it, and the systems deployed with them and other similar devices they call "Health Mashups".

Knowing is Better (with RFID?)

The Canada Health Infoway TV commercial (also appears on my blog as a Google ad!) is really what health consumers are looking for. Implementing it is another story. It is the ehealth mystery of the patient who arrives in the ER in a coma with absolutely no identification. A solution advocated by John Halamka (looke for the study in the New England Journal of Medicine "Straight from the Shoulder") is RFID implants. RFID readers in the ER would scan the patient for the chip. Minimal identification information on the chip would lead to the database with the patient's electronic medical record, i.e., penicillin allergy, diabetic, medications to avoid etc. I am not 100% what the Infoway solution is, but I am not sure it is an RFID one. The thing about RFID is that developments in technology might lead to less invasive ways to create identification tags. For example, take the nanosensor tatto that tracks glucose and sodium via an iphone. In the "Knowing is Better" video the ER doctor asks "Is he on any meds", and a nurse responds "Neighbour says the wife is out of town". On the rerun, when knowing is better, the EMR is already on the screen when he arrives, thus answering the question about medications. One way for the EMR to be on the screen in the ER would be something like an RFID embedded health card, just like Ontario has "enhanced driver's license" for quicker Canada-US border crossing. Otherwise, just scanning a bar code on the health card could do the same thing. What if no wallet?

Knowing is better ads on this site

http://www.knowingisbetter.ca/ Since I added google ads on this site, I have been following what kind of ads pop up. Most of them have been good, maybe even relevant to what this blog is about. I found the Infoway ad to Knowing is Better is popping up quite a lot. By mistake I clicked the link to it off my site, which you are not supposed to do according to the "contract" with Google. I am going to label this a consumer health informatics, and start a new label called "infoway". Not sure "Knowing is Better" would be an appropriate label. Who knows what that might mean, right?

Online physician question/answer

http://www.avvo.com/ I was reading the Kevin Pho MD e-newsletter and heard about this site. Sounds like trusted health on the internet to me. I am not talking about the rate your lawyer or find a lawyer section of the site, which I find a little paradoxical in fact. The Avvo blog had an article about a webinar that discusses how physicians can using blogging to get more referrals. Could be an American physician thing.