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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 health informatics. Show all posts
Showing posts with label health informatics. Show all posts

Thursday, October 8, 2015

CBC - Keeping Canada Alive website design & programming

The navigation web programming & design is excellent for this CBC project.
http://www.cbc.ca/keepingcanadaalive/

I looked at the Page Source for the coding trying to see if I could identify how they designed it. I am still not sure. I missed the ajax boat in programming utility and so I am not sure how that programming forms the navigation circle, if at all. Some of the navigation circle might be all done in CSS, maybe what they call "CBCcarousel":
http://www.cbc.ca/i/css/v11/scripts.css
Then I found out that "carousel" is actually a CSS class for design < here >.

It reminded me of an old style of web page design using photoshop image over layers.  The circle mouse over links to entire video documentaries is very useable. CBC may be selling off their buildings and laying off employees but at least they know how to deliver digital information. It could even be flash scripting? I've really not kept up with that either.

I think web design and programming for healthcare sites is part of a study of Health Informatics. We may recall the fiasco of the Obamacare healthcare.gov website that had usability and server crashing issues.  For that matter, any electronic medical record system is first and foremost a web design application that must prioritize usability.

Speaking of Usability I have been trying to read through Steve Krug's "Rocket Surgery Made Easy: The Do-It-Yourself Guide to Finding and Fixing Usability Problems." Krug is right - he is not a book writer. Interesting layout for a book though.

The episodes for the CBC series don't appear to have one dedicated to an ehealth contextual scenario. I think that is because ehealth is usually kind of implicated throughout many aspects of healthcare, and not an all star focus?

Anyway, having watched a half dozen or so episodes, I am finding the whole thing quite an awesome educational trip! Here is a short clip intro to the project:


Tuesday, September 23, 2014

Twitter feeds about eHealth - Dr. C. Michael Gibson & WikiDoc

I have a twitter feed, ( I like to call it a feed because I still think of Twitter as just a more streamlined sort of RSS reader ) mostly about eHealth , but I do have a life and I am not always following eHealth or posting about it. I currently have 7 people following me (which is not like an RSS newsfeed ). I was flattered to discover not long ago that Dr. C. Michael Gibson, an eminent Harvard cardiologist had followed me from his Twitter. But when I went to his Twitter page, I find out I am only one of 97,400 Twitter feeds he follows. He has made 14,000 tweets and has 120,000 followers! I might be one of those followers who might soon stop following, because while there is information about eHealth, there is also a lot about cardiology and clinical trials. In fact, there is just a ton of information streaming from there and I can't follow it all. I also "subscribed" if that is the word, to the New York Times Health Twitter, which is an incredible fountain of information ( again, too much in fact). But if you want to follow the current Ebola crisis in timely updates, Dr. Gibson's twitter feed seems to be the place to be.

What is also very interesting about Dr. Gibson, is that he must be one of the great eHealth pioneers of his generation, because he was the founder of WikiDoc - the living textbook of medicine -  to which he has contributed thousands of articles. I always did wonder who was writing those articles about medicine on Wikipedia, but it turns out, Wikipedia might not be the best place to get your best information about medicine.

Tuesday, March 4, 2014

Health Informatics Books on the HIMSS website

Heard about John Halamka's book Life as a Healthcare CIO which you can purchase off the HIMSS bookstore webpage. Browsing through all the other book offerings on HIMSS one need not go any further to procure an education on Health Informatics. 

Wednesday, May 22, 2013

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.

Sunday, March 3, 2013

HeLa High School will Teach Health Informatics

HeLa High School, opening in the Fall 2013 in Vancouver, Washington State USA is astonishing in a number of different ways:

  • It has Health Informatics as major concentration in the curriculum
  • It makes the term "pre-med" even more pre-med
  • It honours naming the school after Henrietta Lacks, stem cell medical research participant  who's cancerous tumours became the HeLa stem cell line
  • It follows maybe the Swiss education model which is based more on apprenticeship and job training models?
I've read the book by Rebecca Skloot about the life of Henrietta Lacks, and it is highly recommended. Quite appropriate for ethical reasons to name a STEM (Science, Technology, Engineering and Math) school for her. Well they named it for the stem cells too. I know some Canadian university Health Science undergrad programs have a reputation being thought of as "pre-med", but this is even more competitive. How are students chosen for admission? If students are studying Health Informatics that early, what will that do the applied M.Sc. in Health Informatics in the future? 

New Vancouver high school will focus on health, bioscience

Evergreen Public Schools' HeLa High will open in fall

The view from a west-facing window inside the media center of the new Henrietta Lacks Health and Bioscience High School, which opens in the fall.
The view from a west-facing window inside the media center of the new Henrietta Lacks Health and Bioscience High School, which opens in the fall.


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Evergreen Public Schools Director of Facilities Susan Steinbrenner, left, and Public Information Specialist Kathryn Garcia-Stackpole tour the new Henrietta Lacks Health and Bioscience High School, the only such school in the state.
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Henrietta Lacks' cancerous cells were harvested without her knowledge and cultured for medical research to create an immortal cell line. Her story was told in the nonfiction book "The Immortal Life of Henrietta Lacks" by Portland author Rebecca Skloot. HeLa High is the first school building in the nation to be named for her.
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Evergreen Public Schools spokeswoman Carol Fenstermacher stands inside the school's simulated hospital nursing station, where students will get hands-on, real-world experience on their way to pursuing careers in health care.
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Map data ©2013 Google - Terms of Use

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Hybrid

HeLa High School

9105 N.E. Ninth St., Vancouver
• School opens: Fall 2013. •Total estimated construction cost:
$23.7 million.
• Maximum number of students: 500.
• Size: 60,000 square feet.
• Curriculum focus: A biosciences and health care curriculum that includes extensive partnerships with Peacehealth Southwest Medical Center and others to provide opportunities for hands-on learning.

Programs of study

• Nursing and patient services.
• Health informatics.
• Biotechnology.
• Biomedical engineering.
• Pharmacy.
The pharmacy is nearly ready. The state-of-the-art nursing station is down the hall. But this isn't a hospital. It's Vancouver's newest high school.
Henrietta Lacks Health and Bioscience High School — HeLa High for short — is such a rare model that a very small number of similar schools exist nationwide. When its doors open in September, students will experience hands-on learning with state-of-the-art technology and partnership opportunities with PeaceHealth Southwest Medical Center, just a block away.
"The state has a number of schools focused on STEM — science, technology, engineering and math, " said Julie Tumelty, the school's principal. "But we haven't heard about another school in Washington that is specifically focused on health and bioscience."
As baby boomers age, studies point to an increasing need for well-trained health care workers. An Evergreen Public Schools study indicated about 20 percent of its ninth-graders planned to pursue a career in health care. It seemed an opportune time to pursue the specialty school. PeaceHealth Southwest Medical Center has worked with the school district for almost a decade to help plan the school. The medical center benefits by helping funnel more local students into health care fields.

How HeLa is funded

In 2002, Evergreen Public Schools received a $200,000 federal Workforce Investment Act grant to investigate how to develop employees to meet the growing demand for the health care industry. That led to the decision to build a heath-focused high school.
The total estimated construction cost is $23.7 million. To help with construction, the district received a $17.4 million Qualified School Construction Bond, federal stimulus money that is part of the American Recovery and Reinvestment Act of 2009. The remaining money comes from a $1 million grant from the Washington State Department of Community, Trade and Economic Development (CTED), proceeds from the district's previous land sales and state matching money.
The fast-growing district qualified for matching money because it has more than 1,200 high school students taking classes in portables. Moving about 500 of the district's high school students to the new school will ease the overcrowding and prevent the district from having to build another large, comprehensive high school in the near future.

Small footprint

The school's footprint of 2.9 acres is miniscule compared with the district's comprehensive high schools with between 40 and 50 acres each, including large sports fields and much larger parking lots. The outdoor space at HeLa includes four basketball hoops but no sports fields. The parking lot is small. In a nod of cooperation to the neighborhood, the district agreed that all students would arrive at the school via school bus. That'll prevent traffic congestion.
The 60,000-square-foot building was designed by LSW Architects and constructed by Skanska USA. If needed, an additional 20,000 square feet may be added later. Its high-tech design is apparent both inside and out. Two levels of solar panels on the south side will help provide power. The floors on the first level are polished concrete, and in the student commons the floor is heated for comfort.
Students will learn real-world nursing skills in the four-bed nursing station, complete with a simulated, interactive robot patient called SimMan. A simulation pharmacy and well-equipped laboratories will provide more hands-on learning. The library, called the research lab, will be stocked with a combination of electronic books and traditional paper textbooks.

Not traditional

HeLa isn't a traditional high school. It won't have sports teams, so instead of a large gym, the school has a fitness room where students will learn lifelong fitness using resistance training, mats, Pilates and medicine balls. There won't be a marching band or pep band, but a scaled-down music program may offer orchestra or symphony.
The first school year, the student body will consist of about 125 freshmen and 125 sophomores. The next two years, 125 freshmen will be added each year, so that 500 students eventually will be enrolled there. Students interested in attending the school completed an application and are being chosen via a lottery system from the district's comprehensive high schools, with an equal number of students coming from each school.
Classes will be integrated to create an overall focus on health and biosciences, Tumelty said. As an example, she said in English class, students will use informational texts and literature that are science-based.
"The goal is for students to see the connections between the disciplines so that they get a better view of how the real world works," Tumelty said. "Teachers will be working on creating these connections in authentic ways for students."
Freshmen and sophomores will take anatomy and physiology along with chemistry and biology "to give them a really good base in science," said Elisabeth Harrington, the district's director of curriculum and instruction. Before they enter their junior year, students will have to choose one of five pathways: nursing and patient care; health informatics (data processing); biomedical engineering; pharmacy; or biotechnology.
"In the first two years, as they're doing A&P, there will be a heavy emphasis on medical terminology," Harrington said. "Once they've picked their pathway, as juniors they'll partner with PeaceHealth with job shadowing opportunities. Seniors will have internships at PeaceHealth."

Who was Henrietta Lacks?

The cancerous cells of Henrietta Lacks, a poor black woman from Virginia, were harvested in 1951 without her knowledge and cultured for medical research to create an immortal cell line. Her cells were used to develop the polio vaccine, gene mapping, in vitro fertilization and cloning, among other things. Although billions of her cells have been sold for research, her family can't afford health insurance. Her story was told in the nonfiction book "The Immortal Life of Henrietta Lacks" by Portland author Rebecca Skloot. This is the first school building in the nation named after her.

Thursday, December 13, 2012

iPhone EKG Case - Another piece in the Tricorder XPrize?




I thought the iStethoscope was a pretty good missing piece for the Qualcomm TriCorder XPrize.   I blogged about this before < here >. Here is another component which fits nicely.  It won't be long before a powerful point of care diagnostic smart phone finds it way to FDA approval - and an XPrize winner.








This $200 iPhone Case Is An FDA-Approved EKG Machine

HEALTH CARE IS HURTING, AND THE WORLD IS CHANGING. MORE AND MORE, HOSPITALS WILL FIT IN OUR POCKETS.

Most iPhone cases just protect your phone from drops. If you’re getting fancy, it may have a fisheye camera lens or a screen-printed back. But what about diagnosing coronary heart disease, arrhythmia, or congenital heart defects? The AliveCor Heart Monitor is an FDA-approved iPhone case that can be held in your hands (or dramatically pressed against your chest) to produce an EKG/ECG--the infamous green blips pulsing patient-side in hospitals everywhere.
“We think that EKG screening can be as approachable as taking blood pressure,” AliveCor President and CEO Judy Wade tells Co.Design.







There are already apps that take your heartbeat, of course. But there’s a big difference between the fast-paced standards of casual electronics and the strict sanctions of government-approved medical devices. “The heartbeat camera apps are good at wellness,” Wade admits, “but we see ourselves for use by people who want clinical-quality equipment.”







So unlike most iPhone cases that are squirted by Chinese factories at extremely high margins, AliveCor’s case has been in serious development since 2010. Aside from building the gadget itself, to become approved for medical use by the FDA, AliveCor had to participate in two clinical trials to field test both the hardware and the accompanying app. One study investigated how its single-lead EKG compared to a traditional 12-lead device, the other examined if 54 participants could figure out how to use the case properly, with no previous medical training. The latter study was not only successful but led to the diagnosis of two serious heart problems.

THE COMPLICATIONS OF INNOVATING UNDER THE FDA

AliveCor was lucky. Though it took about six months to get the application ready, the approval arrived well within the 90-day approval window, allowing the company to come to market sooner. It was a necessary hassle; FDA approval opens a lot of doors. Instantly, what could be considered some scam iPhone case was marketable to health care professionals--doctors--who’d most likely pay out of pocket for a $200 stethoscope replacement without blinking. FDA approval also allows doctors to prescribe, and potentially have insurance cover, AliveCor’s device for their patients to take home.
But even with an approval in-hand, AliveCor will continue to juggle complicated regulations to stay competitive in the market. For one, the approved monitor was designed for the iPhone 4 and 4S. Before AliveCor can release an iPhone 5 version with the exact same hardware internals, they will need to seek out additional FDA approval. (With previous approval and clinical trials to cite, the process is mostly a formality, but it’s still paperwork that takes more time and resources.)







The company also intends to release an over-the-counter version of the case. The good news is, this device will be eligible for coverage in most employee spending programs. But because of FDA regulations, this OTC version cannot provide the raw EKG data to a consumer who might not know how to interpret the esoteric waveforms. Instead, AliveCor will redesign the app to provide an infographic-esque interpretation of the EKG. “An EKG means something to a trained physician, but we can provide a lot of insights to an untrained consumer that might help explain what triggered a cardiac event,” Wade explains. “Like caffeine is a trigger. With an app, we see being able to offer more insight to an individual about their heart health.”
From a product design standpoint, this second-level data analysis sounds like an ideal, consumer-oriented decision. But from a consumer rights standpoint, why is any government agency standing in the way of consumer access to our own raw data? I can see how strongly my iPhone’s antenna is reaching the nearest cell tower, but I can’t see how well my own heart is ticking inside my body? How absurd is that? Interestingly enough, AliveCor is using this regulation to their advantage, banking on the health care model as it stands now. Its OTC device will offer services to refer you to a physician for deeper result analysis (and access to your actual waveforms, if you’re so concerned), which will provide a backend revenue stream beyond typical hardware sales. Imagine the potential: In-app purchase for a follow-up appointment.







An eagle at the Edinburgh Zoo that had been shot, but AliveCor’s case measured a heartbeat through its feathers. The eagle was deemed fit enough for surgery, underwent the procedure and lived. Needless to say, the device has veterinary applications as well.

THE FUTURE OF MEDICINE

For the time being, AliveCor is continuing to develop their EKG cases into a full line, including that OTC device, which will also be a universal version working for both iOS and Android. (Since the case actually communicates with the phone wirelessly, once the software programming is done, these product differentiations are largely cosmetic in nature.) No doubt, AliveCor sees the case as a stepping stone to the company’s overall vision, that “everyone should have their health at their fingertips,” Wade says. But the company will have to solve a lot of larger problems that the industry is struggling with to make that future a reality.







While diagnostic devices may be coming to the phone, we still have no standards to get such diagnostic information back to our doctors. AliveCor explained to me that it can send a push notification to my cardiologist every time I check my heart, but does my cardiologist really want push notifications all day from their client list? Or worse, would any doctor want a devastating cardiac episode just sitting under 30 other messages in the iOS Notification Center? Should my phone text or not text emergency information? Should doctors be held accountable for app-based information? Should medical devices be regulated to automatically dial 911 in cases of emergency?
No doubt, AliveCor’s Heart Monitor is another case of affordable consumer technology outpacing our brick-and-mortar hospitals, but to the credit of our hospitals, affordable consumer technology is outpacing most of the world. Still, just as Domino’s has figured out to deliver me a pizza through an app (no doubt, saving a few cents in the process), so, too, will the medical community come around to juggling big data at the individual patient level. The real question is, will FDA regulations leave space for the little guys--the weekend app warriors and the Kickstarters--to innovate responsibly, at a price cheaper than clinical trials and a timeframe faster than paperwork?
[Hat tip: Co.Exist]