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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...

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!









Wednesday, December 25, 2013

eHealth tricorder fraudster - impersonating Canadian Deputy Minister of Health

There is a really bizarre story reported by CBC and sundry other new services that has a decidedly eHealth angle. A person named Howard Levanthal in the US impersonated a Canadian Deputy Health Minister to fraudulently win loans from an investment bank. The guy doesn't look remotely like Glenda Yeates, but her signature appears on his million dollar contract with Health Canada. Revolving around these expenses was a supposed medical device his company Neovision had developed called the Heltheo's McCoy Home Health Tablet, named after Dr. McCoy of Star Trek and Tricorder medical device fame.

Tricorder-like devices are actually being developed by the Qualcomm Tricorder XPrize. There are are now 3 Canadian teams in the competition.  I blogged about the XPrize Tricorder competition before and continue to be interested in it. This story was picked up by a delightful science fiction/science fact blog called Giant Freaking Robot. The Robot had the wherewithal to know that there are quickly evolving attempts to develop tricorder like medical diagnostic and assistive devices, and even posted to his story a youtube video to one of the contestants for the Xprize - Scanadu.

It makes me wonder if eHealth is being over-hyped these days ("Healthcare Hullabaloo", as Giant Freaking Robot says) and people are readily responding to new developments. Not that this blog is helping to over-hype eHealth or anything... Anyway, I really like the quote in the CBC news story that: "His actions were the stuff of fantasy and science fiction, valid only in another dimension"

Howard Leventhal pleads guilty to posing as Canadian deputy health minister

Pleads guilty to aggravated identity theft for impersonating Glenda Yeates


The FBI says an Illinois man accused of impersonating a Canadian deputy health minister as part of a fraud scheme has pleaded guilty to wire fraud and identity theft charges.
Howard Leventhal, 56, of Long Grove, Ill., was accused of trying to defraud a number of individuals and entities of millions of dollars by falsely claiming his company, Neovision, had a lucrative contract with the Canadian Health Department.
'His actions were the stuff of fantasy and science fiction, valid only in another dimension.'
- United States Attorney Loretta Lynch
Leventhal pleaded guilty to aggravated identity theft, which carries a mandatory two-year term of imprisonment, for stealing the identity of Glenda Yeates.
When sentenced on April 3, 2014, Leventhal faces up to 22 years in prison, $1,050,819.78 in forfeiture and restitution, and a fine of more than $2 million.

Tablet named after Star Trek's Dr.Leonard McCoy

Court in Brooklyn, N.Y. heard Leventhal told potential investors Neovision had written agreements with Health Canada, whereby Neovision would provide Health Canada with Heltheo's McCoy Home Health Tablet.
yeates_glenda050608
Leventhal pleaded guilty to aggravated identity theft, which carries a mandatory two-year term of imprisonment, for stealing the identity of Glenda Yeates, pictured above.
The device — named after the fictional Dr. Leonard McCoy of TV's Star Trek series — purportedly delivers instantaneous and detailed patient data to physicians and other licensed health-care providers.
Prosecutors alleged earlier this year that Leventhal scammed Paragon Financial Group for $800,000 by claiming it could collect money he said Health Canada owed to his company.
Leventhal also used the purported agreement with Health Canada to solicit more than $25 million from other potential investors, including an undercover law enforcement agent. RCMP allege Leventhal tried to get a $2.5-million line of credit from TD Bank in Toronto in July.
"In Leventhal's world, the truth was cloaked by his web of lies and impersonation. Within this alternate reality, Leventhal marketed non-existent technology, fabricated an online presence, and impersonated a government official, all to defraud investors out of very real money," said United States Attorney Loretta Lynch in a statement.
"His actions were the stuff of fantasy and science fiction, valid only in another dimension."







Thursday, December 5, 2013

Terrapower - very clean nuclear energy?

Bill Gates chairs the board of directors for this new company:
http://www.terrapower.com/

It can burn all the depleted uranium at one waste site in Kentucky to power all the homes in the US for 700 years:
http://terrapower.com/pages/environment

I think they combine supercomputers with the wave vector energy grid to maximize energy production. No special relevance for eHealth, save for the "e". And that is why it is "awesome".

This type of energy source seems more appealing than a 250 mile wide solar panel belt around the moon one Japanese company has proposed. And here I was about to give up all hope on the future of humanity.



Data in Electronic Health Records for Medical Research

The Institute for Ethics and Emerging Technology had an excellent article by Donna Hanrahan entitled "Data Mining, Meaningful Use, Secondary Use, & Potential Misuse of Electronic Health Records". It has an excellent synopsis of what many clinical researchers, ethicists, and privacy experts have been saying for many years, about how data in the EHR can be used for medical research purposes.

There are ways to do that, like consent management, audit record logs, and increasingly better means to de-identify data and prevent it from being re-identifed. This latter work is really being pioneered by Dr. Khalid El-Emam. That is, before one would be able donate the data in the EHR to science, post-mortem.

I will copy in here just the section on how data in EHR can be used for medical research:

Beneficence of Electronic Data in Medical Research
Despite the ethical concerns addressed above, the use of electronic health data is critical to ensuring patient health, improving our healthcare system, and making new scientific discoveries in this technological age. Critics may question whether EHRs are truly meaningful or whether it is an “excessive bureaucratic requirement to spend public dollars on doctors’ computer systems.”xxxii This answer to this question can be discussed through the principle of justice. It is ethical, one could argue, to expend public funds for EHR systems that provides for the greater good and benefits for the public as a whole. Having data that is structured and easily retrievable benefits clinicians, patients, and the greater population. These benefits include safer prescribing, prevention of medication errors, epidemiological tracking to protect population health, and public medical error reporting. Furthermore, there is a clear need to switch from outdated, burdensome, and inefficient clinical charting traditions to electronic format.
EHR adoption aims to reduce cost, which is a primary goal of health reform in the United States. The increase in information available to clinicians can help prevent redundant or unnecessary tests and imaging. Furthermore, EHRs can provide point-of-care clinical decision support (CDS) as doctors prescribe tests, medications, and imaging requests, which can also help reduce costs. Lastly, “shared savings,” or “gain-sharing,” allows hospitals and healthcare providers to collaborate to reach quality metrics.xxxiiiAccordingly, EHRs enable users to measure desired outcomes and report this data more quickly and easily, saving both time and money. With regard to the costs associated with EHRs, studies have documented the strong return on financial investment that may be achieved following EHR implementation.xxxiv Other financial benefits include increased revenues due to improved care coordination, averted costs of paperwork, chart pulls, and billing errors, and fee-for-service savings including the rate of new procedures and charge capture. Furthermore, the secondary use of health record information is anticipated to become one of the healthcare industry’s greatest assets and the key to greater quality and cost savings over the next five years.xxxv In fact, a recent report by the McKinsey Global Institute, estimates the potential annual value to the healthcare industry at over 300 billion dollars.xxxvi These savings in cost benefit both the patient and provider.
There are also several patient-centered benefits that result from the “meaningful use” EHR data. Perhaps one of the most promising results of EHR data mining is the use of predictive modeling techniques to identify medical conditions and promote interventions before the onset of symptoms. Furthermore, retrospective analysis of the health data mined from EHRs could expedite scientific discovery in medicine by providing valuable information for research. In addition, physicians’ access to data and analysis could demonstrate the efficacy of different treatment options across large populations, which could help treat and prevent chronic conditions. Lastly, such data can be used to identify evidence-based best practices, identify potential patients for clinical trials, and monitor patient compliance and drug safety. These measures show beneficence towards the patient by providing better more individualized care.



Sunday, December 1, 2013

IBM's Watson now an API for cloud development - is there a Doctor in the House?

I am still trying to pin down a focus on eHealth application for this, but IBM has opened an API (application program interface) for the Watson cognitive computing intelligence. This sounds like developers can open up smartphone applications to query the cognitive fireworks of the Watson computer that defeated the best humans in the world of TV game Jeopardy

For eHealth, the API needs to tap into the right data content. IBM already has several services for this:

MD Buyline: This provider of supply chain solutions for hospitals and healthcare systems is developing an app to allow clinical and financial users to make real-time, informed decisions about medical device purchases, to improve quality, value, outcomes and patient satisfaction.Hippocrates powered by IBM Watson will provide users with access to a helpful research assistant that provides fast, evidence based recommendations from a wealth of data, to help ensure medical organizations are making the best decisions for their physicians' and patients' needs. 
Guess there's not much else you could ask for? But yes there is - Welltok:
Welltok: A pioneer in the emerging field of Social Health Management™, Welltok is developing an app that will create Intelligent Health Itineraries™ for consumers. These personalized itineraries, sponsored by health plans, health systems and health retailers, will include tailored activities, relevant content and condition management programs, and will reward users for engaging in healthy behaviors. Consumers who use Welltok's app -- CafĂ©Well Concierge powered by IBM Watson – will participate in conversations about their health with Watson. By leveraging Watson's ability to learn from every interaction, the app will offer insights tailored to each individual’s health needs.  

And there is more. Watson Path is diagnostic education program, and perhaps even a clinical decision support aid for diagnosis? All this from a game of Jeopardy?



Is US Homeland Security Accessing Canadian Personal Health Information?

There is a disturbing story about how more than several Canadians have been denied entry to the United States by Homeland Security because of the information they held on their medical condition. You can read an instance of the story < here >. Ontario Privacy Commission Dr. Ann Cavoukian says it is a "matter of grave concern". I find it quite shocking too. Actual facts may point to Homeland Security receiving the medical condition information through 911 call records, and not somehow directly accessing medical records (as the story might suppose), but still...

A digital umbilical cord for life extension

A project at Lifenaut aims to create a digital image vault of your life history where avatars of the future will live forever. At least, that is my interpretation. It reminded me of a project Ray Kuzweil has to bring his father back to life. He has a store room full of bankers boxes of information about him. Probably that is all digitized now. This is not an actual eHealth application like the Virtual Self, which can be used for diagnostic simulations.

Create a Mind File

How it Works

Upload biographical pictures, videos, and documents to a digital archive that will be preserved for generations.
Organize through geo mapping, timelines, and tagging, a rich portrait of information about you. The places you’ve been and the people you’ve met can be stored.
Create a computer-based avatar to interact and respond with your attitudes, values, mannerisms and beliefs.
Connect with other people who are interested in exploring the future of technology and how it can enhance the quality of our lives.