Epic vs. Meditech

John Halamka had an interesting post on how Meditech is changing it's EHR/EMR architecture to meet the current demands of the market for "cloud hosted, standards-based, web-centric and mobile enabled hospital information systems". The Epic systems already do that (as well as having a widely used MyChart personal health record system - which is not to be confused with MyChart developed by Sunnybrook Hospital in Toronto and now owned by Canadian mobile communications company Telus). I have been hearing a lot from people in the industry about Epic (no wonder that they probably don't advertise) and it all sounds good. (Their website design looks to my eye as being very "mobile oriented"). There is also another interesting post on the CIO Healthcare blog by a guest on personal health records for adolescents.

Consumer health information discoveries

I have been finding a lot of consumer health information websites, both local and international - a whole bunch of them - and I think it all started when I went to the announcement yesterday for the CISCO/McMaster University Professorship in Integrated Health Biosystems, as well as a Research Chair in Bioinformatics. This doesn't have a consumer health informatics label on it, but should have a Big Data one and be a separate post. Patients come into it when data from clinical trials will finally not go to waste but will be cross-linked with research databases to be put to use for medical research. If personal health records ever catch on, and patients consent to have data (whether de-identified or not - but probably de-identified) used for research, this would also be a mine of information as the original vision for PHR was to include genomic records, the intent being the development and perfection of personalized medicine.

This made me think of Dr. Danny Sands who teaches Medical Informatics at Harvard and is working for CISCO. He had a presentation at a conference (AHIC) where I was also delivering my first student paper presentation. Anyway, I read Danny's bio at CISCO which lead me to a blog he participates in called e-patients.net. It has interesting links to the Society for Participatory Medicine, and the Journal of same.

Impressed with that find, I came across by happenstance the meforyou.org website - a website that can cure you. For some reason this site reminded me about some research and journal articles I read, on how intercessory prayer doesn't work scientifically speaking.  It is a website inspired by Facebook new media but created by U of San Francisco:

UC San Francisco is the only university exclusively focused on human health. For 150 years, we've tackled the world's most vexing health issues, from diabetes and malaria to AIDS and cancer. We are driven by the idea that when the best minds come together, united by a common cause, great breakthroughs can be achieved. Because we believe it is perhaps the greatest single breakthrough that can be achieved, we have committed ourselves thoroughly to the realization of precision medicine. We began this movement knowing that we could not do it alone, and continue assured that we will do it together. Join us.

And then I found this surprising and local "searchless" health information website - hi - consumerhealthinfo.ca (a URL I wished I could have claimed). You can't not appreciate the layout, and user interface (think old people with no time to read extensively.) I think Dr. Mike Evans  ( Dr. Mike Evans curates the best health information found online. ) contributes to this site which lead me to his blog and website, which is simply brilliant, and this viral video!




And finally after this amazing journey just seemed to be beginning, Dr. Evans recommended the ultimate consumer health informatics website NHS.UK  I had recently read on a Yahoo website the UK's National Health Service was in the top ten biggest employers in the world! Well, a lot of them were busy preparing this website, and I relish reading their entire medical encyclopedia someday.

australia's personal health record system falls behind

I have blogged before about Australia's national architecture approach to personal health records for every citizen and it would appear the expensive mega-project is still slow to attract clients:
http://www.crn.com.au/News/340617,feds-fall-behind-on-e-health-sign-ups.aspx
My opinion from my research is that physicians should prescribe personal health records to patients where it is clinical sound to do so. Most healthy people don't need to use them. They should be integrated locally but with the potential to be mobile and transferrable anywhere. A tall order? Maybe, my own family doesn't have this yet.

Feds fall behind on e-health sign-ups

By Charis Palmer on Apr 22, 2013 12:28 PM
Filed under Services

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Data already delivering insights.

The Government will likely struggle to meet its target of 500,000 registrants for the personally controlled electronic health record (PCEHR) by June, after it was revealed only 109,000 Australians had registered in the last nine months.
The system, launched last July, has been plagued with issues, including with its online registration system and availability for general practitioners.
Speaking today at a conference on big data in health, Department of Health & Ageing chief information and knowledge officer Paul Madden encouraged attendees to sign up to the program.
He said the $628 million e-health records project had the ability to change the game for health, with significant flow-through data from the records already being gathered.
So far, Madden said, the e-health records of the 109,000 people already registered had delivered 5.4 million Medicare records, 2.9 million pharmaceutical benefits claims, 16,600 immunisation registrations for children over the age of seven, and 23,000 organ donor records.
Only two hospitals are currently uploading discharge summaries to the system. All public hospitals were expected to be doing so by July, Madden said.
Based on the information gleaned from the electronics records, the average Australia visited the GP four times a year, ordered 12 pharmacy prescriptions, visited a specialist three teams, went twice to allied health care workers and once to the dentist.
He said 2000 health care practitioners now had access to the system, and 90 percent of GPs had access to the software deployed by the National E-Health Transmission Authority.
He called the PCEHR a "leap forward in health”.
“The way that we use, maintain and manage health care delivery throughout Australia will start to change as a result of the information we are able to put together which we’ve never had access to before in the way we do now."

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Models for Information System Success for eHealth?

I am doing some research on electronic systems used by Research Ethics Boards in Canada. One of the models we are using to determine if systems are liked by ethics boards and their respective research communities is the DeLone and McLean model. This model has been used a lot in information systems success studies and there is a lot of literature on it.

What there is not a lot of (to my knowledge), is how the model can be applied to eHealth applications. A little bit of searching on the internet and I discovered it has been used by the eHealth people at the University of Victoria in British Columbia, and I think it is very interesting what they have done. Roughly expressed by them is a Benefits Evaluation model. The team at UVic has applied this to evaluating Canada Health Infoway projects, called the Infoway BE Framework. Coincidentally I recently read a CBC article that Infoway had saved a billionaire dollars by implementing Electronic Medical Record systems for physicians in Canada. After reading some of the comments by the public on the CBC website for this story, I reminded again of the old adage that the Return on Investment in healthcare is improve in quality of life.

 

E-health records saved medical system $1.3B in 6 years

Use of electronic records more than doubled from 2006-2012, from 23% to 56%

CBC News

Posted: Apr 22, 2013 11:04 AM ET

Last Updated: Apr 22, 2013 4:22 PM ET

Health Minister Leona Aglukkaq (right), seen with Richard Alvarez, CEO of Canada Health Infoway in 2009, announced $500 million in funding four years ago to improve the implementation of electronic medical record systems, but the funding was held back for a year until the government received more information about how it would be spent. (Handout/Health Canada/Canadian Press)

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Read the Canada Health Infoway report

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Online health records popular with patients

A study done for Canada Health Infoway, the federally funded organization set up to monitor and improve the use of information technology across Canada's health care system, has found that increased use of electronic medical health records has saved $1.3 billion over the last six years.
The study by PricewaterhouseCoopers LLP (PwC) examined the switch to electronic medical records (EMR) by family doctors from across Canada between 2006 and 2012 and found:

• $800 million in administrative efficiencies (less time by staff pulling and filing charts or processing finding lab test results, less time by doctors reading and maintaining paper files).
• $584 million in health system benefits (reduced duplicate diagnostic testing, reduced adverse drug events).
• Improved chronic disease management and illness prevention (higher mammogram screening rates, higher pneumonia and flu vaccination rates).
• Improved communication amongst care providers and with patients (less time spent repeating patient histories among care providers, electronic alerts prompting follow-up care for things like medication recalls.)

The study's methodology included a review of current research, national survey and cost data and interviews.
"In some cases, it's the sum of a lot of little things, " said Jennifer Zelmer, senior vice-president with Canada Health Infoway.
"When you're using electronic medical records, staff in a medical practice tend to spend less time … pulling charts, and they're able to use that time for clinical services," she added. "
And when you add that up those kinds of efficiencies, both in terms of chart pulls and in terms of tracking down test results, actually the value of that is quite significant."
The study's findings don't surprise Stephen McLaren, a family physician in Markham, Ontario. He says many patients already understand the efficiency of an electronic record, especially if their paper record or test results were ever misplaced.
"Their visit with their provider is a very inefficient, unproductive visit and very often means you have to come back," Dr. McLaren said.
McLaren says there's also better treatment of chronic illness because electronic medical records allow a doctor to easily spot trends in a patient's tests, over time.
"In the paper world, you have to flip through pages and pages and pages, hoping to catch onto a trend if there was one there to see."

Use of electronic records still growing

Despite the growing use of electronic medical records, only 56 per cent of patients have one. McLaren says their use continues to grow, as more and more patients ask for them.
Meanwhile, he says the next big step in this area is to link up health care institutions — hospitals, labs, nursing homes, and doctors offices — so that a patient's information can be shared more easily, while still protecting the privacy of the data.
In a press release, Health Minister Leona Aglukkaq encouraged provinces, territories and other stakeholders to keep working to increase the adoption of electronic medical records and other e-health technologies "so that Canadians can benefit from a better integrated health care delivery system," added Minister Aglukkaq.
"We expect significant additional gains as adoption grows, use matures, and connections to other care settings expand," said Richard Alvarez, Canada Health Infoway's president and CEO, in the same release.
Canada Health Infoway had set a target for half of Canadians to have electronic health records by the end of 2010. The federal government delayed $500 million in funding for the agency by one year, seeking more information about how the contribution would be spent.
A 2009 report from the federal auditor general found contracting and reporting problems in early efforts to move more Canadian health records online.

Brain research projects - no more digital computers or programming!?

There are several huge "artificial brain" research projects going on now. There is one in Israel, United States (biggest NIH research grant in history), and the one in Europe is called the Blue Brain Project. One of the leading directors of the BBP is Henry Markham. I was listening to an interview with him in which he stated that within 10 years, once the virtual brain is created, it will mean computers will no longer need to be programmed - it would mean the end of the line for digital computers! These computers would not need to be programmed because they will have ability to learn by themselves. This really astonishes me. He further stated that the desktop computers in the future will be both digital and artificial brain.

The eHealth implications for the BBP are astronomical. At first the goal of such a virtual brain would be simulations to test drug reactions for Parkinsons or Alzheimers. Of course, those are more translational bioinformatic type of applications, but it would mean that every ordinary computer device would have access to a Dr. Watson type of medical intelligence.

In the spirit of this movement towards neuroscience integration of knowledge and huge research, I am reading Ray Kuzweil's new book "How to Create a Mind: The Secret of Human Thought Revealed". Parts of the book are beyond my ken, especially the chapters describing how the brain grid is constructed and how it works, but I like reading Kurzweil because his theories of the evolution of computers is compelling. Not everyone appreciates the Kuzweil vision, and I found very humorous a review of Kuzweil by Don Tapscott in the Globe and Mail where he quotes a detractor of his writings:

He also has many detractors. Douglas Hofstadter, the Pulitzer Prize-winning author of Gödel, Escher, Bach, once said that Kurzweil's books are “a very bizarre mixture of ideas that are solid and good with ideas that are crazy. It's as if you took a lot of very good food and some dog excrement and blended it all up so that you can't possibly figure out what's good or bad.”

I have to return "How to Create a Mind" to the library now, but I almost finished. Can't say I completely understand the "hidden Markov models". I also don't fully agree with Hofstader. Kurzweil even has quotes from Albus Dumdeldore and one of the Weasley clan, and I don't think that detracts from the scholarly work. Many times throughout reading the book I get the feeling that the book was written for both a human and a computer audience. Future "Hals" from 2001 a Space Odyssey are a target audience, and I think this book is a great contribution for computer understanding of human intelligence and how the brain works. br />

Health Coach - York University Program

I was at an National Institute for Health Informatics (NIHI) conference at York University when I heard about York's Health Coach program. From my relatively short time studying and being involved with Health Informatics, I really think this program will have relevance in the future. Here is part of the description I thought most interesting:

"York's commitment to health coaching is related to the increasing capacity of 21st century technologies to eliminate the need for office consultation. Many tests that are presently implemented or planned during medical office consultations will be planned by phone and undertaken at home as primary care and specialist physicians increasingly use remote monitoring to precisely assess patient status. As this trend develops, patients and caregivers will become increasingly motivated to improve behavioural effects on health. The health coach will be the first line of contact in stimulating and supporting health-behaviour change, acting in alignment with treating physicians. This improves the scope of services being delivered and lowers delivery costs by leveraging cost effective people."

It does sound to me in-line with Dr. Eric Topols' "creative deconstruction of medicine", but I haven't read the book yet, and have no idea if he mentions this type of role. Dr. Topol will be a keynote speaker at the eHealth conference in Ottawa this spring. Certainly, from the research I have seen on personal health records, there is room and a need for Health Coaches.

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.

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