Free Course in Healthcare Data Analytics Offered by OHSU

This is a really interesting opportunity that I just registered for from the Informatics Professor - Dr. Bill Hersh:
http://informaticsprofessor.blogspot.ca/2016/09/free-course-in-healthcare-data.html

Medical smartphone apps need research and evaluation

So I finally did start reading a book by Eric Topol - The Patient Will See You Now: The Future of Medicine is in Your Hands - and this book is an eHealth classic! So much of the focus is on how the smartphone is becoming the major medical instrument of choice, it often makes me think that the smartphone for medical applications is already the TriCorder. Smartphones with visual heart rate monitors are replacing stethoscopes for first year medical students! Seeing the heart is better than hearing the heart?

From a health informatics perspective it really made me think that we need research and evaluation on all the apps that are being used for medical purposes. Just looking around the WWW a little and indeed there are organizations and research about this:

http://www.imedicalapps.com/about/#

https://iprescribeapps.com/

 http://www.jmir.org/2016/8/e222/

Eric Topols's NIH grant for Precision Medicine & Health Informatics Research

I have tried to read Eric Topol's classic books on digital medicine:  "The Patient Will See You Now: The Future of Medicine is in Your Hands" and the "Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare" but my local libraries don't seem to carry them. Not in the habit of buying every book I want to read on Amazon. I think Dr. Topol was a keynote at a nearby eHealth conference not long ago. Instead of attending, I subscribed to his Twitter feed which is well worth a look if you are not already inundated with more information feeds than a human could possibly digest in one lifetime.

The biggest news to come from Dr. Topol I may have first read in the San Diego Union Tribune, a news source I normally would never dream of reading, but for various disparate reasons (or algorithms) came to my attention from sundry WWW news sources. In fact I probably first read about it on the good doctors' Twitter posts.  Here is the link to the San Diego article, but it soon became apparent that the RSS was broadly distributed internationally. The Scripps Translational Research Institute, where Professor Topol works, just happens to be in San Diego:
http://www.sandiegouniontribune.com/news/2016/jul/06/NIH-scripps-topol/

The NIH doesn't often dole out $120 million grants for research. The last I heard of a grant with that largess was for research on the artificial brain, and I even blogged about that.  What I have not blogged about is precision medicine, which is defined well in this NIH Medline Plus article.  I am kind of wondering if precision medicine is just a plain English way of saying translational bioinformatics and health informatics all rolled into one.

This research project, that involves tapping into the blood samples, DNA, social media, health apps, sensor data, Big Data analytics and health records of a million volunteers, reminds me of  The Canadian Longitudinal Study on Aging. It certainly does bring to mind a classic in health informatics and epidemiologial research - The Framingham Heart Study of 1948 - which is still providing data for researchers. One can only imagine how the data generated from this research will be analyzed sixty years from now. Artificial Intelligence tools like IBM Watson and Alpha Go, which will probably be employed to help the data scientists, are just in the teething stage, compared to what their exponential computer grandchildren will be able to byte off.

Journal of Medical Internet Research - Good!

Recently out of the blue in spite of Canadian anti-spam laws I have been receiving email updates from the Journal of Medical Internet Research. This is no problem with me. I think the JMIR is the best eHealth journal out there. I think I may even have applied for a job doing web stuff for them once. I have 8 years experience as a technical editor for an open access academic journal plus a diploma in web design and development. Anyway, if there is one eHealth journal I would read all the time and / or want to be published in, it would be the JMIR.

Blip culture, eHealth, and Tibetan Medicine

Another "Pastism" and Alvin Toffler "Futurism" post. The theme seems to be again about the early days of the internet, with only a smattering of relevance to ehealth.

I don't know what it is like now in Nepal but in 1996 in Boudhanath, the enclave of Kathmandu where there is a large population of Tibetan refugees living, using the internet was limited to one of only a dozen or so internet cafes in the entire city of Kathmandu, let alone Boudanath.  The internet cafe was mostly a place to make a long distance telephone call or send a fax. Not many in my immediate family even used email then. Anyway, I wanted to find out how my father was doing following his prostate surgery.  To digress, what was I doing in Boudhanath in the first place?

First off, I had just finished a one year career college diploma in Visual Basic/C Language Programming but instead of looking for a job like I was supposed to, I gave in to the notion to go to Nepal. I was a little disappointed that I had not studied HTML, Java script, and & Web Design because at that time, there was something called the "Internet' developing and I was a sort of a pioneer in that area because I had run a Bulletin Board System (BBS) system and I lived in Silicon Valley North (Ottawa). I guess the allure of the Himalayas had just too powerful a hold over me. The career college I graduated from would later change it's name to Everest College.Why equate getting a job and climbing the highest mountain in the world, I will never know.

I had gone to Nepal with the idea of studying about traditional Tibetan medicine and how ignorant westerners like me could be schooled to learn about it. A few years before I had had an appointment and a health check up with Yeshe Donden in Dharmasala India, the Himalayan town which holds the residence of the Dalai Lama and a large Tibetan refugee population. Yeshe Donden was once the personal physician of the Dalai Lama. Of course, I heeded some of his advise to improve my health, and bought his book "Health Through Balance" when I returned to Canada. I also possessed at the time more than several "medicine buddha initiations from my Tibetan Lama and other Lamas as well.  It was a meditation practice that somehow always had deeply resonated within me and I valued the "mantra as medicine" ideal.

I support Tibetan refugees and human rights and at that time two Tibetans and their families who I had known and corresponded with for many years were both living in Boudhanath. It was a good opportunity for me to travel there then. One of the Tibetans was actually a trained physician from Tibet, but in modern Chinese medical science, not traditional Tibetan medicine. Apparently, he almost had no choice but to study medicine under the Communist education system. Now as a refugee in Nepal, he was more keenly interested in following his natural bent, which was studying Tibetan Buddhist meditation practices.  Through his connections I was able to meet a number of Tibetan physicians, one of whom was Amchi (Doctor in Tibetan)   to the King of the Royal Family of Nepal.  Alas, this was a few years before the bad seed in that royal family took an automatic weapon and annihilated a dozen of the lot, including himself. That left a distant uncle  or relative of the royals to try to take up the vacant throne.

Another Tibetan physician who wore the robes of a monk (some do not) was a keeper and supplier of bags of herbal medicines, all hand picked in the Himalayas.  The bags were larger than 25 kilogram rice bags stacked up from floor to ceiling. From my experience living in South Korea doctors there could speak reasonable English because they had studied western medicine textbooks in English. These Tibetan physicians I was with had no such English language skills, and this was another reason for my being there - teaching English.

Anyway, once it was learned that my father had just gone through surgery for prostate cancer I was informed that traditional Tibetan medicine for him would be very good. Next thing I knew I had a bag of pills to take back home with me. When I got back home and visited my father in the hospital he was still listening to the Qi Gong meditation tape I had given him. I don't think he ever took the Tibetan medicine, but the pills were all nicely wrapped in gold leaf and looked good.  I had  previously heard about PADMA 28, Tibetan medicine for the heart, but had no idea about all the "precious pills" the Men-Tsee-Khang had in their stores for other illnesses and conditions. 

So this is all just to say that medical systems like those in Tibet are ancient - comprising thousands of years of evolution and development - while eHealth systems in comparison are a "blip culture", a phrase coined by Alvin Toffler. If you click that link you will find an interesting chapter (by the same name)  in a book called Evidence-Based Health Communication".

One spin off of the ancient meditation cultures like Tibet for eHealth has been a proliferation of apps  for mindfulness meditation.  I think this an amazing development, in line with computer brain interfaces, EEG mindfulness feedback systems, virtual reality temple visits, and whatever else you can think of from the touch of a button. The cultural anthropologist in me still thinks an app is not real communication, but since I successfully completed an online 8 week course on mindfulness meditation, I am not one to talk. I thought the course was brilliant and I have done the real 10 day silent mindfulness meditation retreats.  I blogged about that < here >.

eHealth Ontario Innovation Lab at Mohawk College

Innovation Lab Pilot Now Live

We have recently launched an Innovation Lab – in partnership with Mohawk College – where over 100 early adopters from educational institutions, health care organizations, and private sector companies across the country are testing and refining solutions to help transform patient care in a virtual electronic health record (EHR) environment. Available in its initial form at innovation-lab.ca, this free online service gives access to a data set that simulates the provincial client registry – the repository which uniquely identifies patients based on demographic information and links them to medical records such as lab results or hospital discharge summaries. The lab also provides a moderated forum for discussions. Patient names and data used are fabricated to safeguard privacy and confidentiality. “This is the first time we’ve been able to offer IT solution developers and vendors open access to a virtual EHR testing environment,” says Peter Bascom, Chief Architect, eHealth Ontario.  “The lab encourages experimentation with eHealth Ontario products by demonstrating interoperability with provincial EHR assets. It will create the opportunity for more companies to enter the digital health market and it will help vendors who want to respond to procurement proposals to better understand the risks and costs associated with EHR asset integration.” Interested in becoming an early adopter? Go to innovation-lab.ca, provide some basic information through registration, and begin testing. The lab will be rolled out more broadly this fall with more EHR data and services as well as lessons learned from our early adopters.

Reading the Third Wave Riding the Flying Scotsman

I was reading about conferences on Futurism and the implications for healthcare and health technology, but this post is about Pastism, and how I discovered that the computer would be the future for me.

I was in London England in the spring of 1981 and the city was awash with people pouring in to watch the Royal Wedding of Prince Charles and Lady Diana.  There was almost no place to find a room to stand let alone a room to stay. I was caught up in the atmosphere of expectation and exuberant fanfare but at the same was starting to feel closed in by the crowds of people and a city I didn't know that well.

Something possessed me to get out there. The solution: a ticket north on the Flying Scotsman to the land where my family clan and others of their ilk had immigrated from a few generation ago. When I arrived in Edinburgh, on the station platform a train master said something to me in the thickest Scottish brogue I had ever heard - no idea what he said.  It was cold and late at night wandering the streets and I was lucky to find a bread and breakfast to stay at. Arriving up the stairs and sitting at the kitchen table near the hearth, the cordial host said: "Welcome to a Polish house."

I had heard about a 2 week rail pass to explore Scotland. Having survived a two month Eurorail pass tour 6 years previously, that would be a piece of cake. Getting to Scotland on the Scotsman was just the preview. The Flying Scotsman reeked of history but in 1981 I don't think it was a steam locomotive chugging me along to the North. In fact, at that time I was immersed in a book I had picked up at Heathrow Airport- The Third Wave by Alvin Toffler, and almost didn't notice the passing scenery.

Possessing as I did then an Honours degree in cultural anthropology plus some additional courses and fieldwork at the graduate level in the Educational Foundations of the Mayan Indians during a summer school program in Guatemala, I was interested in studying something about the future of cultural evolution. I had read Toffler's Future Shock, and because I had traveled to a Third World country I was familiar with a related concept called "culture shock", something I went through in Central America and then again when returning home. It is difficult to come out of a total cultural immersion.

What I found most interesting about "The Third Wave" was the idea that the developing worlds would by-pass the industrial revolution and go straight into the Information Age.  That was a prescient observation if we look, just as an example, at the fact many African nations today don't have an internet infrastructure but everyone has one or more cell phones.  Without going back to the book, one other thing that stands out for me was the chapter on the "Death of the Secretary". Even before the advent of digital information Toffler foresaw changes in the way office culture/proxemics would evolve because of computer technology. Information flows would break down hierarchical authority structures and there would be no need for a secretary when you had PBX exchanges, etc.  Prophetically as well at around that time I think Intel in the beginning of Silicon Valley had open office spaces and no walls between workers and higher management. (Please read the biography of Gordon Moore, called "Moore's Law"). The book was also a more contemporary read of culture and economics. I had spent four years reading all the old classics in cultural anthropology, from Darwin, Frazier, Morgan, Boas, Malinoski, Mead, Stewart, Levi-Strauss, White, Wolfe, Mead, Evans-Pritchard, Geertz - well, you can imagine people like that.

Somewhere around that time I heard or read that when Anthropology and computers meet the angels will weep. And who could ever forget the mind numbingly brilliant formula of cultural advancement C = E x T: Culture equals Energy times Technology. There will be a quiz at the end of this blog post on who the celebrated anthropologist was, now well lost to posterity and the annals of time, who came up with this formula. Anyway, for me, trying to find employment in cultural anthropology and seeing no prospects, it was a tough transition to move into the computer sphere.  Never did like the idea of studying punch cards in university, but now the momentous time had come.

Days of Futures Passed

The Third Wave influenced my decision to quit pursuing an interest in studying more cultural anthropology and I jumped on the computer band wagon in 1983 by taking a diploma at the community college in Integrated Office Systems. Before then I had also had a few part time jobs where I could use a CRT screen and a ruby wand to scan student  library bar codes into a hidden mainframe somewhere and I thought the technology was kind of cool. At the community college we had a study space with a network of computers and email was so new, it could only be sent from one computer to the computer beside it - a really local LAN. We were learning Visicalc, because Excel didn't exist yet. We learned how to program a graphic of a rocket taking off in BASIC. We studied 'office automation' and a book we read told us how the Japanese wanted to automate anything that could be automated. We had a tour of a financial office in downtown Toronto that was "paperless". They challenged us to find any paper anywhere in the office. They had mostly CRT screens networked to hidden mainframes. I did see some sticky notes.  From 1984 I still have a copy of MacWorld magazine with a picture of Steve Jobs on the cover and the first Apple Macintosh computer, but I never did buy an Apple computer until 2010.

Writing about the past is fun. Might try this again in a future post.