Category: e-health

Is Medsphere betraying the open source community?

published date
November 12th, 2006 by

Is Medsphere betraying the open source community?

Fred Trotter of GPL Medicine is unhappy about the behavior of Medsphere.

Medsphere is arguably the most famous VistA vendor. However, some in the VistA community have wondered why Medsphere, which touts itself as an open source company, has not released their improved code back to the community. I and other VistA community members have been concerned that Medsphere might have made a proprietary product around VistA. I have been publically commenting about this for quite some time.

Apparently, there’s a nasty legal dispute under way between Medsphere and its founders. Trotter explains why he’s on the founders’ side. Go have a look at what he has to say.

Stupid pet tricks, aka Google diagnosing

published date
November 10th, 2006 by

Stupid pet tricks, aka Google diagnosing

From the BBC

A team of Australian doctors googled the symptoms of 26 cases for a study in the New England Journal of Medicine.

In 15 cases, the web search came up with the right diagnosis, the paper published on the British Medical Journal website reports.

In each of the 26 cases studied, researchers based at the Princess Alexandra Hospital in Brisbane selected three to five search terms from each case and did a Google search without knowing the correct diagnoses.

They then recorded the three diagnoses that were ranked most prominently and selected the one which seemed most relevant to the signs.

The doctors then compared the results with the correct diagnoses as published in the journal.

Google searches found the correct diagnosis in just over half of the cases.

The crucial paragraph from the BMJ paper seems to be:

We then did a Google search for each case while blind to the correct diagnosis (that is, before reading the differential diagnosis and conclusion of each case record). We selected and recorded the three most prominent diagnoses that seemed to fit the symptoms and signs.
They looked through 30-50 results to find three that seemed reasonable. If a real decision support tool like SimulConsult doesn’t rank the correct diagnosis within the top 10 it’s considered as evidence of failure, not success. When there is such a failure typically there is some important fact missing from the database, a situation that is then corrected. It is not clear if Google has a similar ability to learn from the wisdom of the community of users.
Searches are less likely to be successful in complex diseases with non-specific symptoms … or common diseases with rare presentations …
These are the situations where decision support software is most useful.

Google is incredibly powerful. If you are too lazy to think you can type any thoughtless thing in and get something at least somewhat relevant out. That doesn’t mean Google should be used for clinical decision support.

ICE is cool but primitive

published date
October 19th, 2006 by

ICE is cool but primitive

When rescuers or emergency room personnel want to contact next of kin, they have a tool that wasn’t there in the past: cell phones. Many patients have cell phones, and those phones often contain directories of phone numbers. However it’s often hard to figure out who to call. Spouses are often listed by name instead of relationship, “Mom” might have Alzheimer’s of be a code name for someone’s drug dealer, and so on.

ICE stands for “In Case of Emergency.” The idea, which seems to have gained popularity from last year’s London bombings, is to put ICE in front of emergency contact names. For example, “Mom” becomes “ICE Mom,” making it easy to figure out whom to call. It sounds like a good idea, and a simple one.

It would also be nice to have one’s full or partial medical record on the phone. Maybe it would be a good idea to include a listing that says ICE Medical Records and then have an entry with important info (like allergies or chronic conditions if the phone allows text fields) or an 800 number that has access to the patient’s personal health record. It could also be a number that returns the patient’s PHR info in response to a text message. Handset makers could even include an ICE button.

There is a bit of a problem for people like me who use voice dialing. If I add ICE in front of frequently called names I’ll have to say “ICE Mom” or “ICE John” instead of just Mom or John. However a way around that could be to make duplicate entries, one with ICE in front and other not. They can have the same phone numbers associated with them.

I think I’ll give it a try. Now, we just need to make sure people know to check for it.

Get a taste of personalized medicine

published date
October 18th, 2006 by

Get a taste of personalized medicine

The Brain Resource Company of Sydney, Australia has developed a standardized, international database of the human brain. Their objective is to make personalized medicine a reality for neurological and psychiatric conditions. The company has a touchscreen-based cognitive testing tool, which is very effective. To extend their reach they have recently developed a web-based version.

I received this notice from the company’s COO today. Feel free to give the web-based system a try. (And enjoy your Aussie dollars.)

I thought some of you may be interested participating in a study we are conducting. This will help us and also allow you to see how WebNeuro, our new web based cognitive test product, operates. This study simply involves completing WebNeuro, which consists of a short questionnaire (personal and demographic history questions), followed by a series of simple tasks which are designed to assess your cognition (“thinking functions”). It should take you around 30 minutes to complete and we will reimburse you for your time (once the test has been completed successfully we will send you a cheque for A$30).

The data obtained in this study will be used as ‘normative’ comparison (or
reference) data (to compare, for example, to data obtained from people with neurological or psychiatric illnesses). If you are interested in participating, please email your email address and contact telephone number so we can give you further information.

All ages are welcome – we are particularly interested in the under 20’s and over 65’s.
Some other details:

1) To do this test, you will need access to a Windows based PC, with internet access.

2) Participation is subject to a number of screening questions (all answers provided will be treated as strictly confidential, as will your test results).

3) It is a study requirement that you have not have not previously taken this particular test.

Information is the answer

published date
October 16th, 2006 by

Information is the answer

ABC News is running Prescription for Change, a week-long series focusing on what ails the US health care system and what to do about it. As part of the event they asked me to write an opinion piece, which is published on the ABC News website under the headline More, Better Information Key in Fixing Healthcare. Matthew Holt of the Health Care Blog also contributed an article, entitled Why is Fixing American Healthcare So Difficult?

Here’s my original piece:

The US health care system is a mess by any measure. Costs are far higher than anywhere else in the world but life expectancy and infant mortality are worse than average. To add insult to injury, customer service is often abysmal.

It doesn’’t have to be this way. Other sectors of the US service economy –such as retail, financial services, and lodging– are the envy of the world. Companies like Vanguard, Target and Hampton Inns offer higher quality, better customer service and lower prices than you’ll find in other countries. The US health care system could be like that, too, but the archaic culture of medical providers, distortion of the market by the third-party payment system, and resistance to trading off costs and benefits complicate reform.

The best hope for reforming US health care lies in utilizing information. We need to generate more and better information, make better use of the information we have, and be willing to use information to make tough choices.

The good news is that it is starting to happen.

Generating more and better information

The kind of information we take for granted in other sectors is unavailable in health care:

  • How good is your doctor, really?
  • Which specialist is best for your condition?
  • Is that academic medical center with the great reputation better than the community hospital down the street?
  • How likely are you to die from a medical error?
  • How much does an operation cost at one hospital compared to another?
  • Does that drug you were prescribed work? What were the other options for treatment?
  • How much does the drug really cost (not just the co-pay)?
  • Is the drug any better than a generic?
  • How does your genetic makeup affect the treatment you should get?

These questions are beginning to be answerable. Consortia like Massachusetts Health Quality Partners and Integrated Healthcare Association along with private companies such as HealthGrades provide objective information on quality and patient experience. (They still can’t quite say ““customer satisfaction.”) Medicare’’s Hospital Compare website has information about key quality indicators. Various ““transparency”” initiatives are underway to provide information on costs. Consumer Reports rates drugs and Wal-Mart is showing just how inexpensive generics can be. Genetic profiling is farther off, but groups like the Brain Resource Company are starting to make personalized medicine a reality.

Making better use of information

It’s not enough to make information available. We have to become better users of information and better communicators. We should also analyze and act on data that are currently ignored. Empowered consumers are taking the lead: doing research on the internet, establishing personal health records, demanding a greater role in their care, even negotiating prices. Now we need medical professionals to step up.

Many physicians are lousy communicators. Doctors are hardworking and dedicated, but generally donՉ۪t use email, donՉ۪t keep records electronically, rely on treatments theyՉ۪re comfortable with rather than using evidence-based medicine, and are insufficiently skeptical of information from biased sources (like drug reps). Physicians rarely explain alternative treatments; many do a poor job communicating diagnoses, laboratory findings and information about drugs. Primary care physicians and specialists often drop the ball in communicating with each other about patients they are treating, leaving the patient or caregiver to try to close the loop on their own. And most physicians have no idea what anything costs.

Pharmacists are rarely better. They spend six years in school learning more about drugs than most doctors will ever know, then disappear to the back of the pharmacy to count pills. Pharmacies are convenient and accessible; their pharmacists are a vast untapped information source.

The introduction of electronic health records and electronic prescribing are helping, but are only part of the solution. We need health information exchanges, like the ones piloted by the Massachusetts eHealth Collaborative, to share patient data. We need secure, efficient platforms such as RelayHealth for doctor/patient messaging. We need decision support tools like SimulConsult to organize clinical findings to help diagnose rare diseases, sparing patients the misery of going from doctor to doctor in search of a name and treatment for their condition. We need more patient communities such as Patients Like Me and treatment planning tools such as NexCura.

We should make better use of information from existing diagnostic tools. Advanced analysis software from companies such as AMID mines digital data from inexpensive ultrasounds, reducing the need for expensive MRIs and PET scans. iCardiac Technologies analyzes ECGs already collected for clinical trials, identifying cardiac safety problems early in drug development, before the next Vioxx comes to market.

Using information to make tough choices

Better availability of information will improve quality and customer service, but while information technology cheerleaders promise that big cost savings will inevitably follow adoption, thatՉ۪s by no means certain. Some efficiencies will be gained by eliminating transcription costs and reducing duplication of tests, but better information may actually lead to higher spending. After all, with more information about their conditions, patients may seek additional treatment.

Information can be used to hold down health care costs, but that requires political will. In the UK, the ironically named NICE (National Institute for Health and Clinical Excellence) evaluates treatments based on data and decides if benefits outweigh costs. When the answer is no, as it often is, the National Health Service won’t cover the treatment. In Germany, whole classes of drugs are evaluated to determine whether on-patent products are more effective than generics. If not, branded products are reimbursed at the same (low) level as generics.

If we choose as a society to use information for hard decisions, costs will be contained. But the model will be different from the UK and Germany. WeՉ۪ll use incentives and cost sharing, not outright bans and price controls. Examples are emerging in the public and private sectors.

Within a decade there will be plenty of good information available and we’’ll have learned to use it well. Then we’ll finally be headed toward a health care system worthy of respect.