Category: e-health

Someone else who doesn’t drink Kool Aid

published date
November 15th, 2006 by

Someone else who doesn’t drink Kool Aid

I’m sick of reading all the glowing articles (for example here, and here) about using Google for diagnosis. Fact is, it’s not a great idea, as I’ve written (Stupid pet tricks, aka Google diagnosing). So I was glad to see a letter to Modern Healthcare by Joseph Britto, MD, CEO of Isabel Healthcare (a decision support company) entitled “Google inadequate for diagnoses.

While the idea of using Google as an ersatz clinical decision support system is clever, a 58% accuracy rate is unacceptable — in either a human clinician or a software program. Google, of course, was not designed for this purpose…

Older-generation diagnosis decision software systems have much higher accuracy rates. In addition, the latest generation of diagnosis reminder systems…consistently suggest the proper diagnosis 90% of the time. These new programs use advanced natural-language processing algorithms — a newer, more powerful search technique — to scan a specific database of medical journals and texts. This produces more accurate, higher-quality search results.

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.