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Patient blogs & the Electronic Health Record April 29, 2005

Posted by Hans in : analysis, news, opinion , 2comments

In a previous post, I wondered about the utility of turning electronic health records into blogs, owned and maintained by the patient with health care providers providing additional contributions. It wasn’t a completely thought out idea, but I was just brainstorming a bit.

iHealthbeat.org reported on how High Point Regional Health System in North Carolina is using patient blogs on its corporate website. In this particular case, the patient blogs seem to be used as more of a public relations tool (i.e., marketing and branding). Hey, there’s nothing wrong with that, as long as the patients don’t mind sharing their experiences. In fact, having the experiences available on-line might be a good means of sharing information with other “potential” patients. Another use might be as an informal quality improvement tool. I would hope that the postings aren’t altered or moderated because then I would question the true value of this type of tool.

But, my original idea wasn’t about marketing. I was getting more at the idea of using a blog-approach to documenting the patient encounter. From what I know of medicine, patients spend very little face-to-face time with the provider (usually measured in seconds or minutes). Often, it’s very difficult to remember all of the symptoms and circumstances that a health care provider needs to accurately diagnose and treat a patient. What if we allow patients to contribute to their own medical record using a blog format? Patients could write how they are feeling more frequently and report whether they are improving, complying with the treatment, and what have you. Actually, questions from assessment tools could be embedded on the side somewhere for more continuous monitoring.

Anyway, enough for now. I just thought that it was interesting to read about patient blogs on hospital websites so close to my post.

Popularity: 9% [?]

Telemedicine in the news April 29, 2005

Posted by Hans in : analysis, news , add a comment

Here’s an article reporting on how technologies can be used to connect patients and physicians over great distances (i.e., telemedicine). The article is in Today’s Globe and Mail, titled “Hi-tech checkups byte into travel“.

What I find interesting is how the technology is portrayed in an entirely positive light. It’s as if the technology can do no wrong. On the surface, I would have to agree that connecting patients with care providers is wonderful thing, especially if it’s done in a way that is more effective and convenient to patient and provider. In the examples provided, I don’t think anyone can really point out anything negative.

But, I must ask - is this a good thing? Marshal McLuhan and his “disciples” like Neil Postman warn us that technologies have many unintended consequences, empowering some things while disenfranchising others. Is it possible to have an application that is “win-win” for everyone? Is it really possible to have the sense of getting a hug from the computer screen (see my previous post on the “Story of eHealth“)? I wonder…

Now, don’t get me wrong. I think exploring new possibilities is a great thing. It’s just that in the eHealth domain, too often the focus and emphasis is on the technology rather than the soft/human issues.

Popularity: 8% [?]

Reference manager, electronic databases, and other thoughts from a systematic review April 28, 2005

Posted by Hans in : academics , 1 comment so far

Here are some thoughts as I work on my systematic review.

Electronic Databases

I’ve been searching Medline and EMBASE and I have as good a search strategy that I’ll get. Since I’m mostly looking for theory-type papers, I think I’m going to get a considerable amount of “noise” - okay, I can deal with that. What I find frustrating is the process of getting the citations out of the databases and into a reference manager (I’m currently using Thomson ResearchSoft’s Reference Manager 10). In my current search, I have close to 5000 hits to sift through (my colleague has a list of over 9000!). What I find frustrating is that I can only save/export 200 citations at a time. What is up with that? For your information, I’m using the Ovid versions of the databases. So, I have to download 200 citations at a time and then load them into Reference Manager. What a tedious process. Oh yeah, and when downloading, there must be at least a hundred different formats - what’s up with that?

On another note, I wonder if GoogleScholar will ever provide the functionality of being able to download the search results into a file or reference manager? Hmm…now wouldn’t that be interesting?

Reference Formatting

Since I’m in a pseudo-rant mode, what is up with the hundreds/thousands of different reference formatting styles? Okay, I can understand that there are some significant differences between body notes (e.g., APA formatting), footnotes, and end-notes (e.g., Biomedical journals), but is there really a need to have more than that? Considering that the differences amount to cosmetic differences? I’m a bit bitter because I spent a weekend fighting with Reference Manager to get my references into a journal’s format when submitting a manuscript - it wasn’t fun. In all fairness, I understand that the biomedical journals are trying to come to some consensus with the Vancouver/Universal Biomedical Journal style. I suppose change has to occur somewhere.

Personally, I like the APA reference format because when I read a body note, I’m more aware of the source than when seeing superscript numbers. The body notes seem to provide more information - I also like the reference list because it’s in an alphabetical format. But, body notes are a real pain when there are several references, or a list of items referenced extensively. The read-ability of the text becomes almost impossible because it’s interrupted with body notes. In this circumstance, I’d have to say that end-notes are probably superior because it’s less obtrusive. But, by using numbers, you lose something. I know that for me, I’m less likely to look-up the reference when end-notes are used because it’s more work to stop reading and find the reference - maybe that’s a bad habit of mine.

Well, back to work on my systematic review. I’ve got to load up some more citations into Reference Manager.

Popularity: 13% [?]

IBM to build computer models of health system April 27, 2005

Posted by Hans in : news, opinion , add a comment

Now here’s an interesting report that I came across today. It’s titled “IBM developing test system to share health data” available from the Computerworld.com site.

The article reports how IBM has decided to develop a “test” system that will allow for simulations of health encounters to see what types of information are to be shared between different agents in the system. This system is to use “open standards” and is to be called the “Interoperable Health Information Infrastructure”.

Okay, so far so good. I think this endeavour is actually very good. As the project leads indicate, there is good reason to use computer models to test out new ideas before unleashing them on the real system. We sure know that it’s expensive to try it in the health system, so any means of making the process of adopting new technologies better and more efficient is a bonus.

Where the article totally loses me is this absolute belief that technology can solve our problems. I get the sense that the system designers feel as if the technology will be able to save lives by having information in electronic format, and poof! it will reduce errors and save lives. Okay, I’m being a bit harsh here, but my bias is that health interactions are much more complex than banking transactions. Technological determinism is not something that we should assume to be true. Perhaps this sentiment that technology is better stems from what Friedman articulates as the “Fundamental Theorem of Medical Informatics”. You can read an earlier post about my thoughts on the fundamental theorem of medical informatics here.

Popularity: 14% [?]

The story of eHealth April 26, 2005

Posted by Hans in : analysis, opinion , 3comments

Okay, so I’ve been thinking about what the “story” behind eHealth is, and I think I’ve finally found an image that captures it.

As you can see, there’s a gentleman seemingly receiving a hug from someone emerging from the computer screen. I think that in many ways, we like to think that the technologies we use can supplant the real life relationships that we have. I suppose technologies can be used to extend and maintain relationships, but I have serious concerns about the ability to create new ones - maybe I’m wrong.

Are we, as Neil Postman writes, moving towards a society that worships its technologies because we imbue them with human characteristics? Sure, we can receive some reassurance and comfort from friends when we use ICTs to stay in touch, but it’s not the same as a real hug. The phrase “no man is an island” didn’t really have much meaning to me until recently. Now, I’m coming to realization that technologies provide only cheap copies of the real thing.

Sure, eHealth can be a wonderful tool - I truly believe that. But, eHealth can’t replace a great many things that we often take for granted.

Popularity: 22% [?]

"Give it away, give it away, give it away now" April 26, 2005

Posted by Hans in : analysis, opinion , add a comment

Sure, the title of this post is from a Red Hot Chili Peppers song, but it’s an interesting one. Today’s Globe and Mail had an article reporting on how much information is available for free on newspaper websites (”How much should newspapers give away?“).

The content wasn’t that interesting or surprising in and of itself, but I found it interesting that the general public and media are starting to become aware of the issue regarding access to online information. I’ve made a few posts on this topic because of my interest in open source and open access publishing.

So, how much should a newspaper make available for free? I know that as a customer, I’d like to have it all for free (which very few papers do). In my household, we have three papers delivered each day: The Globe and Mail, The Toronto Star, and a The Korea Times (for my parents). As a regular subscriber, I think online access to articles should be included. I can understand that newspapers need to make money in order to stay in business. But, I recall hearing somewhere that information *wants* to be shared, accessed, and freely distributed. Information isn’t like a tangible good. We only accrue the benefits when information is shared, not hoarded and protected like a precious stone.

If newspapers begin to start charging for access to reports and information, I don’t see health specific sites staying “free” for too long. It may only be a matter of time before we need to pay for everything. I don’t consider myself socialist, but in this case, I think we need to encourage sharing of information rather than limiting access. As health information sites start to charge for access to information, aren’t we saying that health is a luxury available to those who can afford it?

Popularity: 8% [?]

Who uses eHealth? April 24, 2005

Posted by Hans in : news, research , add a comment

Here’s an interesting article that just came out describing the people who use eHealth, titled “Survey details data on those using eHealth“.

Some quick findings:

The findings are not surprising, but interesting nonetheless.

Popularity: 9% [?]

Blogs for the medical field? April 22, 2005

Posted by Hans in : analysis, news , 1 comment so far

I came across this interesting article from BusinessweekOnline titled “Blogs will change your business“. The article was a description of the blog phenomenon and how it may impact businesses. While the examples were interesting to illustrate how the power of information is changing the dynamic between companies and customers, I got to thinking about the potential applicability to health care.

The actual elements of a blog are that information is added fairly regularly on a particular topic (or it could be general, depending on the nature of the blog). But, given that I’m in researching ehealth, what if we converted (or viewed) medical records into blogs. In its current state, medical records are periodic entries about a particular topic (i.e., the patient) with a collection of different “links” (e.g., lab results, assessments, etc) with a commentary provided by the physician and nurse. What if we used electronic tools, such that the patient records information about their health status and condition, with health care providers and health care organizations providing additional links to the blog? Instead of having specialized silos of information for the physician, the nurse, the social worker, etc, we could have section that can provide a running diary and log of symptoms, treatments, and the like.

In all fairness, one challenge would be to provide a “summary” of the current status or major conditions for those providing emergency treatments, but there may be an application of blog-technology here. Why not harness the power of blogs to improve our health care system? Who knows, blogger may be the next big health care information technology company.

Popularity: 8% [?]

Free thinking Fridays April 22, 2005

Posted by Hans in : academics , add a comment

I just returned from one of my regular meetings of the “Monday Morning group” (we now meet on Fridays). Today’s discussion was tentatively about Michel Foucault, using Discipline and Punish as the text. We weren’t able to get into a real in-depth discussion because the group had difficulty understanding the text. Why is it that Foucault (and other philosophers in general) are so difficult to understand? I’ve observed that there is a wealth of literature written about Foucault. I get the impression that Foucault is very influential to much of the social sciences, and perhaps now the “biomedical” sciences.

The discussion lead us back to one of our favourite topics: paradigms and metaphors. It was interesting to see how these two concepts interplayed with the notions of power and living in the present. I’m interested in this notion of post-modern science and what the ramifications are for the future.

On a totally different note, I’ve been asked to start contributing to the Centre for Global eHealth Innovation’s blog (under development) - more to come on this subject.

Popularity: 12% [?]

Welcome to the WiFi world - is this a good thing? April 21, 2005

Posted by Hans in : analysis, news, opinion , add a comment

It seems like WiFi (wireless fidelity or wireless networking) is all the rage at the moment, with Wifi hotspots popping up everywhere. I can see how having easily accessible access to the Internet can be a good thing. But, is it so good when hospitals jump into the foray? Here’s an article that I found titled “Hospitals take the pulse of WiFi tracking“.

So after reading the article, you may be wondering, “what’s all the fuss?”. Well, by itself, the fact that hospitals are starting to deploy wireless networks isn’t newsworthy. What is troublesome is the seeming increase in e-crimes like identity theft and security breaches to corporate networks. Wireless networking provides just another means of gaining access to the system. In today’s Globe and Mail, there was an article discussing the headaches that widespread WiFI access is causing to IT staff (”WiFi access wherever you go, giving IT staff the blues” pg. B12). As we have health care professionals becoming mobile using more devices, the opportunities for theft, loss, and ultimately attack increase. So, I ask again, is this move toward WiFi a good thing? When we consider the serious consequences of having one’s health information breached, I would have to wonder if it may be better for hospitals to wait a bit.

On a related note, I am somewhat surprised that reports of breaches of corporate systems goes relatively unnoticed. I can’t recall the specific company (I think it is shoe retailer DSW), but over the past few days, there has been a steady series of articles discussing how millions of customer records were stolen. Isn’t this at all disconcerting to anyone? Have we grown tolerant to this break of confidentiality and privacy? If this happened in health care, you know that there would be inquiries and a huge fuss. I don’t mean to sound cynical, but how do we know that it isn’t happening already? Ironically, I’m sure that the health care industry’s slow adoption of electronic tools has been mitigating some of the risk - it’s funny how the “paper record” keeps health care safe in an era of digital identity theft.

Popularity: 8% [?]