Podcasting in Healthcare: Is there a future? June 17, 2005
Posted by Hans in : analysis, opinion , 7commentsI’ve been following the “podcasting” phenomenon ever since I heard of the term. At this year’s Apple World Wide Developer’s Conference, Steve Jobs announced that future versions of iTunes will have features to make it easier for users to find and listen to podcasts.
Basically, “podcast” or “podcasting” is a combination of the words “broadcasting” and “iPod”. To put it simply, podcasts are like blogs but using the audio/sound format. The most popular uses right now seem to be in creating personalized music playlists and even radio-type shows [You can read more at the Wikipedia entry for podcasts/podcasting].
I came across this entry on Macobserver.com titled “Forecasts: U.S. Podcast Users to Hit 60 Million by 2010; Tool Market to Reach $400M” that piqued my attention. I’ve been wondering if there is a natural application for podcasting in health care. To date, I really haven’t been able to think of anything that seems to seem obvious or intuitive. But, I get the sense that podcasting will be something more than a passing fad. But, what role will podcasting have in health care, if any?
The more I think about it, I suspect that podcasting may not find a significant role in health care - at least none that I can see at this point in time. Why? Well, here are some of the challenges that come to mind:
- Podcasts are meant to be “heard” - By this, I mean that you listen to a podcast. Health professionals already have too little time to listen to patients. When would they find time to listen to something else? Perhaps podcasting could take the place of dictating notes (assuming voice recognition could translate the recordings into some print format).
- Not text - In my experience, I find it easier (and faster) to scan through large documents if they are in text versus having to listen to something. Since podcasts are not natively in text format, it makes it more difficult to “analyze” the files. I suppose we could start by adding XML-type tags or other such markers to help organize the files. Basically, the podcasts need to be transformed in some fashion to make it useful.
- Not entertainment - For the most part, health care isn’t entertainment. I think podcasts have “taken off” because we’re dealing with music, and for the most part, entertainment activities (I know that people are slowly starting to use podcasts for education-type activities like lectures, but so far, it seems to be a minority activity). So, if you can have the podcast running in the background and not really care if you pay attention or not. I don’t see that happening in health care, particularly with the patient safety ethos of the moment.
Not to be overly pessimistic, here are a few possibilities that I think could utilize podcasting:
- Patients talking to patients - We already see patients telling and sharing their stories on the Internet in a variety of forms. Could patients take the next step and literally *tell* their own story for others to hear?
- Recording discussions & meetings - Podcasting could be a quick way to record the discussions that take place between patient and provider. The files could be stored for review by either the patient or provider. A patient could also use podcasting as a means of recording their own thoughts/symptoms and then later upload the file(s) to the provider’s “system” for review/analysis (see challenge above).
- Education - Podcasts could be used to deliver health education messages either as specific “lessons”, instructions on use, or as a lecture. Actually, now that I think about it, a medical student (either a nurse or physician) could record their interactions with patients and then later review them alone or have their supervisor/instructor review them and provide feedback.
I can’t seem to think about any other possible uses at this time. Honestly, I can’t really think of any reasons why podcasting can’t be used in health care. The most significant challenge will be to find a way to manipulate and transform the podcast in such a way that you don’t have to listen to the entire thing to get the information.
If anyone else has any other ideas, I’d love to hear about them.
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Google Scholar - not ready for prime time June 15, 2005
Posted by Hans in : analysis, opinion, reviews , add a commentI came across a comprehensive review of Google Scholar available from the Thomson Gale Publishing group. As you know, Google Scholar is a dedicated search tool aimed at “academics” to search information regarding journal articles, reports, and other “scientific” literature.
In a previous post (Google Scholar: Don’t believe the hype?), I shared some of my preliminary experiences of using Google’s service. I wasn’t impressed by the offerings at the time. This more recent and comprehensive review seems to validate some of my experiences.
I must admit, however, that for quick searches to find an author name or some other piece of information, Google Scholar isn’t bad, especially if I don’t have access to an academic library’s website.
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Case report: A paperless hospital June 15, 2005
Posted by Hans in : analysis, research , add a commentHere’s an interesting article/case study from Computerworld.com titled “The paperless hospital - really!“. The article is a profile of Baptist Medical Centre South hospital and how it managed to succeed when others (i.e., Cedar-Sinai Medical Centre in Los Angeles).
My take home message after reading this article was that technology is not the problem (nor the solution). While the technology is complicated and needs to be constantly addressed, in my opinion, the social/cultural factors are critical success factors. It’s what Bonnie Caplan identified as “fit” in her review paper (Ref: Evaluating informatics applications–some alternative approaches: theory, social interactionism, and call for methodological pluralism).
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Is this the end for Canada’s health care system? Some preliminary thoughts on the Supreme Court of Canada’s ruling June 9, 2005
Posted by Hans in : news , add a commentWow.
If you haven’t heard, the CBC.ca reported that the Supreme Court of Canada has judged that “Quebec patients should be allowed to buy insurance to cover medical treatments already provided by medicare, citing the physical and psychological suffering caused by long waits for services in the publicly funded system” (Health-care ruling called ’stinging-indictment’ - CBC.ca). I must say that I was surprised and not surprised by the finding.
The interesting thing is that the judges voted 4-3 for the plaintiff in Quebec (i.e., Quebec’s laws are illegal). But, the justices voted 3-3 regarding the legality of prohibiting purchasing of private health insurance in light of the Canadian Charter of Rights and Freedoms (i.e., no immediate impact outside of Quebec). I’m going to think about some of the potential consequences before commenting more. But, my first thought when I heard the judgment was “is this the end for Canada’s publicly financed health care system?”. What happens now? As expected, the politicians and interest groups were out in full force trying to spin the news in their favour.
I’m going to read the full document to see what the Supreme Court judges found before I write more on the subject. You can read the full judgment from the Supreme Court of Canada here. The document is quite long (134 pages), probably reflecting the complex nature of the issue.
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Waiting for a ruling from the Supreme Court of Canada June 9, 2005
Posted by Hans in : news , add a commentToday, the Supreme Court of Canada is to release its decision regarding two cases regarding the legality of the existing health care system in Canada.
Basically, the two cases question the legality of prohibiting patients from paying to receive health care services faster and for health professionals from charging for services covered under provincial health plans. Potentially at stake is the legality of maintaining a publicly funded health care system as we know it.
I’ll write more on the topic when the decision is announced. In the mean time, you can read more about the specific cases on the CBC.ca website here.
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Hospital rating web sites June 7, 2005
Posted by Hans in : analysis, news , add a commentHere’s a quick follow-up to my previous post on Patient Reports and how these types of reports have the potential to change health care and eHealth considerably. The article is from BusinessWeekOnline and is titled “Hunting for Hospitals That Measure Up“.
The article doesn’t reveal anything new, but I found the small vignettes to be useful. Also, the article mentions several different websites and services for patients looking for information to help make decisions on where to get treatment. There is an informal “evaluation”, with the authors comments on the quality of the different sites. It’s an interesting read.
As I wrote in my post, these types of websites are coming. The questions that need to be answered are how can we best use them (as patients) and how should we respond to them (as a health system).
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A step in the right direction…standards for health interoperability June 6, 2005
Posted by Hans in : news , add a commentComputerworld.com reports in an article titled “HHS tackles health care IT interoperability” that the US Health and Human Services Department announced a new initiative to address the lack of a commonly accepted interoperable standard for health care.
Basically, a new committee, the American Health Information Community (AHIC) will be charged with working with public and private groups to “make recommendations to HHS on how to ensure electronic medical records are interoperable while protecting the privacy and security of patient data”. The AHIC will solicit proposals for “contracts to create processes for data standards, product certification, privacy and security, and the architecture for an Internet-based, nationwide health information exchange”. I find it interesting that there wasn’t any emphasis on actually getting people/groups to use the standard(s). As one of my colleagues at the Centre for Global eHealth Innovation commented, the problem isn’t the lack of standards. The problem is in getting people to use the existing standard(s) instead of creating new ones.
I applaud the government for trying to provide leadership by taking the first step. But, I wonder if this initiative will be enough. In such a fragmented system like that in the United States, can all the different groups get along? I mean, here in Canada, we are supposedly “one” system with a single payer and yet we can’t even get a single system in place. I just hope that for everyone involved, this initiative is successful.
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Disruptive Technology #6: Wearable technologies June 6, 2005
Posted by Hans in : analysis, opinion , 3commentsThe disruptive technology profiled in this post is what I generically call “wearable technologies”. By wearable technology, I mostly mean “wearable computers”, but I don’t want to limit myself to just computers. Wikipedia.org defines a wearable computer as “a small portable computer that is designed to be worn on the body during use” (you can read Wikipedia.org’s full entry on wearable computers here). Because the technology is affixed to your body (i.e,. you wear it), a great potential exists to automate and utilize functions directly related to the body and body processes.
I don’t think that I need to go into too much detail as to the unlimited possible ways in which we can use wearable technologies. But, I will focus on a few specific health care applications that I see as plausible.
- Biomedical Devices - This one is a no-brainer. We already have devices that are worn on the body (i.e., Holter monitor for recording heart rates/ECGs), and using sophisticated “wearable technologies” is just a natural extension of this idea. The only difference would be the types of things that can be monitored and having the ability to automatically have the collected data transmitted to a health care provider, information system, or other processing unit for immediate analysis and action (whatever that may be). If you’re still not sure about what I mean, just watch some of the Star Trek: The Next Generation or Star Trek: Voyager episodes. Wearable technologies, specifically for health applications, seem to be the norm. An example could be a device that automatically measures blood glucose levels.
- Delivering Treatments/Drugs - An extension of the idea of wearing biomedical devices, technologies could be worn that would delivery drugs directly into the body (probably through some sort of system that “sprays” the chemicals into the blood stream through the skin - again, think Star Trek and the “hyposprays” for an idea). Keeping with the diabetes theme, in addition to measuring and monitoring blood glucose, a device could also inject insulin to regulate the body’s processes. Something that I think could be more practical could be some device for emergency situations for people with extreme allergic reactions.
- Visual Interface Devices - Wearing technologies in the form of “glasses” is something that is probably something that is likely to happen. The glasses could function as a both a scanning device or even a monitor that displays information that is called up by the user. For example, a physician could be wearing some sort of hi-tech glasses that pulls up a patient’s medical record as well as the most recent information regarding treatment options while the physician (or nurse) is speaking and engaging with the patient. Stephen Mann has been experimenting with wearable glasses, or the “eyetap” as he calls it (http://eyetap.org). Mann’s basic argument (as I understand it) is that the eye is perhaps one of the fastest ways to interact with our minds.
- Sensory Interface Devices - While I’m pretty sure that wearable glasses could work without too much challenge, we do have other senses that could be used as interfaces. I can’t remember the exact person and/or company, but a British group is exploring the use of auditory interfaces to give us a different means of interacting with technologies. Why couldn’t we use other devices that work with our sense of touch, smell, and voice. The question you have to ask then, is a “prosthetic device” a wearable technology? I don’t know.
I know that I’ve only just started to scratch the surface on applications for wearable technologies in health settings. I’d have to give much more considerable thought to think of specific examples and applications, but I’m pretty confident that wearable technologies will prove to change health care and ehealth.
As I think about wearable technologies, I am left with several questions:
- At what point does a technology become too invasive?
- Does the technology have to remain “outside” of the body?
- If something is implanted or integrated into the body, is it still considered “wearable” or are we starting to talk about cyborgs?
MSNBC.com has an interesting special series on evolution, with an article that tries to predict what humans will look like in the future. In one article titled “Human evolution at the crossroads“, one scenario explores cyborgs and how computers slowly invade and become part of the human body. Our ideas about technology remaining outside of the body may change in the future to when we start talking about cyborg technologies.
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A summary of disruptive technologies in health care
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bio-diversity revisited June 3, 2005
Posted by Hans in : analysis, opinion , add a commentPreviously, I wrote on the topic of bio-diversity as related to standards (read post here). I read an interesting post on slashdot.org that is prompting me to re-visit the idea of bio-diversity in health care, and specifically in eHealth.
As we know from our high-school biology classes, “bio-diversity” means having a variety of biological matter, be it genetic material (i.e., genes, DNA, etc), different species, and different types of life forms (for a more in-depth description, you can view the wikipedia.org entry here). Basically, the concept asserts that having a selection of biological options is advantageous because the diversity provides greater protection from catastrophic events like disease, natural disasters, and other conditions. Basically, the example everyone likes to use is when only a single species exists (like us homo homo sapiens), the risk of a single disease or event wiping out the species increases because there is essentially no difference between people. Thus, a disease that makes one of the species vulnerable makes everyone vulnerable. The concept of bio-diversity suggests that having differences in each person increases the likelihood that there will be some form of resistance on the gene pool somewhere. I liken this concept to a derivative of what we learn about evolution - that only the most strongest and most adaptable survive.
Anyway, in terms of eHealth, I wonder if we are going to suffer from a lack of bio-diversity. For one, we see that the smaller vendors are either being bought and consolidated or simply closing shop. On the one hand, it’s not such a bad thing that the small vendors are closing because they probably can’t provide the enterprise leve support that hospitals or regions are wanting. Let’s face it, the trend in health care is towards bigger, regionalized, and (dare we say) “centralized” forms of care all mediated and facilitated by technology. If this is the case, then we are also moving toward fewer and fewer options.
Now, to exacerbate the issue, hardware vendors (and perhaps software vendors too) do not only supply products to health care. As we read in the slashdot.org post, hardware vendors may be slowly discontinuing products that other industries no longer want (makes sense), but that health care may need. Health care has different needs than the financial services, technology, or consumer goods industries.
Now that I think about it from a bio-diversity perspective, I wonder (and this is just a “think outside of the box” type of thought) if having a fragmented health system has any value at all. I mean, not having a single information system keeps risks of breaches and system-wide failure at a minimum because we aren’t connected to one another. Also, by having hundreds of different alternatives, there is a greater opportunity to identify the elements that are beneficial and effective. Okay, practically speaking, this isn’t such a good thing. Variety is good, but how much variety is sufficient?
As an industry, does health care and eHealth need to push the technology vendors to pay more attention and provide more options? Why can’t new and innovative products be developed for health care and then be pushed out to other industries rather than the other way around? As an industry, do we need to ensure that competition and health alternatives remain in order to maintain the biodiversity of the system? Perhaps that’s why the technology industry (in general) has been so successful - there is plenty of competition and diversity to churn out new and innovative products. Diversity is welcomed and encouraged.
With this push for efficiency and “economies of scale”, are we trading short term “gains” for potentially long-term pain? Are we digging our own grave?
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A patient-specific DNS? June 2, 2005
Posted by Hans in : analysis , 2commentsHere’s an interesting opinion piece by John Halamka, titled “Health Care Needs a DNS for Patients” available from Computerworld.com.
Basically, Halamka argues that there should be a better way of accessing and locating patient information that is stored in physician offices, hospital records, patients homes, and wherever else patient information is stored. He argues that instead of a patient number of unique identifier, health professionals (I assume he means only health professionals) should be able to type in someone’s name and then voila! the information should appear collected from all of its various sources.
Okay, I think the idea is an interesting one, but practically speaking neither realistic nor feasible. For one, how are we to ensure that people with the same name will not have their information accessed by unknowing health professionals (with potential opportunities to mis-diagnose based on using the wrong data)? Even here in Canada, trying to create a unique identifier is posing to be a significant challenge. In my limited exposure to the work being done in Ontario, I learned that trying to create a single identifier (much like a name) is one freaking complicated task, let alone doing this on a national scale.
Finally, how would we resolve the issue of people with the same name? I mean, if we’re supposed to have a DNS entry for each person, we can’t all have “Hans Oh”, can we, right? The idea is interesting. Maybe we need to start brainstorming for more ideas. In the US, I think they have bigger problems than trying to create a unique patient identifier.
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