Generation X Doctors to the Rescue

Posted 22 September, 2007 in trends, future tech

It’s no secret that many doctors are, if not technophobic, at least VERY SLOW to implement new technologies. To wit, according to the report called “Health Information Technology in the United States: The Information Base for Progress,” only one in four doctors (24.9 percent) use EHRs to improve how they deliver care to patients.¹ Fortunately, our Luddite physician friends are being joined by Gen X’ers, who, having grown up with computers, are not afraid to break out of the restraints of paper forms and charts.

One of these early adopters is Jay Parkinson, MD, MPH (from Penn State and Johns Hopkins.) Jay is an EMR-enabled, private physician practicing in Brooklyn. Jay prefers to “e-visit [his patients] by video chat, IM and Email for problems that don’t require an actual face-to-face visit. It’s the future of cost-effective medicine.” All of that, plus two home/work visits a year for $500.00. Jay also gives out his cellphone to his patients.

Can you video conference with your doctor?

1. http://answers.google.com/answers/threadview?id=785923

Back to School (health records for kids)

Posted 1 August, 2007 in education, future tech, solutions

Summer is just about over and that means a return to school for many children around the nation. Mixed into the stack of papers your child will bring home might possibly be an immunization form from the school health office. Do you remember where you last placed the immunization cards?!? Is it time for a DTP shot? an HBV? a Hep A? If you’ve switched primary physicians, or worse still, states, your current doctor might not have a backup record of the vaccinations. In fact, “One in five U.S. children receives at least one unnecessary dose of vaccine by the age of two, wasting $15 million in vaccine cost each year.”^*

To help with this problem, many states have implemented their own electronic immunization repositories (no national database exists.) For example, in Utah, for the past five years or so, every newborn child has been automatically enrolled into USIIS (”Utah Statewide Immunization Information System”, pronounced “you sis.”) Qualified health care providers and educational organizations alike are granted access to the system. Now, after a visit to the doctor, a child’s immunization record is updated in the state database (running Oracle, by the way), which can then be accessed in report form by the school nurse.

Though I applaud the Utah Department of Health for their efforts to gather and store medical information electronically, the USIIS system falls short in a couple of aspects. For one, there is no facility for direct parent access to the system (no “parent portal.”) As well, having a separate database for immunization data apart from the rest of a persons’ medical information seems divergent from the goal of a universal personal health record. Finally, there is no access/permissions model controllable by the parent. Once data is entered into the system, it is viewable and editable by *all* of the users on the system.

On the up side, USIIS does have a web interface and an HL7 interface and USIIS can be configured to work with EHR systems. As well, it has the ability to connect to other states’ immunization record systems (recently it was coupled with Louisiana’s when Hurricane Katrina refugees came here.)

Does your EHR system have the ability to interface to your state’s immunization system?

* Source: National Vaccine Advisory Committee (NVAC)Report, Centers for Disease Control and Prevention (CDC).

Black Bags to Robots: 100 Years of Medical Progress

Posted 28 July, 2007 in future tech

There was once a time when doctors did house calls^*. Then a population boom, decreasing physician/patient ratios and new hospital technologies largely obsoleted personal house visits. For the past 50 years, nearly all contact with one’s physician has occurred in a doctor’s office. Recently, EHR patient portal software has allowed email and instant chat with physicians. Some EHRs now even have live video conferencing/telemedicine capabilities (which are particular handy in a corrections environment, for example.) Increasingly, remote medical encounters (with robots) are enabling a specialist to operate from the other side of the country or world.

I think that remote medicine is particularly exciting because it allows the mechanical motions of the procedure to be recorded for review. Previously, procedures could be video recorded, but now every movement and pressure and cut can all be saved and analyzed for best practices and training.

As well, once the operation data is stored, it can be combined with outcomes data to find useful trends and patterns. How’s that for cool?

* Just yesterday I heard that some doctors are beginning again to make house calls, in an effort to curb expensive  emergency room visits.

near-Future innovations in personal health

Posted 25 June, 2007 in future tech

Many EMR vendors, like RemedyMD, offer a web-based “patient portal” (e.g. MyHealthManager), which provides a handy interface for recording daily meals, activities, blood pressure, weight, glucose levels, etc. The screens are intuitive enough for the computer novice to master while remaining feature-rich for the power-users.

The problem is one of diligence. For the ADD-afflicted (such as myself), it’s hard to remember to daily chronicle my weight or calories consumed, so I find myself backdating entries, feverishly (and inaccurately) attempting to recall the events of past days.

Those times of difficultly might be soon over. It’s just a matter of time before a host of wireless devices are linked up to an intelligent and user-friendly patient portal. When they are within range, these wireless devices transmit back data to your PC which data is consequently uploaded to the web. Then, periodically you (or your physician) can review the much-more-useful data.

Wireless healthcare devices that are/soon-will-be available include:

• Scale
• Pedometer
• Meters for:
  • Blood Pressure
  • Body temperature
  • Glucose
  • Blood/oxygen levels
  • BMI/Body Fat %

Hanging the meat on the bones (the search for better organized data)

Posted 21 June, 2007 in future tech

Thankfully, many hospitals and physicians are beginning to store their medical data into electronic medical records system which, in turn, use a relational database such as Oracle or MSSQL. Relational databases are powerful tools because they provide fast access to non-redundant, consistent data.

And the real advantage of all that data is the promise of data aggregation: being able to extract useful information over a range of different databases in difference practices. Relational databases alone, however, fall short when you’re trying to integrate disparate systems. The problem is the lack of a structure of meaning (what researchers call an “ontology”) which ties data together in meaningful relationships and then back to a universal set of medical terminology and hierarchy. When a carefully constructed ontology is employed, particular information can be combined with other matching pieces of information.

The data (meat) alone is useful, but when combined with an agreed-upon structure (bones), suddenly we begin to have real possibilities for integration and collaboration.