Dissecting the “Real Age” Phenomenon

Posted 23 August, 2007 in current trends, demos, problems, solutions

Recently a number of websites have been offering “real age” calculators which, upon asking a number of health/lifestyle questions, attempt to predict how long you will live. The difference between how long you are going to live and how long people live on average determines your “real age.” If, for example, you are a heavy smoker with a family history of heart disease, you might have been born 28 years ago, but your real age could be closer to 35. As a measure of its popularity, even Oprah and her ilk have been jumping on the real age bandwagon.

These real age calculators are not without their faults however.

1. No (or little) research is offered to substantiate their healthcare calculations
2. The numbers are frequently a little *too* clean (what are the chances that all bad things raise your real age by EXACTLY 1 year?)
3. No distinction is made between elements you can and cannot control
4. At the end of the survey, no action items are provided to allow the user to alter their Real Age. After all, unless you can glean some ACTIONABLE INTELLIGENCE from the results, these calculators are ultimately of little utility.

After seeing the calculator at http://www.poodwaddle.com/realage.htm, I spent a few hours reverse engineering it. healthtech’s real age calculator is an attempt to rectify the aforementioned deficits.

1. Based on XML: see the real age XML now: download and modify the XML as new scientific studies are released. add your own questions, etc.
2. Open Source: download the Real Age code and run it yourself
3. Better health summary at the end (action checklist)
4. Items are distinguished as controllable or not

RemedyMD’s tagline is “Better Data, Better Decisions, Better Outcomes,” and you might be tempted to think that better data leads automatically to better decisions, but that is not always the case. More often, it is the application of intelligent analytic algorithms (predictive informatics, if you will) which transforms the raw data into actionable information. A lot of EHR systems collect medical history, for example, but how many of them process that information to produce actionable knowledge?

What is your Real Age?!?

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).

More Data != Better Data

Posted 18 July, 2007 in problems, solutions, tech choices

The World Wide Web is terrifically empowering because it carries a nearly infinite wealth of knowledge on innumerable entwined topics right into the leisure of your home. The caveat to this blessing is that intermixed in this wave of data is erroneous, incomplete and misleading material. Also, a deluge of information without context and experience can lead to inflated confidence and poor consequent decisions. This is particularly troubling in the healthcare domain, for after reading up on a variety of medical topics on wikipedia, it’s not uncommon to overvalue your medical competence. Doctors in Australia, for example, say they spend, on average, “1 day per week reassuring patients who have misdiagnosed themselves due to using the Internet to find health related information.”^*

The problem of Internet information is not only a shallow, encyclopedic rendering of complex topics^**, but also an ever-growing cesspit of misinformation from unscrupulous persons (see quackery.)

The internet is choked with unscientific “alternative” health sites which purport to hold insights into “what doctors don’t want you to know.” They prey on the uniformed, the naive and the desperate, to peddle dietary supplements, exotic foreign juices and daily colonics. All of which are, at best, expensive placebos, and at worse, dangerous and sinister. These fraudsters sidestep the FDA, double-blind tests, and the scientific method by verbal slight of hand and faulty logic such as, “If doctors were successful at curing people, they would be out of a job, so it’s in a doctor’s best interests to keep you sick.”

And then there is Web2.0 that, with all its promise, is also full of user-generated nonsense. “Blogs have become so dizzyingly infinite that they’ve undermined our sense of what is true and what is false, what is real and what is imaginary. These days, kids can’t tell the difference between credible [information] by objective professional[s] and what they read on [any blog]“^***

So, in summary, ten minutes of Goolging doesn’t make you a doctor, much of what you read online is false, massive doses of vitamin C doesn’t cure cancer and Kevin Trudeau is a con man.

So, how do we solve this problem? “All animals are created equal, but some are more equal than others,” was certainly bad policy for the pigs in Animal Farm, but when applied to Internet medical content, it’s unarguable that not all content is created equal. Perhaps some sort of non-profit certifying organization could help mark the reliable and credible sources of information? Democratic moderation isn’t the answer, because what is popular is not the same as what is correct. Expert systems are a step in the right direction. An EHR that allows you to chat/email with physicians is another good remedy. What do you propose?

* “A survey of 106 GPs, published last month in Australian Doctor magazine, found almost 40 per cent of doctors spent nearly a day a week on patients who had incorrectly diagnosed themselves or their children.”
see http://www.smh.com.au/news/technology/diagnosis-by-internet-wastes-time-say-gps/2007/07/13/1183833772789.html

** “A little Learning is a dang’rous Thing;
Drink deep, or taste not the Pierian Spring:
There shallow Draughts intoxicate the Brain,
And drinking largely sobers us again.”
An Essay on Criticism, Alexander Pope

*** Andrew Keen, The Cult of the Amateur: How today’s Internet is killing our culture

How good is your hospital? (JCAHO CMS to the rescue!)

Posted 10 July, 2007 in EHRs, news, solutions

We’ve talked before about the importance of universal metrics and standards (e.g. IT security metrics (see: HIPAA intro and HIPAA enforcement) and EHR functionality.) Well, now that you have patient encounter data safely in your hosted EHR database, you’ll need some way to measure how well the medical practitioners are doing their jobs.

Enter JCAHO^*– Joint Commission on Accreditation of Healthcare Organizations and Centers for Medicare & Medicaid Services– CMS (I know, they forgot an M in there…)

Those two organizations have identified “core measures” which they use 1. to determine JCAHO accreditation and 2. to determine if the hospital gets government money (Medicare & Medicaid).

An example, please!

A patient is admitted to the ER who has suffered a heart attack. JCAHO/CMS core measure AMI-1 states that the patient needs to be administered aspirin within 24 hours. There are five main categories of core measures with over thirty sub-measures. Running through your encounters manually to check against core measures would quickly become exhausting.

Wouldn’t it be nice if your EHR program could analyze your EHR encounter data and produce handy reports which show your JCAHO/CMS compliance levels? Well, there is at least one EHR vendor whose product now does that: RemedyMD’s OutcomeTrack. You can now even test drive their core measures analysis tool for free online (registration required).

If JCAHO accreditation is in the present or future of your hospital or practice, be sure that your EHR supports JCAHO/CMS reporting. If not, switch to an EHR vendor who does!

* The Joint Commission, an independent, not-for-profit organization, is the nation’s predominant standards-setting and accrediting body in health care. JCAHO is committed to improving healthcare nationwide and it evaluates medical facility compliance based on a focused set of “requirements” that are long known as essential to the delivery of good patient care.A JCAHO certification is considered the gold seal of approval and current law says hospitals accredited by JCAHO are automatically eligible for Medicare reimbursement.

The JCAHO web site can be found at www.jcaho.org (which is an alias for http://www.jointcommission.org/ )

You Can’t Improve What You Can’t Measure

Posted 21 June, 2007 in solutions

That’s a tagline that RemedyMD uses on their promotional trade show give-aways. To be perfectly accurate I suppose you can’t measurably improve what you can’t measure, or maybe it’s that you might be able to improve it but how would you know? The point, of course, is that metrics act as signposts to verify that you’re proceeding in the right direction.

With healthcare, that means that it’s easier to track the progress of a patient if the patient is frequently entering data points (like weight, calories consumed, medications taken, exercises, etc) into a personal health record (PHR.)

Elements of a good PHR include:

1. User-friendly; simple to create and update information
2. Single location (so discrepancies don’t creep into multiple copies)
3. Confidential
4. Controlled by the user (who grants permission to doctors/hospitals to see/modify the data)
5. Universal format (so other systems can interact seemlessly with it)