Secondly, if we’re talking medicinal, you want to know something that is broken in the health care system? I’ll tell you: pharmacies. What value does a pharmacist add? None. They can be immediately replaced by vending machines and websites (thx, Zach.) I can read my own labels, thank you very much.

Finally, why are many non-addictive medications by prescription anyway? Here’s an example: ibuprofen. You can buy OTC ibuprofen, and they usually come in 200mg tablets. 200mg doesn’t do anything useful, so what do people do? They take 4-8 of them. If you go to a doctor with a bad headache, they’ll prescribe you ibuprofen in 800mg tablets. I’m sorry Mom, but that’s retarded. Ibuprofen doesn’t need to be by prescription. Here’s another: Liptor. Lipitor is used for reducing cholesterol. “But wait,” Mr. Wily protests, “what if a user bought Lipitor and decided to take more than the label suggested? That would be bad.” Indeed, but the side effects of Lipitor are headache and muscle soreness, hardly cause for alarm. On the other hand, too much of lots of OTC drugs can be harmful as well. For example, excessive Tylenol can hurt your liver, but Tylenol isn’t by prescription. Why?

While I’m at it, doctors themselves are close to obsolete. The Internet is making elite bearers of information unnecessary. When I last went to the doctor for a checkup, he GOOGLED a symptom during our visit. GOOGLED. I can google. Thanks for charging me for your web surfing.

That’s all.

Let’s design the most inefficient, error-prone, hackable system for transmitting medical information.

We’ll start by having persons with notorious handwriting, doctors, scribble in code onto a piece of paper.

Then, the afflicted person (the patient) jams that paper into their pants’ pocket and carries it down to a non-doctor (a pharmacy tech), who attempts to decipher the information and enter it into the computer.

If it’s a new pharmacy or a new doctor, they have NO IDEA what you’ve been prescribed before, or what you’re currently taking.

Why, why, why?

On the upside, they did get the permissions model right, “Its privacy controls, the company said, are set entirely by the individual, including what information goes in and who gets to see it.” That said, the WSJ article goes on to mention that the data, stripped of some identifiers, will be data mined by third parties.

The news of this launch prompted a Slashdot reader to quip, “[this brings a] whole new meaning [to the blue screen of death.]

Would you trust Microsoft with your personal medical information?!?

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

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?!?

I wrote a quick program that extracted the blogs listed there and for each of them, I spidered the first page for links and checked to see if those links linked back to the original 50. Then my program created a network graph that displayed the connections while scaling the size of each site’s node proportional to the number of other sites linking to it. I used PHP to do the spidering and JavaScript to graph it out. The result of all this effort can be seen in the graphic to the above right.

Did I lose anyone yet?

All this effort to grade sites based on inbound links forms the basis for Google’s PageRank^tm algorithm. However, as mentioned before, popularity does not necessarily equal truthfulness.

So is there a better way to evaluate healthcare IT blogs? How can we sift through all of them to discover those worth reading, that is, the best health IT blogs?

Well, for that we’ll need to establish some rating criteria. That criteria might include

1. Post weekly?
2. Been around for a year?
3. Allow comments? (a blog without the ability to comment isn’t a blog!)
4. Interesting?
5. Company or individual?
6. Moderation ranking system, where bloggers from highly rated blogs have greater weight

What criteria would you add (or subtract) from this list?

Be sure to click on the above right graphic for a larger picture of the Health IT Blogosphere!

UPDATE: As it turns out, this algorithm is called TrustRank. The next step is to brush off my old linear algebra skills and calculate the intra-PageRank of these TrustRank select seed pages. Eigenvectors, here we come!

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).

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.

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