Future of Health IT: Trends and Scenarios

Personal Tech: Medical Apps for the iPhone

From NY Times Personal Tech: Medical Apps for the iPhone

After a lot of time reading "best medical apps" stories online, asking Twitter users for their suggestions and reading online reviews, I finally boiled the list down to about 50 promising apps. I tried them out and further winnowed the list to a bunch that I ultimately demo'ed in my talk. Eventually, the video of the talk will be posted at ted.com/talks, but in the meantime, here's what I covered.

(I haven't really given them full-blown testing, so read the online reviews before you spend good money on them. Except for the free ones--you've got nothing to lose!)
--Dave Pogue

I read David Pogue's personal tech blog at the NY Times to keep up on consumer IT trends, but this post from a couple weeks ago seemed really relevant to the readers of FutureHIT. I've been putting off posting because I wanted to say something eloquent, but work and home life have made that impossible. I'll settle for a few hints at what I believe are the most interesting among the items Pogue lists. I'm focused on the ones targeted at health professionals, but the consumer tools have a lot of potential as well.

• OsiriX. "An amazing viewer of medical images (X-rays, scans of all sort)".  I think this is probably just a DICOM viewer, but it requires special server software, so it may be adding some value. Regardless, it's very cool.
• AirStrip OB. "Lets an obstetrician monitor a patient’s status, right down to the baby’s heartbeat, from elsewhere in the hospital (or the town)."  As Pogue points out, this is a good pointer at the types of remote monitoring applications we can expect to see as ubiquitous/pervasive computing moves into the mainstream.

Actually I will mention a thought I've had about one of the consumer apps...

• Retina. "It’s for color-blind people like me. You hold it in front of something—clothes in your closet, for example—and it tells you by name what color you’re seeing."  This is an examplary augmented reality application, intriguing not so much for what it does -- which is of great value, I don't mean to denigrate it -- but for what it portends.  As image analysis becomes more sophisticated, it's easy to picture diagnostic tools that will look at the patient in visible light and infrared and point out diagnostic signs the clinician might overlook. A more prosaic application not yet built but within the reach of current technology would be a program that "looks" at the patient and points out relevant facts and decision guidelines based on the part of the patient's body on which the phone's camera is focused.

I think all this is intimately related to the technology I spotlighted in my recent post on the Open Data Kit, which is aimed at moving advanced tech for the clinician into community settings. As I said in that post, these types of tools will serve the developed world as well as the developing world, because even in the most advanced economies there are segments of the population that are underserved because they can't or won't go to a traditional healthcare provider setting.

There are challenges in all this that take some of the rosy glow out of the picture, notably patient privacy and truth maintenance, i.e. making sure the various information stores relied on by the remote devices have the most up to date information, and can update it as well. In addition there is the very real concern I feel as a patient that healthcare providers may become overly dependent on distributed computing and communications technologies, and be at a loss when connections break down (and they will, oh yes, they will).

Nonetheless, on balance the future for these technologies is bright and getting brighter, and the value they add is potentially enormous.

Wiser OWL learns to unravel doctor talk (The University of Manchester)

I saw a really good news bit today, actually two days old but that's how far behind I am on non-critical email:

A good example of the scale of the problem facing medics and computer scientists is the NCI Cancer Thesaurus that has swollen from 20,000 medical terms in 2004 to over 50,000 terms today.

As new terms are being added all the time, ensuring that all these terms are described, updated and linked together correctly is a mammoth task for humans. However, by using OWL 2 definitions can be written in such a way that computer programs can tirelessly update these terms, enriching the structure of the Thesaurus and pointing out where there are errors.
 
"The first stage was writing the NCI Thesaurus in the original version of the language, OWL, but now OWL 2 enables computer programs to interpret these terms in a much more human-like way, for instance reasoning that if a fracture is located on a bone which is part of a leg then that fracture is a fracture of that leg," said Bijan Parsia of the University of Manchester’s School of Computer Science.

via www.manchester.ac.uk

I can't write more about it now, but it's a critical step in the right direction for the evolution of the Semantic Web. Some maintain it hasn't even been born yet, much less started to evolve. There's an element of truth in that, but it's a sign of the change in our sense of time that we would expect something as complex as the Semantic Web to  move along more quickly than it has so far. Kudos to the folks at Manchester and Oxford who made this manifest earlier this week.

Driven to Distraction - At 60 M.P.H., Office Work Is a High-Risk Job - Series - NYTimes.com

On Wednesday, the Transportation secretary, Ray LaHood, called the broader phenomenon of distracted driving a “deadly epidemic” at a meeting on the issue in Washington. Real estate brokers, pharmaceutical sales people, entrepreneurs, marketers and others say they have little choice but to transform their cars into cubicles. In this merciless economy, they say, they have to make every minute count, and respond instantly to opportunities and challenges.

And they argue that the convenience of constant contact — and the chance to tick off items from an endless to-do list while driving — far outweigh what they think are slim chances that it could lead to a wreck.

via www.nytimes.com

The NY Times has been running a series on the perils of multi-tasking while driving. Today's installment highlights how work pressures, often self-imposed in the case of knowledge workers, are causing people to kill themselves as well as innocent bystanders through stupid mistakes made while trying to be on the telephone, send email, and drive all at the same time (or similar combinations of ICT activities).

It may be that in our culture, this pattern of behavior is Darwinian natural selection at work, though the loss of innocent bystanders doesn't quite fit the pattern. It does represent a continuation of the obliviousness we feel with respect to the dangers of multitasking. In addition to this kind of life-threatening danger, there are less obvious but more pervasive effects. In a paper published earlier this year in PNAS Early Edition, "Cognitive control in media multitaskers", Ophir and colleagues described a controlled behavioral trial in which they showed that media multitasking degrades personal productivity and effectiveness:

A trait media multitasking index was developed to identify groups of heavy and light media multitaskers. These two groups were then compared along established cognitive control dimensions. Results showed that heavy media multitaskers are more susceptible to interference from irrelevant environmental stimuli and from irrelevant representations in memory. This led to the surprising result that heavy media multitaskers performed worse on a test of task-switching ability, likely due to reduced ability to filter out interference from the irrelevant task set.

In all likelihood, many of us in the knowledge business will be as oblivious to this evidence as we have been to the numerous past studies of the dangers of using cell phones while driving. Sad, but true, I fear.

BBC NEWS | Virtual health care gets UK trial

You can read about the Aberdeen Royal Infirmary's venture into the brave new world of virtual healthcare in the  BBC News article entitled Virtual health care gets UK trial.Here's a taste:

Cutting edge telemedicine technology, that will allow medical staff to offer "virtual" health care, is being trialled at Aberdeen Royal Infirmary.

HealthPresence, a system developed by Cisco, links up doctors with patients through a video conferencing booth.

Blood pressure, temperature, pulse rate, weight and lung function can be assessed at a distance in the booth if patients can not make appointments.

If the trial is successful, booths may be set up in locations across the UK.

Possible future locations for the mobile health suite could include schools, workplaces, shopping centres and even people's homes.

(picture from BBC news story)

This trial uses kiosks manned by a human attendant; the kiosk can administer simple diagnostic tests, in addition to providing audiovisual teleconferencing. The presence of the human attendant goes a long ways toward allaying my fears about patient data security.

While not exactly a groundbreaking innovative concept, the Aberdeen trial is one of the first uses of rich Internet-based telecommunications media in the mundane world of primary care. I'm excited to see it, especially on behalf of my less well-off rural relatives and friends who currently have limited access to high-quality healthcare.

Now, if we could only get them health insurance coverage... :-)

More on Microsoft's HealthVault Strategy

Sean Nolan, chief architect of Microsoft HealthVault, commented on my post of a few days ago regarding Microsoft's HealthVault strategy. He gave me a pointer to an entry on his own blog to clarify how they are tracking the the provenance of data, or its "pedigree" as he refers to it (And Now for a Little Usability, April 17, 2008).  One of the comments on the post got me looking more closely at HealthVault, and thinking about how it can help with the current dismal state of the art regarding the search for consumer health information on the Web.

My thesis work tapped into a huge body of server log data  that accompanied a Microsoft Research grant to my thesis advisors, Lada Adamic and Suresh Bhavnani,  as part of the research program leading up to last summer's Microsoft Live Search Summit. The data set provided a remarkably clear picture of search behavior "in the wild". The bottom line: the quality of the result sets returned by major search engines from the queries of consumer health information seekers was questionable at best.

This came as no surprise, for two reasons. First, consumers seeking any kind of information, even about a subject as critical as a mortal illness, tend to submit terse, vague queries. Search engines are hard put to discern the user's intent. Their general-purpose algorithms do a pretty good job of bringing relevant information into view, but it is not uncommon for outdated or unscientific information to appear in the midst of (or even ahead of) authoritative results.

Challenges facing translational biomedical research

I was at two different meetings last week at the NIH in Bethesda, MD, both of which were related to the fostering of clinical research networks. The first meeting, called "Clinical Research Networks: Building the Foundation for Health Care Transformation", was the culmination of the NIH Roadmap "Re-Engineering the Clinical Research Enterprise" program, in which a dozen academic health centers and other research institutions fulfilled contracts to do research and develop tools and techniques for the creation, care and feeding of clinical research networks.

The network concept was defined broadly to include disease-focused networks, practice-based research networks (PBRNs), transplant donor/recipient networks, and others. There were keynote speakers from the NIH leadership, but the bulk of the meeting consisted of panels composed of principal investigators discussing the lessons learned in the fulfillment of their contractual obligations. While each contract produced some sort of intellectual property, but the lessons learned were the primary goal of the program, and the lessons were rich and diverse.

Broken Is Fixed: Health informatics standards in light of Clay Shirky's "In Praise of Evolvable Systems"

I recently re-read an old essay by Clay Shirky (shirky.com) called In Praise of Evolvable Systems. It opens with a laughable description of designing a novelty protocol to slip past the IETF as a joke - however, the feature set described is an accurate description of the World Wide Web, as it existed when Shirky wrote the essay in the late 1990's. That lead-in ends with this:

HTTP and HTML are the Whoopee Cushion and Joy Buzzer of Internet protocols, only comprehensible as elaborate practical jokes. For anyone who has tried to accomplish anything serious on the Web, it's pretty obvious that of the various implementations of a worldwide hypertext protocol, we have the worst one possible.

Except, of course, for all the others...

It seems the WWW protocol family has turned out to be another example of "less is more", or more accurately, "broken is fixed".

IEEE Spectrum: Visualizing Electronic Health Records With "Google-Earth for the Body"

I haven't much time to write today, but I absolutely had to let you know about this article from the January issue of IEEE Spectrum: Visualizing Electronic Health Records With "Google-Earth for the Body":

Andre Elisseeff leads a research team at IBM’s Zurich Research Lab that in September demonstrated a prototype system that will allow doctors to view their patients’ electronic health record (eHR) using three-dimensional images of the human body. Called the Anatomic and Symbolic Mapper Engine, the system maps the information in a patient’s eHR to a 3-D image of the human body.

There's more...

Peter Suber's NIH public-access policy FAQ

Peter Suber at Earlham has published an FAQ concerning the NIH public-access policy. His FAQ may have been there for a while - the policy itself went into effect in 2006 - but it came to my attention due to an internal discussion we are having here. Here's the gist of the legislative intent behind the policy, which Peter has quoted from the House Rules Committee record:

The conferees are aware of the draft NIH policy on increasing public access to NIH-funded research. Under this policy, NIH would request investigators to voluntarily submit electronically the final, peer reviewed author's copy of their scientific manuscripts; six months after the publisher's date of publication, NIH would make this copy publicly available through PubMed Central. The policy is intended to help ensure the permanent preservation of NIH-funded research and make it more readily accessible to scientists, physicians, and the public. The conferees note the comment period for the draft policy ended November 16th; NIH is directed to give full and fair consideration to all comments before publishing its final policy. The conferees request NIH to provide the estimated costs of implementing this policy each year in its annual Justification of Estimates to the House and Senate Appropriations Committees. In addition, the conferees direct NIH to continue to work with the publishers of scientific journals to maintain the integrity of the peer review system.

In brief, the intent is to give the general public - taxpayers - access to the results of the research they paid for.

There are caveats galore.

Doctors Need Help Dealing with Personalized Medicine

Evidence-based medicine is all about giving healthcare professionals a more informed way to decide what care to provide a patient and how to provide it. The problem is getting the right evidence-based information to the docs, nurses, and other care providers in a timely fashion, and then giving then the time required to absorb it and take advantage of it. eWeek discusses this in an article they referenced in a recent Health Care Update. The article was actually published on the CIO Insight site about a year ago, so it's a bit of a mystery as to why it is being recycled at this particular moment, but I didn't see it then and it's still timely, so I'm happy they brought it to my attention. It'scalled Doctors Need Help Dealing with Personalized Medicine. Here's a taste.

It's an open secret that half of people taking certain long-term, high-cost drugs won't benefit from them. As patients are being asked to shoulder more of the costs, and decisions, for their health care, they face tougher choices about whether the dollars for their daily doses are well spent. Researchers are starting to figure out which treatments work for which people, but those answers will come as statistics, not certainties. They promise to cut expensive, unnecessary care, and prevent more-expensive, more-harmful medical injuries. They will do neither, however, unless doctors are given more training, support tools and time with patients.

Amen. But IT can help. Prompt and reminder systems such as Cielo Clinic can be a major part of the solution, as I wrote back in April in a post entitled The Killer App of 21st Century Healthcare. Cielo Clinic doesn't give the doctors and nurses more time, but it does create a set of pithy reminders about chronic and/or ongoing issues in the patient's medical history just as the caregiver is about to walk in the door of the exam room.

"Less is more" is paradoxical but necessary in the age of information overload. The near future of the US healthcare system does not hold much promise for caregivers getting more time to absorb information, so it is critical that we provide the needed information, and ONLY the needed information, at exactly the right moment, so the important facts as in the doctor or nurse's short-term memory as the exam room door begins to open. That may not be the best solution, but it's likely to be the best we can do for the time being.