Future of Health IT: Trends and Scenarios

The future of health IT, today: Virolab

An article in the November issue of IEEE Computer Magazine (Sloot et al., From Molecule to Man: Decision Support in Individualized E-Health) turned me on to Virolab. This is a European Union-funded prototype "virtual laboratory" that the project page describes as follows:

...a virtual laboratory will be developed enabling easy access to distributed resources as well as sharing, processing and analysing virological, immunological, clinical and experimental data. As a prototype for this virtual laboratory for infectious diseases, the problem of HIV drug resistance will be used. The virtual laboratory will integrate the biomedical information from viruses (proteins and mutations), patients (e.g. viral load) and literature (drug resistance experiments) resulting in a rule-based distributed decision support system for drug ranking. In addition ViroLab will include advanced tools for (bio) statistical analysis, visualization, modelling and simulation, enabling prediction of the temporal virological and immunological response of viruses with complex mutation patterns for drug therapy.

The system seems to me to be very well thought through. It is targeted initially at a very important medical challenge, but this single focus is an artifact of its being a proof-of-concept project; the underlying technology is generically applicable to all manner of challenges in medical research and clinical care.

Open Source Science: A New Model for Innovation?

Harvard B-School's Working Knowledge newsletter has a great article this week called Open Source Science: A New Model for Innovation.

In a perfect world, scientists share problems and work together on solutions for the good of society. In the real world, however, that's usually not the case. The main obstacles: competition for publication and intellectual property protection.

Is there a model for encouraging large-scale scientific problem solving? Yes, and it comes from an unexpected and unrelated corner of the universe: open source software development.

Karim Lakhani, an Assistant Professor at the B-school with lots of research experience in the Open Source software community, looked at ways the concept could be applied to research. In particular, he focused on the question of whether scientific advances spring naturally from the privileged core of a discipline, those immersed in it 150% of the time, or whether outsiders with a fresh perspective had an edge. His findings:

...it was outsiders—those with expertise at the periphery of a problem's field—who were most likely to find answers and do so quickly.

...The problem may reside in one domain of expertise and the solution may reside in another. I've done interviews with scientists who participated by posting problems for broadcast, and most of these scientists were highly skeptical about this method because they considered themselves to be at the top of their discipline. However, they had never thought about the possibility of scientists in other disciplines looking at their problem, reconceptualizing it, and coming up with a solution that could be off-the-shelf. So when they actually see solutions from this type of method, they're blown away.

This is the Web 2.0 mindset reaching the hallowed halls of science. It's a great interview piece, with more objectivity than I'm presenting here. He and the interviewer discuss the risks as well as the benefits of this approach. To me, though, this is all good news. No paradigm shift is all upside, but we are a world in desperate need of innovative, out-of-the-box solutions. Now let's see if the silos of the world can tolerate such openness.

Second Life and Institutions

Because I am interested in technology innovation per se, I read the blog of IBM Research executive Irving Wladawsky-Berger on a regular basis. He posted recently about Second Life, a phenomenon about which I have mixed feelings (see my posts Second Life and the Amish and Real Is Beautiful). A few things intrigued me. 

First, he agrees with my belief that Second Life exemplifies a new mode of human-computer interaction and interpersonal communication that will transform society at some point in the not-too-distant future. Second, his avatar looked a lot like he does in real life.  Third, he is looking closely at how this will affect the behavior of institutions, as opposed to the changes it will bring about in interpersonal psychology, which is what I have been observing. Finally, his view sounds a lot more positive than mine. Hmmm...

Remote monitoring: Ready for prime time?

A mention on the UK-based counterpart of this site, ace healthcare IT consultant Colin Jervis' FuturehealthIT blog, caused me to pay more attention to a couple of posts on remote monitoring that treated it in considerable depth and very thoughtfully.

Meanwhile, back on this side of the Pond, remote monitoring seems to be on everyone's mind recently. This past week's FierceHealthIT e-newsletter had an editorial on remote monitoring with some good insights into the challenges one can expect when venturing into this cutting-edge arena. Getting into a collaborative relationship with patients is more difficult than it first appears.

Drowning in Information

I've been thinking about a post I read in Irving Wladawsky-Berger's blog entitled Information-It's All Around Us. There are a lot of insights in it so it's taking me a while to digest. But today I learned that eWeek just posted an article entitled Report: Clinicians Use Inadequate Message Devices. It resonated so loudly with Wladawski-Berger's post that I have to show you how the two tie together, and lure you into reading both posts. eWeek's story is news, and Irving's post is Op-Ed material, so don't expect parity. It does go to show, though, why it's important not to read just the news: pundits can place the conceptual sound-bites we get from news stories in a larger context.

More EHR products get certified, and I become a convert

CCHIT recently announced the second round of Certified EHR Products, bringing the total number to 33. This is great news. I'm curious, though about the use of the word "evolve" in this excerpt from the press release:

The certification criteria have been developed to ensure that products provide a broad foundation of functionality, will evolve to deliver standards-based interoperability with other systems, and include security features to protect the privacy of personal health information.

Oops. I thought we were doing this to achieve interoperability in the first place. One of the goals in CCHIT's About page reads: "Ensure interoperability (compatibility) of HIT products ".  It turns out that is in the future, and it's not clear when interoperability standards will be delivered.

Forget all those things about being skeptical about interoperability with respect to CCHIT's efforts (for example, see CCHIT EMR Certs: The Prisoner's Dilemma Revisited). CCHIT is starting from a different Square One than I was assuming, so at least some of my complaints are off-target. My bad.

QUICKIE: Internet2 report says funding mechanisms work against creation of research IT infrastructure

From the folks at internet2: Final Report: A Workshop on Effective Approaches to Campus Research Computing Cyberinfrastructure.

This is from back in July, but the link just got re-sent to me yesterday, and I hadn't noticed it back then. The report's analysis and recommendations are not specific to clinical research or even to biomedical research, but are still very relevant to our world. Between the advent of the genomic/proteomic/metabolomic era and its petabyte-level data storage requirements and the introduction of HIPAA Privacy and Security regulations, the need for a state-of-the-art, reliable, secure IT infrastructure in biomedical research is becoming mission-critical.  As I have noted before, the barriers are mostly non-technical, but instead related to issues of financial incentives, organizational culture, and human nature:

Major negative reinforcements exist in the current environment. For example, grant solicitations at several major funding agencies seem to favor "autonomous, small clusters in closets" over more sustainable and secure resources. Personal lambdas are sought by scientists less for their performance needs than to obviate the "friction" of campus network security. Lack of coordination of Institutional Research Boards (IRBs) creates major obstacles to inter-institutional data collaborations. Campuses may be legally liable to continue to provide services that were committed to by researchers who have since left these institutions; such situations can dissuade a campus from future commitments.

"Lambdas" are light frequencies, and refer to reserved bandwidth on optical backbones such as those used in Internet2 implementations such as the Abilene network.

Second Life and the Amish

My misgivings about Second Life expressed in the post Real Is Beautiful brought an email response from Paul Hartzog, a fellow grad student at Michigan and the a leading proponent of Panarchy, the most obviously sane, rational, and just form of government - therefore perhaps the one we are least likely to experience in our lifetimes. :-) Our brief exchange is reproduced here with permission. We ended up with him pointing me to a Wired article about technology and the Amish, which led me to look more deeply into the concerns I have.

Cambrian House And "Crowdsourced" Software

In one of the Release 1.0 blogs, I saw a strange but also stragely attractive idea about applying the underlying paradigms of Open Source, recommender systems, and Darwinian survival-of-the-fittest to venture capital. I'm not sure how it would apply to clinical or biomedical research, but it certainly has potential in the realm of heatlhcare startups, another realm of fascination for me as I watch companies like Healia, Novo Innovations, and Cielo MedSolutions take off.

Storytron: an Interactive Storytelling Engine

The October Dr. Dobbs Journal has an interview in which Editor-At-Large Mike Swain talks with Chris Crawford, one of the early Atari game development gurus, about the interactive storytelling paradigm, of which Crawford is the inventor. It gives an exciting glimpse into the possibilities for the future of computer games, and I believe games will play a huge role in the future of healthcare - indispensable for training staff and patients and highly varied in their therapeutic applications as well.