Future of Health IT: Trends and Scenarios

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general-purpose algorithms do a pretty good job of bringing relevant information into view, but it is not uncommon for outdated or unscientific information to appear in the midst of (or even ahead of) authoritative results.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.

Interactive Health Communication Applications for people with chronic disease (Cochrane Review)

I just noticed one of Cochrane Collaboration's Cochrane Review documents entitled Interactive Health Communication Applications for people with chronic disease:

People with chronic disease have multiple needs, including information about their illness and the various treatment options; social support; support with making decisions; and help with achieving behaviour change, for example, changes in diet or exercise. Computer-based programmes which combine health information with online peer support, decision support, or help with behaviour change may be one way of meeting these needs, and of helping people to achieve better health. This review sought to find out how such computer programmes, known as Interactive Health Communication Applications (IHCAs), might affect people with chronic disease. The reviewers found that IHCAs improved users' knowledge, social support, health behaviours and clinical outcomes. It is also more likely than not that IHCAs improve users' self-efficacy (a person's belief in their capacity to carry out a specific action).

The Cochrane Collaboration is a well-regarded UK-based publisher of information on evidence-based healthcare (a superset of evidence-based medicine). This report struck home because at our Centere we are supporting a project called Internet-Enhanced Management of Fibromyalgia, headed by University of Michigan investigators David Williams PhD and Daniel Clauw MD and operated onsite by the Avera Research Institute in Fargo, ND.  This project overview reads as follows:

Fibromyalgia (FMS), a condition marked by pain, fatigue, and memory complaints, is considered a chronic condition, and is most commonly treated or managed using symptom-based pharmacological interventions.

Previous studies have found benefit in adding cognitive-behavioral therapy (CBT), a non-pharmacological intervention, to standard pharmacological care in order to obtain better outcomes in terms of improved functional status and symptom reduction. While the addition of CBT to standard care has been shown to be beneficial, it is not a form of therapy that is widely available to patients with FMS. This protocol will examine the relative merits of adding CBT to standard care in an experimental format.

The experimental format uses an informational website. The website will contain the content of CBT, a social support capability, and data transfer capabilities.

The experimental CBT format will be compared to standard care alone. The researchers are interested in assessing improvements in physical functional status, the symptoms of FMS, and the relative costs of the interventions as compared to the savings in healthcare utilization over a 12-month period.

To me this sounds very much like the US equivalent of an IHCA as described in the Cochrane paper. I'm especially eager to see the outcome of this because the Web technology underneath it is pre-Web 2.0, though somewhat prescient for its time in including some social networking capabilities.

If this study proves Web-based CBT is beneficial, I'm hoping the next round will explore in more detail the new communications media invented in the past four years that fall into the admittedly loose category called Web 2.0. I'm writing a series of books on business blogging for professionals, the first one being Business Blogging for Heath Professionals Using TypePad™: A Jump-Start Approach, which has just been released today. A major part of the mission of the book is to explore how healthcare practice can be improved through the use of business blogging. Business blogging is a code word for blogging done deliberately for a serious business or professional purpose, as opposed to the idiosyncratic musings, ramblings, and rants one often finds in personal blogs.  The book is a first step in my explorations of how the Web 2.0 paradigm can best be put to use delivering evidenced-based healthcare (including but not limited to medicine).

This all seems to fall under the rubric of health marketing, which is not about marketing particular health products, but rather about selling the general public on the idea of better health and ways to attain it. I think it's a great idea, and I want to help in any way I can.

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Shameless Commerce: You can see the Website for the book at http://hunscher.typepad.com/bizblogging4professionals. In fact, you can even buy a copy while you're there. ;-)

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.

eWeek: Delivering Psychiatric Care Through Broadband

eWeek is running an article entitled Delivering Psychiatric Care Through Broadband that describes the use of two Australian Web sites to monitor and treat depression. Our Depression Center's program, called Michigan Depression Outreach and Collaborative Care (M-DOCC), has just started using a Web interface to capture patient self-reports, but the Aussies have already gone us one better. They are using their Web presence to teach and reinforce evidence-based treatment using an online version of Cognitive Behavioral Therapy (CBT), and the results sound very promising. Not bad for people who have to stand upside down all their lives!

'Most Wired' Hospitals Study: What it means for your career in health IT

An eWeek article describes a study highlighting and analyzing the correlation between healthcare IT excellence in the secondary/tertiary care hospital and its ability to reach patients using state-of-the-art information technology:  'Most Wired' Hospitals More Likely to Reach Patients at Home.

On the surface, this is a no-brainer - or as the hoi polloi would say, Duh! What caught my eye, though, is the key reason why this is so. Turns out it's not about the gadgets - its about organizational learning. If you are a bits-and-bolts guy like me, this should be a wakeup call.