Future of Health IT: Trends and Scenarios

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. ;-)

SERENDIPITY: Older Wiser Wired

While looking at the Guidelines Sorting Tool, a cool feature of the US DHHS's usability.gov guidelines tome, I stumbled across the AARP's subsite on computer use by adults over 50 - Older Wiser Wired - Adults over 50 Online, Life and Living - AARP. 

This is a great find for those of us interested in making our Websites usable to persons other than college sophomores and baristas, who in any case spend most of their time on MySpace, YouTube, Second Life, World of Warcraft, and Google Everything rather than visiting the sites and applications we build and the blogs we write.

Social Computing is transforming healthcare

Two recent posts in blogs I follow touched on the significance of Web 2.0 and the social computing paradigm. Given that I work at the intersection of information technology, research, healthcare, and higher education, my interests are fairly diverse, and it is nice to see the convergence in thought now occurring in society at large as Web 2.0 takes hold.

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.

Real Is Beautiful

I don't consider myself a technophobe, nor do my friends and colleagues see me as such. I carry around a Bluetooth-enabled camera phone, a Nokia 770, and a Palm Tungsten T3. I spend a lot of time on the Web, even more on computers generally. It's how I make my living, and it's also been a kind of passion for the past 26 years of my life. But over the past couple of years, I have become increasingly afraid that the emerging global culture is losing touch with reality, consciously and deliberately entering into a kind of endemic psychosis. I want to be wrong, but the evidence is becoming more and more compelling. A great example: the Second Life phenomenon.

eWeek: Java's Momentum Is Running Low

eWeek published an opinion column yesterday by Larry Seltzer, with the headline Java's Momentum Is Running Low. Here's a taste:

Many lawsuits and real-world trials later, Java is still a major platform for server-side application development, but only one of many and no longer the one with momentum. Heavily influenced by Java, Microsoft's .NET has more mind share where it counts.

On the client, I can no longer say that Java is in freefall because it's closer to rock bottom. As a client application development platform it's far behind a wave of interpreted languages like Ruby and Python. Yes, there are still a few oddball Java applets out there, but you rarely hear about innovative new programs being built in it.

Java dead? Sometimes I think it's true. Then I stop thinking.

Agent Architectures - the next paradigm for software engineering?

Just about the time I got back from my vacation, HISTalk posted a very interesting interview with Novo Innovations CEO Robert Connely. In it, they discuss in some depth the way Novo's EMR synchronization solutions work. They have had what appear to be some remarkable successes integrating hospitals and labs with community clinics, not just one-offs but across what sound like some mid-sized health systems (check out the Company News items on the right side of their Website) and a one-pager about their implementation at Atlanta's Northside Hospital [pdf], a 455-bed community hospital with 1450+ physicians on staff.

What caught my eye is that they are using an agent-oriented distributed architecture. This is one of the architectures that I believe will dominate the future of healthcare informatics, as I predicted in my 2001 scenario planning paper on application architectures. But - such architectures present challenges in terms of performance and security, and can be awfully hard to debug when things go bad.  Still, Novo's example is worth studying if you are responsible for designing large-scale systems, particularly in the healthcare arena.

Web 2.0 synergies

Shahid Shah is reporting that HIMSS is getting interested in Web 2.0 technologies.  It will be fascinating to see how far this interest goes. Real-life Health IT is generally so far behind the innovation curve as to be near-ludicrous at times, and HIMSS would do us all a favor by becoming an exemplar in this realm.

The Nursing Informatics 2006 conference in Seoul, Korea this year was the first medical informatics conference I've seen to start leveraging Web 2.0 technologies. Their conference blog was a great example of how these technologies can be used to further face-to-face interaction as well as keeping remote would-be attendees in the loop real-time. I reported on NI2006 back in mid-June when the conference was going on (Back to the future...).  It came to my attention because they used one of my scenario planning posts on the future of health information technology (Resident Physician 2010)  as material for one of their panel presentation sessions.

Living and Working in a Virtual World: New paradigms for human culture and application architectures

Recent posts in a number of blogs I follow have been converging on a vision of the future of global culture as shaped by information technology. Consider this from the blog of IBM executive Irving Wladawsky-Berger:

While it may be still too early to tell, I am beginning to sense the shape of the next major era of computing.  It feels much more ubiquitous and collaborative.  It also feels much more "intelligent," realistic and human.  I almost get the sense that we are creating a very rich virtual world that complements our physical world, with all kinds of capabilities to help us in our life and in our work.

Socialtext Partners with Dan Bricklin on wikiCalc

Dan Morin of Cielo MedSolutions clued me in to Google's entry into the nascent online spreadsheet market space, Google Spreadsheets (you may have to log in to view it). From the reports I hear it's an alpha version but pretty much feature-complete.  Exciting! I posted about electronic spreadsheet inventor Dan Bricklin a while back (When the Long Tail Wags the Dog), but didn't mention WikiCalc, an open source web-based spreadsheet he was toying with at the time.  It turns out he was doing more than fooling around - he's got a serious product in the works, complete with an industry partner relationship with the Web 2.0 company Socialtext.