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The differences in structure, format and meaning of healthcare data is one of the biggest barriers to true interoperability, which is why having standards and specifications in place to support information exchange is essential. Ensuring that software vendors and industry initiatives are working together for the advancement of interoperability is also important.
The healthcare industry is attempting to remove barriers to interoperability and implement the necessary technology infrastructure in various ways. Here is a snapshot of some of the initiatives that have been established.
The boundaries between the physician – patient relationship have always been difficult as the relationship is based on trust, intimacy and the ability to share information from both sides of the desk. This relationship has grown more complex due to the rise of social media engagement. Physicians are being friend-ed, followed and reviewed across the digital channel like crazy, placing the doctors that care for them in difficult positions regarding the confidentiality of their patients who often don’t think about the impact of their digital-buddy request. Similarly, due to the ease of digital communications, the commonly time-stretched doctor also faces temptation to use quick communication methods to reach their audience, in lieu of a more professional path. No-one really wants their test results Tweeted to them! These examples of digital doctoring to be avoided are covered in the guidance. Protecting patient privacy and confidentiality is stressed as the main area for focus when using social media. In order to help doctors better understand digital communication best practices and to fill a gap than many medical practice management efforts have neglected, about a week ago, the American College of Physicians (ACP) and Federation of State Medical Boards (FSMB) published a policy paper entitled“Online Medical Professionalism: Patient and Public Relationships.” Some of the highlights from this publication can be found in this helpful table
Seventy percent of doctors report that at least one patient is sharing some form of health measurement data with them, according to Manhattan Research’s annual “Taking the Pulse” online survey of 2,950 practicing physicians.
A research team in Oxford is 3D-printing little mounds of tissue-like material that can “flex like a muscle and transmit electric signals like chains of neurons,” Nature News writes. Their only two ingredients: oil and water.
American Medical News reports that health insurance giant WellPoint has struck up a deal with IBM and Memorial Sloan-Kettering Cancer Center in New York to use the supercomputer — which has spent its post-Jeopardy days amassing and “learning” massive amounts of data about the American health care, insurance, and public health industries — for two pioneer programs to automatically process, review, and pre-authorize medical claims and treatment requests, as well as a third program dubbed “Interactive Care Insights for Oncology”. The latter will “identify individualized treatment options for cancer patients, starting with lung cancer” in order to advise oncologists on the latest and most effective treatment regimens by incorporating up-to-the minute longitudinal medical studies and cancer data into its suggestions.
Have a heart problem? If it's fixable, there's a good chance it can be done without surgery, using tiny tools and devices that are pushed through tubes into blood vessels. Heart care is in the midst of a transformation. Many problems that once required sawing through the breastbone and opening up the chest for open-heart surgery now can be treated with a nip, twist or patch through a tube. These minimal procedures used to be done just to unclog arteries and correct less common heart rhythm problems. Now some patients are getting such repairs for valves, irregular heartbeats, holes in the heart and other defects -- without major surgery. Doctors even are testing ways to treat high blood pressure with some of these new approaches. SAN FRANCISCO -- Have a heart problem? If its fixable, theres a good chance it can be done without surgery, using tiny tools and devices that are pushed through tubes into blood vessels.
A Vancouver doctor has spoken out against a dysfunctional $258-million information-sharing system that is failing B.C. doctors. “I have a patient who has a very serious heart condition and because of that he went to Eagle Ridge Hospital [in Port Moody],” said general practitioner Dr. Etela Neumann. “Most of his records, if not all, are kept at St. Paul’s [in Vancouver], but because the [emergency room] physician had no access to them he ordered several tests that were already done a few weeks before and the patient was very frustrated.” At the heart of Neumann’s complaint is B.C.’s physician electronic medical and health records system that has been under development since the mid-2000s and has so far cost $258 million. On top of that cost is the Physician Information Technology Office, which has a budget of $108 million to roll out technology and support doctors using the doctor’s information-sharing system — dubbed EMR. The Ministry of Health has acknowledged the implementation of the EMR system has been a costly challenge. “Each health authority introduced computer systems and programs more than 10, 15 or even 20 years ago,” the ministry explained in a statement. “These older systems were designed to improve service delivery in the local health authority and meet their business and patient needs at the time. The focus at the time was often not on sharing records or discharge information between the other health authorities.”
Prominent San Diego cardiologist Eric Topol gave a major address in New Orleans Tuesday extolling the use of a small, portable device for examining people suffering heart distress. Three hours later, he used the device to determine that a woman on a commercial airline flight was experiencing an abnormal heart rhythm. It was the second time in two years that Topol -- one of the nation's leading advocates of wireless mobile medical equipment -- had used such a device to diagnose a patient on a commercial aircraft. "I'm starting to think that these devices would be well-suited for being carried on planes," said Topol, chief academic officer at Scripps Health. "It's a simple way to get information and transmit it."
The number of technical tools available to help patients live healthy lifestyles or control chronic health conditions has grown considerably during the past few years. But the percentage of patients who use some form of technology, such as mobile apps, to track health indicators has remained virtually unchanged for three years.
The Pew Internet & American Life Project published a report Jan. 28 that found 69% of U.S. adults track at least one health indicator such as diet, exercise or weight. The survey of 3,014 adults conducted between Aug. 7 and Sept. 6, 2012, found that 49% monitor their progress in their heads, 34% track the information on paper, and 21% utilize some form of technology, including mobile apps, which 7% use. The results mirror findings from a Pew survey in 2010.
One of the updates to the Apple App Store recently is the inclusion of a specific collection entitled, “Apps for healthcare professionals”. This collection can be found within the ‘Medical Category’. It is a useful starting point for physicians with new mobile devices looking for relevant apps. The collection is further subdivided into:Reference Apps, Medical Education Apps, EMR & Patient Monitoring Apps, Nursing Apps, Imaging Apps, Patient Education Apps andPersonal Care Apps.
IBM’s Watson first role in frontline healthcare will be to serve as a combination lung cancer specialist and expert in the branch of health insurance known as utilization management. Thanks to a business partnership among IBM, Memorial Sloan-Kettering and WellPoint, health care providers will now be able to tap Watson’s expertise in deciding how to treat patients. Pricing was not disclosed, but hospitals and health care networks who sign up will be able to buy or rent Watson’s advice from the cloud or their own server. Over the past two years, IBM’s researchers have shrunk Watson from the size of a master bedroom to a pizza-box-sized server that can fit in any data center. Processing speed has been improved by 240%. Now what was once was a fun computer-science experiment in natural language processing is becoming a real business for IBM and Wellpoint, which is the exclusive reseller of the technology for now. Initial customers include WestMed Practice Partners and the Maine Center for Cancer Medicine & Blood Disorders.
drlj writes: At times it is convenient and even desirable to omit a patient’s name in a conversation. It was suggested on Twitter that it may be better to overhear what ‘bed 9′ needs rather than ‘John Doe is ready for his haemorrhoidectomy,’ and in this case I agree! My worry is that in most cases there is no explicit intent to maintain confidentiality. Instead the convenience of referring to people by their bed number slips into routine communication. I have certainly been guilty of this myself. I worry that this is not merely disrespectful, but that it contributes to the dehumanising experience of being a patient, and negatively impacts on the doctor-patient relationship. There are many factors that contribute to dehumanisation in hospitals. It is often not the fault of individuals, and I would certainly not suggest any of the nurses I work with are uncaring. Instead the environment and structures inherent in the way we work create an “us and them” divide where healthcare workers and patients are in different tribes. This extends to factors as simple as the clothes we wear, an example of “deindividuation.” I am always amazed by the dramatic transformation when a patient puts on their own clothes as they get ready to leave hospital, having previously only worn a generic hospital gown. They miraculously turn into a “person” rather than a “patient.” If and when I become a patient I want my medical team to treat my as an individual, consider my personal context and experience of illness, and integrate this into their decision-making process. I do not want to be referred to as “bed 2.”I realise that as a Medical Reg I would embody ‘the nightmare patient’, but something approaching this true partnership model should be what we aspire to for every patient, not just those (like me) who explicitly demand it. Many things need to change to achieve this ideal including; better data sharing with, and ownership by patients; better public and patient education allowing valuable discussion about trial data and the value and limits of evidence-based medicine; and a dramatic change in our IT structures such that they enhance rather than impede communication across arbitrary boundaries of primary, secondary and tertiary care. We should work to achieve system changes, but they will take time to implement.We can take immediate personal responsibility for our own actions and our own role in dehumanisation in healthcare.
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There’s an important effort underway among health care data experts to enable clinicians and medical researchers to share the same data for analytics to improve patient outcomes. At issue is the structure of electronic health records (EHR) that were originally designed to be used in day-to-day patient care and are not set up to handle much bulkier data types such as X-ray images and genomic tests. As a recent editorial in the Journal of the American Medical Association notes, a critical shortcoming of EHRs of today is that despite their usefulness they can’t hold and analyze much of the ancillary data that health care experts need in a timely fashion. Ancillary data could include laboratory and imaging test results. (See “Why Digital Medical Records Can’t Hold an X-Ray,” below.) This condition persists even though available technology is already able to gather some of this information. “EHRs were never designed to develop insights on large-scale sets of data. They help to collect information that can address inefficiencies of paper records and provide basic error-checking when you saw patients,” says Dr. Graham Hughes, chief medical officer at SAS for the SAS Center for Health Analytics and Insights. Hughes is a developmental neurobiologist and a leader in health informatics.
HealthTap, the popular mobile health platform that connects millions of people with a network of more than 38,000 top doctors for free, today announced it raised $24 million in Series B financing. HealthTap has grown rapidly over the past year, nearly quadrupling the number of doctors in its network, and serving tens of millions of people worldwide via its web and mobile apps. With the new capital, the company will focus on acquiring top talent, expanding its web and mobile offerings, and accelerating its rapid growth. These undertakings will expedite HealthTap's progress in making healthcare accessible and affordable for all.
Modern hip surgery is now so advanced that one can expect to walk immediately after. But there are some hip ailments too complex for standard surgical practices; 3D printing has swooped to the rescue once more. The Mayo Clinic have released a film detailing patient, Brook Hayes who weighs just 70lbs has severe deformities affecting her hips which stops her from doing everyday things like walking up stairs. Unfortunately standard hip replacements would not work, however Dr. Christopher Beauchamp is now able to make a custom built replacement using 3D printing.
In an experimental study, psychologist Victoria Shaffer compared the ratings patients give to physicians who didn’t ask for advice, physicians who asked another expert for advice, and physicians who used decision-making software for treatment advice. “Patients had no problem with [physicians who seek] consulting advice from an expert,” Shaffer said. “It was really the use of the computerized decision aid that makes them most concerned.”
A startup called IntelligentM wants to make hospitals healthier by encouraging workers to clean their hands properly. Its solution is an RFID (radio frequency identification) bracelet that vibrates when the wearer has scrubbed sufficiently, giving employees a way to check their habits and letting employers know who is and isn’t doing things right. Some 100,000 people a year in the United States alone die because of infections that arise from hospital visits, according to the Centers for Disease Control and Prevention, and a lot of these infections occur because doctors, nurses, and technicians don’t wash well enough.
Always innovating, the Mayo Clinic some three years ago introduced a web-based portal to share information with their patients. During that time some 240,000 patients have signed up for online accounts. That’s pretty impressive. But there’s a problem.
According to Eric Manley, product manager of global solutions at the Mayo Clinic, they are having a hard time “getting more than 5% “of all the patients who registered with the patient portal to actually use it."
The man once hailed by GQ Magazine as one of the 12 "rock stars of science" doesn't predict a rosy future for hospitals or medical clinics. But he does expect the individual consumer to be much more aware and proactive about healthcare. In a Tuesday morning 2013 HIMSS Conference & Exhibition keynote replete with pop culture references and visual guides, Eric J. Topol, director of the Scripps Translational Science Institute and author of The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care, delivered a ringing endorsement of the smartphone as the healthcare delivery platform of the future. Digital health has gotten to a point, he said, where the average consumer can measure and track vital signs and other physiological data through his or her smartphone, thereby creating a "Google map of each individual." That, he said, flies in the face of America's healthcare industry, which is poised to experience a technological revolution similar to the 'Arab Spring" revolts that swept through the Mideast. "We practice medicine today at a population level," said Topol, who is also a cardiologist and the West Endowed Chair of Innovative Medicine at San Diego-based Scripps Health. "We do everything the same. We don't recognize each person as an individual." And digital health, he said, will change all of that. Topol argued that population health leads to wasteful and even potentially dangerous practices, such as prostate exams and mammograms. Digital health tools would enable each individual to determine if he or she would need a test, he said. The smartphone – the "lab on a chip" – can and will replace the annual physical, Topol predicted, and offer opportunities to screen for a wide variety of ailments, from lung disease and eye problems to heart issues, high blood pressure and diabetes. Topol predicted that healthcare would move away from the hospital – which George Orwell once called "the antechamber to the tomb" – and toward the home, with consumers in charge of their own health and health data and physicians propelled into the role of specialists. He also touted the development of handheld genome sequencers, and said science and medicine are moving towards a day when an individual's genomes can be mapped and used to detect, cure and possibly even prevent diseases like cancer. And all it's going to take, he said, is a sense of empowerment on the part of the individual, armed with a smartphone. 'What we need to do is tear down that wall," he said.
Engineers at Cornell University used 3D printing techniques to build a new external human ear. The outer ear, also called the auricle, or pinna, was constructed using an extrudable gel made of living cells. Over a 3 month period the ears grew cartilage to replace the collagen base that was used to mold them. Cartilage is an ideal tissue for 3D printed biostructures since it can persist in the absence of vascularization. Formerly, artificial replacement ears had been built from a more styrofoam-like material or sometimes from pieces harvested from a patients rib — a difficult and typically painful procedure, particularly for children. The pinna is much more than just an ornamental curiosity. Without it, sound localization in the median plane is severely compromised. This is because the pinna, together with the ear canal form a selective filter which imparts direction-selective resonances onto the frequency response of the ear. Specific resonances induced by the pinna may also aid in determining the distance of the sound source. 3D printing has come to prominence only recently and has quickly emerged as a powerful new tool for all kinds of biomedical applications. Earlier this month, a group from Scotland, land of Dolly, the first cloned sheep, was able to 3D print structures using human stem cells. Furthermore, they were able to show that the cells continued to express particular biomarkers that were indicative of pluripotence — the ability to turn into nearly any type of tissue.
Already revolutionizing manufacturing, 3D printing technology also promises to revolutionize the field of biotechnology. While scientists have previously had success in 3D printing a range of human stem cell cultures developed from bone marrow or skin cells, a team from Scotland's Heriot-Watt University claims to be the first to print the more delicate, yet more flexible, human embryonic stem cells (hESCs). As well as allowing the use of stem cells grown from established cell lines, the technology could enable the creation of improved human tissue models for drug testing and potentially even purpose-built replacement organs. The scientists printed embryonic human stem cells in laboratory conditions using a new valve-based technique developed by Dr Will Wenmiao Shu and his colleagues at Heriot-Watt's Biomedical Microengineering group. The hESCs were drawn from two separate reservoirs in the printer using pneumatic pressure and deposited onto a plate in a pre-programmed, uniformed pattern through the opening and closing of a microvalve. Dr Shu says that the amount of cells dispensed can be precisely controlled by changing the nozzle diameter, the inlet air pressure and the opening time of the valve. After the hESCs were printed, the researchers conducted tests to see if the hESCs were still alive and if they were still able to differentiate into different types of cells. The accuracy of the valve-based printing method was also assessed by examining the concentration, characterization and distribution of the printed hESCs. “We found that the valve-based printing is gentle enough to maintain high stem cell viability, accurate enough to produce spheroids of uniform size, and, most importantly, the printed hESCs maintained their pluripotency – the ability to be differentiated into any other cell type,” said Dr Shu. “To the best of our knowledge, this is the first time that hESCs have been printed. The generation of 3D structures from hESCs will allow us to create more accurate human tissue models which are essential for in vitro drug development and toxicity-testing. Since the majority of drug discovery is targeting human disease, it makes sense to use human tissues.” The researchers believe the technology could also be used to create artificial organs and tissues that incorporate a patient’s own stem cells, thereby reducing the risk of the patient rejecting the organ and the need for immune suppression. This would also help address the global shortage of organ donors. In what is believed to be a first, scientists have arranged human embryonic stem cells using a 3D printing technique.
Susan Skochelak writes: Rapid changes in health care require a transformation in the way future physicians are trained. They will need to be able to navigate new and increasingly complicated health information technologies, understand, and use advances in personalized medicine and many will need to know how to lead accountable care organizations. Advancing medical education will ensure our future physicians can flourish in a high-performance, physician-led team-based health care system whose business side grows more complex every day. The American Medical Association (AMA) is setting ambitious new goals to meet the challenges and seize the opportunities for the future of health care. These goals include improving health outcomes for patients, enhancing practice sustainability and professional satisfaction for physicians, andaccelerating change in medical education for medical students. As part of the third prong of this strategic plan, we have launched a $10 million initiative to help medical schools develop innovations that will prepare students to thrive in the rapidly evolving health care system. Gaps between how physicians are trained and the future needs of health care must be narrowed. Today’s medical education focuses primarily on the individual, yet physicians increasingly practice in teams. Students today receive most of their clinical training in an in-patient setting, but a majority of patients are seen in an ambulatory setting. Medical schools today provide minimal education about the business and financing of medicine, but our health care system requires a growing understanding of how to run a business. Many schools have begun inventive programs to advance medical education and close these gaps. Many more have considered implementing similar initiatives but lack the resources to implement them. The aim of the AMA’s new initiative is to facilitate bold structural change by providing $10 million over the next five years to fund approximately 10 projects that support a significant redesign of undergraduate medical education. We’re looking for creative ideas to enhance education that will align medical student training with the evolving needs of patients, communities and the changing health care environment. From developing new methods for teaching and assessing key competencies to fostering flexible, individualized learning plans, we aim to develop successful programs that can be duplicated in medical schools across the country. Interested medical schools are invited to submit brief proposal ideas by February 15. From the initial pool of proposals, the AMA will invite a select group of medical schools to submit a full proposal by May 15 and will conduct a thorough review of all materials before announcing the selected schools at its Annual Meeting in June 2013. We’ll be forming a learning consortium so participating schools can share best practices and structural innovations. Medical schools teach some of the best and brightest young professionals in the nation. This initiative will spark the educational collaboration and advancement that is needed to ensure our future physicians are prepared to provide excellent care to the patients of tomorrow.
As patients increasingly turn toward social media to access healthcare and self-diagnose, the patient-provider relationship is changing, the book argues. The first step in this change came when patients gained access to medical information online. Now they're adding the power of crowd sourcing, which means the healthcare industry isn't just seeing a more educated patient but also patients interpreting information and, essentially, becoming a member of their healthcare team. "Patients are becoming our colleagues," said co-author of 'Social Media For Nurses' Ramona Nelson. "It's changing relationships and the kinds of questions and services a patient asks for." With healthcare becoming increasingly virtual, said Wolf, it's becoming the provider's responsibility to direct patients to the best online resources. Looking ahead, Wolf advises that nurses and practitioners need to incorporate social media into a strategic plan to determine how they're going to use different platforms and extend services through them. This plan, she said, should be created from a clinical perspective as well as an IT perspective, allowing for an interdisciplinary approach. "Clinicians in services may not understand websites or synchronized information versus unsynchronized information," she said. "They need help to get them out there virtually."
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