Buzz e-sante

Few healthcare IT policies these days are as delicate, sensitive and potentially emotionally explosive as efforts to restrict or regulate employee social media activity. And yet hospital hierarchies are routinely stepping on these political minefields as providers try to protect their reputations.

Consider a recent incident at the 2,478-bed New York Presbyterian Hospital.

An ER nurse posted a photograph of a trauma room – no staff or patients were in the picture – after caring for a man who had been hit by a subway train. The caption: "Man vs. 6 train." The image simply showed a room that had seen a lot of action moments before. The veteran nurse was fired after the incident, according to an ABC News report, not because she had breached hospital policy or violated HIPAA, but, as she put it: "I was told I was being fired for being insensitive."

This legitimately raises key issues around what a hospital's social media policy should be. This specific incident, though, appears to be an impressively poor choice for the hospital to have selected to make its stand. First, there really was no privacy issue at play. The photo shows nothing more than a slightly messy trauma room. The caption is vague and is hardly worse than a police officer posting a car accident image, with a note warning people against drinking/texting while driving. (To be precise, the injured car would be recognizable to the patient along with friends and family, especially if a license plate were visible, whereas a generic trauma room photo isn't.)

An even bigger problem with using this incident is that the nurse, Katie Duke, didn't even take that photograph. It was taken by a staff doctor and the doctor had posted it on the doctor's Instagram page. Nurse Duke had merely reposted it. The consistency killer? The doctor "was not reprimanded," ABCNews reported. To be fair, it's not clear whether the doctor's post included the "Man vs. 6 train" comment. Given that it appears that the comment – as opposed to the image – is the trigger here, the hospital's disciplinary process may or may not have been inconsistent.

Let's get back to the social media policy issues. I would hate to have to issue a concrete definition – acceptable to our friends in Legal – of "sensitivity." What if there had been no image and the nurse had simply said something like "A grim reminder at the ER today about how dangerous and deadly subways can be. Don't take any chances – ever." Is that insensitive? And if not, how is it meaningfully different than what Duke reposted? She specified the subway line, which, by itself, isn't insensitive nor especially revealing. And she used an image of the trauma center, which showed nothing. Would it have made any difference had she posted a generic trauma center image from Google Images?

If no patient or hospital privacy has been violated, what is the issue? The issue is that she was accused of violating hospital policy. We've now gone full circle. What is reasonable to ban, as long as no one's privacy nor hospital confidentiality is violated? (Classic hospital confidentiality: "Wow, my hospital is getting away with amazing markups. We just charged a patient $XXX for something, and I saw the paperwork that we only paid $X for it." The employee would be using information that she/he could only know because she worked there. That's a fine violation.)

Can a hospital ban employees from saying anything hospital-related on their social media posts? What if it's entirely positive, as in "Our surgical team is brilliant. We saved patients today that most surgeons would have lost"?

Here's the IT nightmare. What if the hospital says, "We're going to decide this on a case-by-base basis"? Danger, Will Robinson! Danger! Then things fall to IT to become the social media police. Are you to then track every social media feed of every employee and to then – gulp – review every posting for appropriateness? And somehow management thinks that this action will avoid lawsuits?

The simple fact is that a social media policy that covers what an employee does in his or her personal time is highly problematic. On the other hand, there certainly is social conduct that has to be dealt with. What if a doctor set up a site that identified herself as working at this identified hospital and then said how her team tries to inflict as much pain as possible and that they then place bets on when different patients will scream or pass out?

The easiest route from an administrative perspective – but certainly not from a legal perspective – is to adopt something akin to the Pentagon's infamous Don't Ask Don't Tell. That would be a program where there was zero effort to uncover such naughty social posts (as IT breathes a major sigh of relief) but a strict policy for punishing employees and contractors who engaged in bad behavior that the hospital happened to learn of.

The problem is that it leads to inconsistent punishment – with most people never getting caught – and to even vindictive behavior, with employees reviewing the social posts of a rival, looking for anything that might get them into trouble.

That policy might simply prohibit posts that reflect poorly on the hospital, which is vague enough to allow senior management to make customized decisions. As long as healthcare doesn't decide that it needs to proactively check on all posts – a thankless task that would almost certainly fall to IT, which would try to automate much of that assignment from Hell – any concrete policy is better than none.

Les douleurs chroniques font partie des troubles médicaux les plus fréquents et invalidants. Les antalgiques font également partie des médicaments les plus utilisés, avec plus ou moins de succès

The Baseline Study is a collaboration between the Google X “moonshot” organization and various clinical and academic partners. The work should fit in well with the health-monitoring aspects of Google’s wearable efforts.

Gérer ses informations médicales à travers des applications est une pratique de plus en plus courante. A cet effet, l'exploitation et la sécurisation de ces données donnent matière à réflexion. Beaucoup d'utilisateurs se posent en effet la question, où iront toutes ces données ? Existe-t-il un cadre légal pour protéger ces informations à caractère personnel ?

Called Baseline Study, Google's project will gather anonymous genetic and molecular information to create a full picture of what a healthy human is.

The early-stage project is run by Andrew Conrad, a 50-year-old molecular biologist who pioneered cheap, high-volume tests for HIV in blood-plasma donations.

Dr. Conrad joined Google X—thecompany's research arm—in March 2013, and he has built a team of about 70-to-100 experts from fields including physiology, biochemistry, optics, imaging and molecular biology.

Other mass medical and genomics studies exist. But Baseline will amass a much larger and broader set of new data. The hope is that this will help researchers detect killers such as heart disease and cancer far earlier, pushing medicine more toward prevention rather than the treatment of illness.

"With any complex system, the notion has always been there to proactively address problems," Dr. Conrad said. "That's not revolutionary. We are just asking the question: If we really wanted to be proactive, what would we need to know? You need to know what the fixed, well-running thing should look like."

The project won't be restricted to specific diseases, and it will collect hundreds of different samples using a wide variety of new diagnostic tools. Then Google will use its massive computing power to find patterns, or "biomarkers," buried in the information. The hope is that these biomarkers can be used by medical researchers to detect any disease a lot earlier.

The study may, for instance, reveal a biomarker that helps some people break down fatty foods efficiently, helping them live a long time without high cholesterol and heart disease. Others may lack this trait and succumb to early heart attacks. Once Baseline has identified the biomarker, researchers could check if other people lack it and help them modify their behavior or develop a new treatment to help them break down fatty foods better, Dr. Conrad said.

Google has already built one of the world's largest networks of computers and data centers to serve online-search results quickly and run other data-hungry services like the video website YouTube. This computing muscle can now be used to store and crunch medical information and let other researchers access it more easily.

The US Food and Drug Administration has proposed to largely deregulate a sizable list of Class II and Class I medical devices and no longer require their makers to go through the 510(k) process.

It's been tough to identify the problems that only turn up after medicines are on the market. An experimental project is now combing through data to get earlier, more accurate warnings.

No one likes it when a new drug in people's medicine cabinets turns out to have problems — just remember the Vioxx debacle a decade ago, when the painkiller was removed from the market over concerns that it increased the risk of heart attack and stroke.

To do a better job of spotting unforeseen risks and side effects, the Food and Drug Administration is trying something new — and there's a decent chance that it involves your medical records.

It's called Mini-Sentinel, and it's a $116 million government project to actively go out and look for adverse events linked to marketed drugs. This pilot program is able to mine huge databases of medical records for signs that drugs may be linked to problems.

The usual system for monitoring the safety of marketed drugs has real shortcomings. It largely relies on voluntary reports from doctors, pharmacists, and just plain folks who took a drug and got a bad outcome.

"We get about a million reports a year that way," says Janet Woodcock, the director of the FDA's Center for Drug Evaluation and Research. "But those are random. They are whatever people choose to send us."

Accessible healthcare solutions that use just a mobile phone are being used simultaneously by patients in both developing and developed markets

A combination of virtual reality and therapy, referred to as "interreality," may help therapist better understand how patients react to stress. 

Researchers say the hybrid therapy known as “interreality” was more effective than traditional cognitive behavioral therapy, which is currently considered the gold standard for more serious anxiety or post traumatic stress disorders

After decades as a technological laggard, medicine has entered its data age. Mobile technologies, sensors, genome sequencing, and advances in analytic software now make it possible to capture vast amounts of information about our individual makeup and the environment around us. The sum of this information could transform medicine, turning a field aimed at treating the average patient into one that’s customized to each person while shifting more control and responsibility from doctors to patients.

The question is: can big data make health care better?

“There is a lot of data being gathered. That’s not enough,” says Ed Martin, interim director of the Information Services Unit at the University of California San Francisco School of Medicine. “It’s really about coming up with applications that make data actionable.”

The business opportunity in making sense of that data—potentially $300 billion to $450 billion a year, according to consultants McKinsey & Company—is driving well-established companies like Apple, Qualcomm, and IBM to invest in technologies from data-capturing smartphone apps to billion-dollar analytical systems. It’s feeding the rising enthusiasm for startups as well.

Venture capital firms like Greylock Partners and Kleiner Perkins Caufield & Byers, as well as the corporate venture funds of Google, Samsung, Merck, and others, have invested more than $3 billion in health-care information technology since the beginning of 2013—a rapid acceleration from previous years, according to data from Mercom Capital Group.