April 30, 2006
Getting Back Credit for Original Writing
I wrote a 22 Rules for Driving in Metro Detroit about 8 years ago, and thought I would revive it on the other blog I write for, Detroit Essentials. Then I searched to see how much it had spread...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 30, 2006 at 06:22 PM | Comments (0)
links for 2006-04-30
Originally posted by dhamdhere in Aashish's Blog, Apr 30, 2006 at 02:22 PM | Comments (0)
April 29, 2006
OFF-TOPIC: O'Connor Decries Republican Attacks on Courts
I found the following very scary post on the Information Clearinghouse entitled O'Connor Decries Republican Attacks on Courts. It is a transcript of a Nina Totenberg quote from a speech Sandra Day O'Connor gave recently. After talking about the implicit connections between statements by right-wing Senators that undermine judicial authority and both death threats and actual violence against Federal judges, O'Connor said:
Pointing to the experiences of developing countries and former communist countries where interference with an independent judiciary has allowed dictatorship to flourish, O’Connor said we must be ever-vigilant against those who would strongarm the judiciary into adopting their preferred policies. It takes a lot of degeneration before a country falls into dictatorship, she said, but we should avoid these ends by avoiding these beginnings.
This from a Reagan-appointed Supreme Court Justice (now ex) who was then pretty conservative. That was when "conservative" meant people who still believed in a democratic republic. Now, sad to say, it stands for fascism bordering on dictatorship.
When will we, the American people, wake up? Are we in some kind of "information paralysis" now that we can know just about everything about just about anything? If we can try to impeach a President for having an illicit affair with an adult staffer (and I was in favor of impeachment then, on moral grounds), why aren't we impeaching a President who has trampled on human and civil rights in an egregious fashion?
Originally posted by Hunscher in FutureHIT, Apr 29, 2006 at 06:07 PM | Comments (0)
links for 2006-04-29
Originally posted by dhamdhere in Aashish's Blog, Apr 29, 2006 at 02:52 PM | Comments (0)
The Killer App of 21st Century Healthcare
I've been thinking a lot recently about the state of healthcare in the United States (abysmal for rich and poor alike), and about evidence-based medicine, and how to apply the latter to fix the former. Prompt and reminder systems seem to be the key to improving healthcare in the clinic exam room and at hospital bedside. I believe the prompt & reminder system will become the "killer app" of 21st Century healthcare, revolutionizing medical practice at the grassroots level.
Disclaimer: I talk very enthusiastically in this post about a technology developed by friends and colleagues of mine and being commercialized by other friends and colleagues of mine. At present I have no financial interest in the product, but it's only because, like Butch Cassidy, "I've been working like a dog all my life and I can't seem to get a penny ahead." I think my enthusiasm is warranted, but I thought you should know my potential bias up front.
In recent months I have been working with Dr. Lee Green, a doc who teaches primary care when he's not busy delivering babies. Lee is a widely respected expert in the area ofevidence-based medicine. Over the past several years he and another doc, Don Nease, conceived of and developed a program called ClinfoTracker, a prompt & reminder system for primary care clinicians. A software engineer named Tim Morris did a lot of the heavy lifting on the programming front, but Lee and Don contributed the medical knowledge that drives the system. Don and Lee wrote it up in an article in the Journal of the American Board of Family Medicine in 2003, but the idea goes back at least to the mid-1990's. I wrote about ClinfoTracker in more detail earlier this year in response to a post in the Driving In Traffic blog about the role of Web 2.0 technologies in healthcare. I think prompt & reminder systems are important enough to deserve multiple posts, for reasons you'll understand as you read on.
The idea behind a prompt & reminder system is simple. Patients end up in the family practice doc's waiting room for many reasons, including but not limited to well-child visits, annual physicals, acute illnesses, and follow-up on secondary or tertiary care. Whenever they come in and whatever the reason, there are a lot of facts and heuristics the doc should have on her mind as she enters the examining room. These relate to the proximate cause of the visit, but also to the patient's demographics, lifestyle, employment, environmental conditions, pre-existing conditions, medications and diet. It would also be useful to have similar but less detailed information about the patient's significant others.
OK, that's the ideal. What happens in the real world? The patient's chart is in a bin outside the examining room. The clinician arrives, her mind still on the prior patient, and she looks at the chart for maybe 30 seconds as she makes the transition to the current case. If she's good at transitioning and not overwhelmed by prior events, she has about enough time to get the high points of the patient's recent history, the nurse's BP reading, and the reason for the visit before she walks into the room. If not, she acquires this information from the patient, on the fly. Either way, more often than not, she examines, diagnoses, and prescribes with insufficient information.
This scenario is arguably almost as likely to occur in an upscale setting as in an inner-city free clinic, not because it has to but because this is our standard of care. This is why we have become so good at training physicians to make decisions under trying conditions, to believe themselves at some level to be omniscient and infallible, and to do the best possible under the circumstances and move on without carrying too much baggage from prior decisions, right or wrong. It's also why we have the dismal quality of care described in the recent Rand report entitled The First National Report Card on Quality of Health Care in America. One quote that summarizes its findings:
Our study shows that everyone is at risk of receiving poor care, no matter what their condition, where they live, from whom they seek care, or what their gender, race, or financial status is.
The policy implications of these findings can be underscored by an example using profiles of two hypothetical, stereotypical patients:
- A 50-year-old white female college graduate, with private health insurance and a household income above $50,000.
- A 50-year-old black male with less than a high school education, no insurance, and a household income under $15,000.
Many would assume that the insured, female college graduate would receive substantially better care. However, given the results of our study, she would receive about 57 percent of recommended care, compared with 51 percent for the black male patient. The difference in care between these two patients is statistically significant. However, the gap between the care that each of them receives and the recommended care they should receive dwarfs the difference between them.
Not very comforting news, is it?
Let's revisit the scenario, and add one new factor. When the clinician picks up the chart and gets ready to take her 30 second look, suppose the top sheet is a summary of all the salient factors in this patient's medical and personal history. Add in the to-do items the doc herself noted the last time the patient was in the office. Top it off with up-to-the-minute evidence-based advice on the best prevention and treatment protocols that apply to this patient's situation. It's a different game altogether.
That's the advantage a prompt & reminder system provides. ClinfoTracker has been doing that for our community-based Health Centers for a few years now. I'm not a clinician, but I am a patient at one of the Health Centers, and my family physician can't imagine life without that cover sheet. My NIH Roadmap contract (of which Lee is a co-Principal Investigator) is involved in a pilot study rolling out ClinfoTracker to some primary care providers (PCPs) that take part in a practice-based research network in which our Health System participates, and there appears to be some serious competition among the PCPs to be in the first round of sites.
Docs tend to be Luddites when it comes to newfangled technology, so this level of enthusiasm is very interesting. These are docs who have signed up to do clinical research, though, and that makes them (I fear) somehat above average in their concern for the quality of care the US population is getting.
We'll soon see whether that enthusiasm carries through to the general population of PCPs. ClinfoTracker is in the process of being spun out of the University to a local startup founded by friends of mine, Cielo Systems, and will soon become manifest as a product called Cielo Clinic. (Remember the disclaimer at the top!) It may be a little while before this appears on your radar screen, wherever you are, but keep an eye out for it and give it a look when you can.
I am very curious to see if the primary care provider market is ready for products like this. Speaking personally as a primary care consumer, I can tell you that we patients are definitely ready for the quality of care that will result from their deployment.
Originally posted by Hunscher in FutureHIT, Apr 29, 2006 at 12:37 PM | Comments (0)
April 28, 2006
OFF-TOPIC: Why the Silence?
It has been a hectic couple of weeks as the semester at the School of Information wrapped up. I took a great class in applications of network theory and will be writing about that quite a bit as time goes by. The professor, Lada Adamic, is a first-year prof here and she is clearly an amazing catch for the school.
I have taken something of a hiatus from blogging during this period due both to the academic workload and the recent return to our household of my 21-year-old daughter and her 10-month old son, who is without a doubt the cutest baby ever. They have been in northern Peru where MIchelle has been teaching and doing social change work for much of the last two years.
As a result of these wonderful distractions, I have a accrued a lengthy backlog of topics I wanted to cover and blog entries to which I wanted to respond. I will either be posting a lot during the next couple weeks, or not at all due to seizing up with indecision over what to attack first.
We'll have to wait and see which way it goes.
Originally posted by Hunscher in FutureHIT, Apr 28, 2006 at 04:07 PM | Comments (0)
April 27, 2006
Being Proper with How You Dress
New roundtable blogger Prego, from Buffalo, takes his first turn with a roundtable post. In his post at Rustbelt Ramblings, expresses his displeasure with the way we all dress. According to him, we...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 27, 2006 at 07:52 PM | Comments (0)
links for 2006-04-27
Originally posted by dhamdhere in Aashish's Blog, Apr 27, 2006 at 02:37 PM | Comments (0)
The Apprentice Has Been Outsourced? Listen In...
Continuing on the theme of outscouring. I have a secret recording of the Indian Apprentice show starring Johnny Dutt. Now it's a bit hard to understand and a bit choppy, but it's still interesting to...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 27, 2006 at 12:52 AM | Comments (0)
Quick Quote on Outsourcing
Outsourcing is nothing new. We've been outsourcing fries to France for years. + Atul...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 27, 2006 at 12:52 AM | Comments (0)
Quick Quote on Outsourcing
Outsourcing is nothing new. We've been outsourcing fries to France for years. + Atul...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 27, 2006 at 12:52 AM | Comments (0)
April 26, 2006
EDS' Next Big Thing Blog: Models with Alternative Vocabularies
I often look to the EDS Fellows' Next Big Thing Blog for ideas about the future of technology. Although a bit more uneven and cursory than some of the quality blogs by mavens at Microsoft and IBM, the EDS Fellows can be counted on to be at or near the cutting edge of the IT world. A recent entry entitled EDS' Next Big Thing Blog : Models with Alternative Vocabularies is a great example, and one with tremendous practical implications for those of us in health IT and clinical research informatics.
The issue addressed in this post is the great technical challenge of enabling intelligent-appearing machine-machine interaction. I say "intelligent-appearing" because I don't personally believe machines need to possess true intelligence in order to do useful things. This allows us to beg the question of whether machines can be said to be truly intelligent. After all, if you want to maintain that Homo sapiens possesses true intelligence, the burden of proof is on you.
The barriers are not so much technical as they are semantic and cultural. Even within one natural language words and phrases have many shades of meaning, just as many different words and phrases can have the same meaning. The difficulties these ambiguities produce are manifold, as eloquently described in Furnas et al., The Vocabulary Problem in Human-System Communication: an Analysis and a Solution. Add in the complication of multiple natural languages, mix with cultural differences in interaction styles and "impedance mismatch" due to different levels of granularity and specificity, and stir in a shot each of "Not Invented Here" syndrome and turf warcraft, and you have a Julia-Child-worthy recipe for siloization.
The challenges are becoming greater as enterprises become global, integrate with global partners, and execute mergers and acquisitions. In addition to having different natural languages in different segments of the enterprise, there are legacies of diverse terminology used to describe shared concepts. We cannot expect to get everyone to use the same terms.
We need modeling tools that separate the vocabulary from the concepts. Such modeling tools would enable a shared model to be expressed in alternative terms that could be for different natural languages, or merely vocabularies of different communities using the same natural language.
I raised this issue at XML conferences back in 2000 and 2001, and suggested then that the only solution worth working toward is a unifying set of tools for federated semantics, tools that would eliminate the requirement that machines all speak the same language in order to talk to each other.
This approach has been incorporated in the Object Management Group (OMG) standard for Semantics of Business Vocabulary and Rules (SBVR). In addition, this specification provides for specification of concept semantics independent of the vocabulary by using the technologies of ontologies and Common Logic. The value of this approach is not yet appreciated in the marketplace.
It is great to know that the OMG is on the case here. To their detriment, they did produce CORBA, but then Ford produced the Edsel and Studebaker the Avanti, and while the Edsel was flop of truly massive proportions and the Avanti did only slightly better, they did portend technologies that did not reach the mainstream of the automotive world until years or in some cases a decade or more had passed. CORBA didn't quite make it in the marketplace - you had to know this was going to happen when Borland's farsighted execs hitched their star to it, as they had to the Pascal language in the '80's - but many great ideas in CORBA are now found in Web Services. Perhaps SVBR will do the same, manifesting in some as-yet-unforeseen protocol that will bridge heterogeneous semantic domains and natural languages seamlessly and without effort.
What does all this portend for health IT? First and foremost, that efforts to produce a Wurlitzer-like Mother-of-all-healthcare-vocabularies are doomed - efforts like HL7v3 and BRIDG, for example. We will learn a lot from them, but it is most unlikely they will solve the interoperability problem, because ultimately they attempt one-size-fits-all solutions.
There, I said it out loud. Now I better hope nobody hears.
What can we do within our own health IT domains? I belieive the most important task is to make sure we each have your own houses in order. Is your organization settled on a suite of standard vocabularies for representing all the various aspects of healthcare? Do you employ implementation-independent messaging protocols? Do all your business units share the job of selecting, implementing, and evangelizing standards, are are there silos that need to be toppled? Let's do what is within reach before we attempt the nearly-impossible.
Or maybe it's actually totally-impossible, in a fragmented world of providers and payers at all strata, and so many of our citizens without health insurance at all. Maybe we must first solve the political and cultural problems that result in young mothers never receiving prenatal care and adults going without diabetes and heart disease screening and counseling, before we tackle anything so abstract as an electronic medical record.
Just another (im)patient point of view...
Originally posted by Hunscher in FutureHIT, Apr 26, 2006 at 06:07 PM | Comments (0)
links for 2006-04-26
Originally posted by dhamdhere in Aashish's Blog, Apr 26, 2006 at 03:07 PM | Comments (0)
April 25, 2006
links for 2006-04-25
Originally posted by dhamdhere in Aashish's Blog, Apr 25, 2006 at 02:52 PM | Comments (0)
April 24, 2006
Quick Quote on The Lonestar State
Mess with Texas. + Atul...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 24, 2006 at 04:07 PM | Comments (0)
links for 2006-04-24
Originally posted by dhamdhere in Aashish's Blog, Apr 24, 2006 at 03:07 PM | Comments (0)
April 23, 2006
Occupational Credit and Respect for Engineers
Engineer? Why would you want to be an engineer? I've heard this said before and it really irks me. Comments like this are evidence that engineers don't get any respect even though they arguably...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 23, 2006 at 11:37 PM | Comments (0)
April 22, 2006
links for 2006-04-22
-
A move from public to private media.
Originally posted by dhamdhere in Aashish's Blog, Apr 22, 2006 at 02:52 PM | Comments (0)
April 21, 2006
Anti-Vegetarianism Revisited
So, after I posted a prior article on Anti-Vegetariansim, I received an alarming number of hits to Things I've Noticed after searching on terms having to do with being against vegetarianism. Some...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 21, 2006 at 06:07 PM | Comments (0)
links for 2006-04-21
Originally posted by dhamdhere in Aashish's Blog, Apr 21, 2006 at 02:37 PM | Comments (0)
Links for 2006-02-24 [del.icio.us]
Originally in Things I've Noticed, Apr 21, 2006 at 01:37 PM | Comments (0)
Links for 2006-02-16 [del.icio.us]
Originally in Things I've Noticed, Apr 21, 2006 at 01:37 PM | Comments (0)
Links for 2006-02-03 [del.icio.us]
Originally in Things I've Noticed, Apr 21, 2006 at 01:37 PM | Comments (0)
Links for 2006-02-02 [del.icio.us]
- Gracenote.com
A database of almost every CD! - 80's Lyrics Quiz
- Geeks to Go: Free Computer Help and Tech Support
- Grand Illusions - Homepage
- Model World | Metropolis Magazine
- Free Online Graph Paper / Grid Paper PDFs
- EarthCam - Webcam Network
Originally in Things I've Noticed, Apr 21, 2006 at 01:37 PM | Comments (0)
Links for 2006-01-31 [del.icio.us]
Originally in Things I've Noticed, Apr 21, 2006 at 01:37 PM | Comments (0)
Links for 2006-01-30 [del.icio.us]
- THE ANTI-BUSH VIDEO GAME
- WorkingForChange : About Us
- World's leading source for promising new business ideas, concepts and innovations.
- TRENDWATCHING.COM: now the world's most visited source for Consumer Trends and Insights.
- Rajesh Jain's Weblog on Emerging Technologies, Enterprises and Markets
- Return of Design - Web Color Schemes
- Web Design Tutorials, Web Development Development tutorials, references and guides
- NASA - Science@NASA
Originally in Things I've Noticed, Apr 21, 2006 at 01:37 PM | Comments (0)
Links for 2006-03-15 [del.icio.us]
- Local Weather Forecast for Royal Oak, MI (48073) - weather.com
- measuring the net | | g-metrics
- Talk Digger: find, follow and join discussions evolving on the Internet.
- AIGA Design Archives
- meebo.com
Originally in Things I've Noticed, Apr 21, 2006 at 01:37 PM | Comments (0)
April 20, 2006
Tom Cruise, Crazy Guy or Public Relations Genius?
Has Tom Cruise always been this weird? It all started with that maniacal display on the Oprah Winfrey Show, and the hits keep on coming. See Joe's take on it in his blog appropriately titled...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 20, 2006 at 05:37 PM | Comments (0)
links for 2006-04-20
Originally posted by dhamdhere in Aashish's Blog, Apr 20, 2006 at 02:22 PM | Comments (0)
Life Commences a Week from Friday
I usually don't talk about specifics in my life on my blog, but this is a landmark time in my life. I am done done done with my MBA! I began the University of Michigan Evening MBA, (focused in...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 20, 2006 at 01:07 AM | Comments (0)
April 19, 2006
links for 2006-04-19
Originally posted by dhamdhere in Aashish's Blog, Apr 19, 2006 at 02:37 PM | Comments (0)
Quick Quote on Faith
Understanding often diminishes faith. + Atul...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 19, 2006 at 02:37 AM | Comments (0)
April 18, 2006
links for 2006-04-18
-
I can see B&L visiting the MO611 class next year. Highly recommended for all second years next year!
Originally posted by dhamdhere in Aashish's Blog, Apr 18, 2006 at 02:37 PM | Comments (0)
April 17, 2006
links for 2006-04-17
-
A scathing review of the Nokia internet tablet. Thanks for trying, next!
Originally posted by dhamdhere in Aashish's Blog, Apr 17, 2006 at 02:52 PM | Comments (0)
April 16, 2006
links for 2006-04-16
Originally posted by dhamdhere in Aashish's Blog, Apr 16, 2006 at 02:52 PM | Comments (0)
Blog sharing: Detroit's French Heritage Gone Forever?
So, I've been busy this holiday weekend and I thought I'd refer you to a post I wrote on the other blog I contribute to, Detroit Essentials....25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 16, 2006 at 12:37 PM | Comments (0)
April 15, 2006
Web 2.0 and Healthcare
Matthew Holt posted an item on The Health Care Blog entitled BLOGS: And on the subject of blog collaboration. It's about more than blogs, though - although the post is brief and is really just a pointer to another post, it's a reverse Pandora's Box kind of thing. Pandora got into trouble by opening the box; we can only get in trouble for NOT opening it.
The entry to which Matthew refers is in Steve Beller's Curing Healthcare blog, where Steve has posted a proposal for linking blogs with a Wiki in support of an effort to formulate a sane, rational policy for addressing the US healthcare provisioning crisis.
<rant>
We are the only developed nation that denies healthcare to the second lowest economic stratum of our population, the working poor. I use the word "denies" rather than "fails to provide" to emphasize the fact that this shameful situation is the result of deliberate decisions based in large part on greed and cowardice, decisions made by our elected representatives, by the bureaucrats who carry out their orders, and by the faceless minions of the healthcare version of Big Business. A sin of omission, once laid bare, becomes a sin of commission if the behavior continues. I have heard a lot of talk about how this problem is too complex and difficult to solve. If you think this is the case, keep in mind that the burden of proof is on you - somehow every other developed nation has figured it out. Unless, of course, you are profiting from this mess, in which case you mean it is too complex and difficult to imagine parting with the profits you are making.
More shameful still is the fact that what healthcare we do provide is at a level of quality that is unbelievably low, so low it gave me chest pains when I learned how low it was from a recent article in the New England Journal of Medicine. I was mighty thankful when the pains went away on their own and I didn't have to seek care, knowing the odds of the system getting it right.
</rant>
OK, now that that's off my chest, what is Steve proposing? He would like to see blog entries feed into a well-organized and moderated wiki, where the ideas of many can be distilled collectively into a coherent policy document, a document that can be used as a lever to bring about the necessary changes. The current state of their wiki is already pretty impressive; you can download a PDF of the entire site content and it already is a fairly comprehensive, fact-laden, well-reasoned analysis of the problem and presentation of the proposed solution.
This is very exciting to me, but not just because some very bright people are openly collaborating on doing something good for society, something more than good by any measure. Working in an academic health center, I am surrounded by people who are doing that kind of thing, both inside the institution and in the online virtual research communities in which I take part.
No, what is exciting to me about Steve Beller's effort is that it is integrating off-the-virtual-shelf Web 2.0 technologies, namely commercially hosted blogs and wikis, in the same way we integrated PC apps with mainframes in the client/server era through middleware, and likewise are now integrating Web applications with Internet servers using COM objects and JavaBeans. Computer-supported cooperative work has been on a trajectory for fifty years now that looks something like this (incredibly oversimplified):
| Time Frame | Domain | Typical Applications/ What's Simulated? |
|---|---|---|
| late '50's-'70's | Accounting, operations research, science | Social Security Administration data processing system; ADP's paycheck factory systems Logical calculations |
| '60's-'70's | Large-scale symbolic and numeric computation and forms-based filing applications using complex databases | New York Times Editorial Archive Archiving & records management |
| '80's | Desktop tasks & routines | Lotus 1-2-3, Wordstar, Pagemaker High-order rational symbol & number manipulation; individual creative gruntwork; play |
| '80's | Individual creativity & entertainment | Arcade & adventure games, greeting-card composers High-order puzzle-solving; emotional fulfillment; personal creative expression |
| '80's-'90's | Informal communications mechanisms | The WELL, AOL, CompuServe, IRC - discussion groups & email; instant messaging Community organizing; collaborative creative expression |
| '90's-'00's | User-controlled, crudely interactive mass communication & search | Online magazines & newspapers (salon.com, economist.com); Web Portals (Yahoo, AOL, MSN); Search engines (AltaVista, HotBot, Google) Newspapers, magazines, television; library research, bookstore & library browsing |
| late '90's-'00's | Personal shopping | e-Commerce Web sites - Amazon, eBay Evaluation, negotiation - the Agora & the Casbah |
| late '90's-'00's | Social interaction; systems that become the needs of your daily life, wherever you are in it | Blogspaces (Livejournal, Blogger, Typepad), wikis (Wikipedia), Massively multi-player online games & fantasy worlds (Battlefield 2, the Sims, Second Life) Highly nuanced, synchronous & and asynchronous communication & collaboration |
So, where does healthcare fit into all this? We're definitely ensconced in everything up to and including the interactive mass communication and search domain (WebMD and cancer.gov for example). Drugstores are on their own in the e-commerce realm. In terms of online social interaction, there are some wild and woolly newsgroups and discussion fora and a small but intrepid troupe of bloggers, but the healthcare establishment virtually no presence in the social interaction arena.
Granted it is grassroots and funky to a large degree, having sprung up like a crop of mushrooms on the compost heap, is heavily weighted toward the young, and has no tried-and-true business models yet. OK, so all the for-profits and the non-profit-but-who-are-we-kidding folks should steer clear for now. But where are the researchers? Isn't research on how to communicate with the public important? Especially when everything your profession knows about how to keep healthy obviously isn't getting through to that morbidly obese, cigarette-smoking couch potato of a teenager over there who is your son or your nephew or your neighbor's kid?
It's not like it's expensive, Dr. Clinical-Translational-Researcher - or difficult - or hard to get into. Ask that teenager, or for that matter your nine-year-old or anybody's nine-year-old child, to show you where to go to set up a free blog in less time than it takes for the kid to go through a Big Grab bag of Doritos, or for you to elegantly sip through that glass of Pouilly-Fuisse '02 beside your monitor there. If you want to be a high-roller like some of us are, you can shell out $8 or so a month for a the Cadillac version of a service like Typepad.
Sure, you need funding. Pick a disease - say, for example, the one in which you specialize. Write a creative proposal and send it to one of the private foundations that funds research on that disease, or hit up the GCRC. Ask for, let's say $25-50,000 to do a pilot. Hire that couch potato for $12 an hour and make him the CTO of your research team. Get a couple of human-computer interaction and computer science grad students to be your research associates. You're in business.
The next-generation Web is open and waiting for you. the possibilities are endless. Come on in and join the fun. Remember, this is a reverse Pandora thing - we get nothing but trouble if we don't open the box.
Originally posted by Hunscher in FutureHIT, Apr 15, 2006 at 07:52 PM | Comments (0)
links for 2006-04-15
-
Someone forgot to tell HCL about agency costs and efficient capital markets.
Originally posted by dhamdhere in Aashish's Blog, Apr 15, 2006 at 02:22 PM | Comments (0)
Web 2.0 and Healthcare
Matthew Holt posted an item on The Health Care Blog entitled BLOGS: And on the subject of blog collaboration. It's about more than blogs, though - although the post is brief and is really just a pointer to another post, it's a reverse Pandora's Box kind of thing. Pandora got into trouble by opening the box; we can only get in trouble for NOT opening it.
The entry to which Matthew refers is in Steve Beller's Curing Healthcare blog, where Steve has posted a proposal for linking blogs with a Wiki in support of an effort to formulate a sane, rational policy for addressing the US healthcare provisioning crisis.
<rant>
We are the only developed nation that denies healthcare to the second lowest economic stratum of our population, the working poor. I use the word "denies" rather than "fails to provide" to emphasize the fact that this shameful situation is the result of deliberate decisions based in large part on greed and cowardice, decisions made by our elected representatives, by the bureaucrats who carry out their orders, and by the faceless minions of the healthcare version of Big Business. A sin of omission, once laid bare, becomes a sin of commission if the behavior continues. I have heard a lot of talk about how this problem is too complex and difficult to solve. If you think this is the case, keep in mind that the burden of proof is on you - somehow every other developed nation has figured it out. Unless, of course, you are profiting from this mess, in which case you mean it is too complex and difficult to imagine parting with the profits you are making.
More shameful still is the fact that what healthcare we do provide is at a level of quality that is unbelievably low, so low it gave me chest pains when I learned how low it was from a recent article in the New England Journal of Medicine. I was mighty thankful when the pains went away on their own and I didn't have to seek care, knowing the odds of the system getting it right.
</rant>
OK, now that that's off my chest, what is Steve proposing? He would like to see blog entries feed into a well-organized and moderated wiki, where the ideas of many can be distilled collectively into a coherent policy document, a document that can be used as a lever to bring about the necessary changes. The current state of their wiki is already pretty impressive; you can download a PDF of the entire site content and it already is a fairly comprehensive, fact-laden, well-reasoned analysis of the problem and presentation of the proposed solution.
This is very exciting to me, but not just because some very bright people are openly collaborating on doing something good for society, something more than good by any measure. Working in an academic health center, I am surrounded by people who are doing that kind of thing, both inside the institution and in the online virtual research communities in which I take part.
No, what is exciting to me about Steve Beller's effort is that it is integrating off-the-virtual-shelf Web 2.0 technologies, namely commercially hosted blogs and wikis, in the same way we integrated PC apps with mainframes in the client/server era through middleware, and likewise are now integrating Web applications with Internet servers using COM objects and JavaBeans. Computer-supported cooperative work has been on a trajectory for fifty years now that looks something like this (incredibly oversimplified):
| Time Frame | Domain | Typical Applications | What's Simulated? |
|---|---|---|---|
| late '50's-'70's | Accounting, operations research, science | Social Security Administration data processing system; ADP's paycheck factory systems | Logical calculations |
| '60's-'70's | Large-scale symbolic and numeric computation and forms-based filing applications using complex databases | New York Times Editorial Archive | Archiving & records management |
| '80's | Desktop tasks & routines | Lotus 1-2-3, Wordstar, Pagemaker | High-order rational symbol & number manipulation; individual creative gruntwork; play |
| '80's | Individual creativity & entertainment | Arcade & adventure games, greeting-card composers | High-order puzzle-solving; emotional fulfillment; personal creative expression |
| '80's-'90's | Informal communications mechanisms | The WELL, AOL, CompuServe, IRC - discussion groups & email; instant messaging | Community organizing; collaborative creative expression |
| '90's-'00's | User-controlled, crudely interactive mass communication & search | Online magazines & newspapers (salon.com, economist.com); Web Portals (Yahoo, AOL, MSN); Search engines (AltaVista, HotBot, Google) | Newspapers, magazines, television; library research, bookstore & library browsing |
| late '90's-'00's | Personal shopping | e-Commerce Web sites - Amazon, eBay | Evaluation, negotiation - the Agora & the Casbah |
| late '90's-'00's | Social interaction; systems that become the needs of your daily life, wherever you are in it | Blogspaces (Livejournal, Blogger, Typepad), wikis (Wikipedia), Massively multi-player online games & fantasy worlds (Battlefield 2, the Sims, Second Life) | Highly nuanced, synchronous & and asynchronous communication & collaboration |
So, where does healthcare fit into all this? We're definitely ensconced in everything up to and including the interactive mass communication and search domain (WebMD and cancer.gov for example). Drugstores are on their own in the e-commerce realm. In terms of online social interaction, there are some wild and woolly newsgroups and discussion fora and a small but intrepid troupe of bloggers, but the healthcare establishment virtually no presence in the social interaction arena.
Granted it is grassroots and funky to a large degree, having sprung up like a crop of mushrooms on the compost heap, is heavily weighted toward the young, and has no tried-and-true business models yet. OK, so all the for-profits and the non-profit-but-who-are-we-kidding folks should steer clear for now. But where are the researchers? Isn't research on how to communicate with the public important? Especially when everything your profession knows about how to keep healthy obviously isn't getting through to that morbidly obese, cigarette-smoking couch potato of a teenager over there who is your son or your nephew or your neighbor's kid?
It's not like it's expensive, Dr. Clinical-Translational-Researcher - or difficult - or hard to get into. Ask that teenager, or for that matter your nine-year-old or anybody's nine-year-old child, to show you where to go to set up a free blog in less time than it takes for the kid to go through a Big Grab bag of Doritos, or for you to elegantly sip through that glass of Pouilly-Fuisse '02 beside your monitor there. If you want to be a high-roller like some of us are, you can shell out $8 or so a month for a the Cadillac version of a service like Typepad.
Sure, you need funding. Pick a disease - say, for example, the one in which you specialize. Write a creative proposal and send it to one of the private foundations that funds research on that disease, or hit up the GCRC. Ask for, let's say $25-50,000 to do a pilot. Hire that couch potato for $12 an hour and make him the CTO of your research team. Get a couple of human-computer interaction and computer science grad students to be your research associates. You're in business.
The next-generation Web is open and waiting for you. the possibilities are endless. Come on in and join the fun. Remember, this is a reverse Pandora thing - we get nothing but trouble if we don't open the box.
Originally posted by Hunscher in FutureHIT, Apr 15, 2006 at 10:07 AM | Comments (0)
April 14, 2006
links for 2006-04-14
-
A look at the Basel Watch fair
Originally posted by dhamdhere in Aashish's Blog, Apr 14, 2006 at 02:52 PM | Comments (0)
HL7 Watch: Is HL7v3 Overrated by being rated at all?
I eagerly await new posts in Barry Weber's HL7 Watch blog. They're not all that frequent, but when they appear they are bombshells (at least in the world of healthcare ontologies). This week Barry posted two new blog entries reporting on the existing deployments of Oracle's Healthcare Transaction Base - or the lack thereof. Look! The Emperor has no clothes! ;-)
On Tuesday, Barry took apart Oracle's pronouncements about sites where its HL7v3-based Healthcare Transaction Base is deployed. They named three. Barry called the first, Byrraju Foundation, and Barry reports
...I am told that there is no V3 application running in India today and that the Byrraju Foundation is presently not using any telemedicine application that utilizes HL7.
Hmmm. Of course, the implementation could be small enough that it was unnoticeable to his contacts. If his contacts are not in positions in their organization where they would know about such an implementation, they may have overlooked something huge, but Barry is pretty well-connected worldwide with the kind of people in whose bailiwick this would lie, so I doubt it. (Barry leads the Ontology Dissemination activities of the National Center for Biomedical Ontology and co-directs the National Center for Ontological Research.) This is the only one of the three that is supposed to be live already.
He moves on to Stockholm County in Sweden, where his Swedish colleagues report:
[the first attempt, in 2005] was abandoned, ...partly because of poor performance (the new application performed significantly less well than the system it was designed to replace, even though it was being run on considerably more expensive hardware), and partly because of a lack of fault tolerance, which made it inadequate as a mechanism for integrating legacy systems marked by a high degree of variation in data quality.
They are now deploying a much smaller pilot that is targeted at handling referrals only. If moving the goal posts leads to victory, we're running at 50% so far, but if we assume the original requirements still stand we are at zero for two so far. Barry couldn't find any information on the third report, an implementation in Louisiana, so we'll assume Oracle is right about that and we're standing at one for three.
My experience with HL7v3 leads me to believe that it has some major problems stemming, oddly enough, from well-intentioned attempts to do things right. HL7 decided that most of the issues with v2.x arose because its design was driven directly from implementation-level requirements and did not capture key aspects of the domain correctly. They decided to develop a comprehensive information model and base v3 on that model. The domain is both broad and deep, though, and a comprehensive information model has proved difficult to achieve.
I gotta go for now but hopefully I will find more time to write after the semester is over, in another week or so. HL7v3 deserves a closer look. I'll try to write up my own experiences with it soon.
I wasn't focused on issues related to HL7 back then, but I'm told this effort has been going on since the late 1990's.
Originally posted by Hunscher in FutureHIT, Apr 14, 2006 at 09:07 AM | Comments (0)
April 13, 2006
"Real video iPod" delayed by display problems, studio talks - Engadget
Now I'm glad I wasn't holding out for the new Video iPod. Seems like it won't be coming out till the winter. Ah well, nothing like a nice hot Video iPod to warm the cockles of your heart this winter. I've had my current Video iPod (60GB) for about two months now and love it. The only problem I Have now is that my iPod has a larger hard drive then my Powerbook G4!!! Hint hint, if someone was thinking of a present to buy then a nice new Apple Intel Macbook Pro would be nice!
Link: "Real video iPod" delayed by display problems, studio talks - Engadget.
Note: Photo taken from www.engadget.com
Originally posted by anant in Anant's WebLog, Apr 13, 2006 at 08:52 PM | Comments (0)
Family Traditions to Pass On
Trish, this week's Roundtabler at her blog and i was the echo, talks today about a new Easter memory, (courtesy of her rommate), that had quite an emotional impact on her since it brought back...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 13, 2006 at 05:22 PM | Comments (0)
links for 2006-04-13
Originally posted by dhamdhere in Aashish's Blog, Apr 13, 2006 at 02:22 PM | Comments (0)
April 12, 2006
links for 2006-04-12
Originally posted by dhamdhere in Aashish's Blog, Apr 12, 2006 at 03:07 PM | Comments (0)
April 11, 2006
Quick Quote on Objects
Once an object creates an experience, it becomes more than an object. + Atul...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 11, 2006 at 11:22 PM | Comments (0)
links for 2006-04-11
-
So what exactly went wrong at Sun?
Originally posted by dhamdhere in Aashish's Blog, Apr 11, 2006 at 02:52 PM | Comments (0)
People Who Wear The Same Clothes Every Day
Every once in a while, I come across people at work or in school who wear the same outfits almost every day. Now, I'm assuming that they change the actual articles of clothes and just wear...25% Humor, 25% Philosophy, 25% Sociology, 25% Politics, oh and I am a car fanatic
Originally in Things I've Noticed, Apr 11, 2006 at 12:52 AM | Comments (0)
April 10, 2006
links for 2006-04-10
Originally posted by dhamdhere in Aashish's Blog, Apr 10, 2006 at 02:52 PM | Comments (0)
April 09, 2006
[UPDATED] Driving in Traffic: Blogs in the Health-O-Sphere
The Driving in Traffic blog had a great post last week about the role of Blogs in the Health-O-Sphere. It asks whether (and how) evidence-based medicine and Web 2.0 technologies can improve the quality of healthcare provided by health organizations. That strikes close to home, being a major part of the research work to which my work contributes, so I have some tentative answers to the questions she raises.
UPDATE: I forgot to mention Fard Johnmar's excellent report on healthcare blogging called The Emerging Healthcare Blogosphere: What Is It & Why Does It Matter?. It costs a few bucks, and by 'few' I mean both very affordable and way too little to compensate for the effort manifested this labor of love. Check it out. Be enlightened on a very important subject.
Carol's thoughts make a lot of sense to me. I work with a physician, Lee Green, who is a strong proponent of evidence-based medicine. He has put this into practice in the form of a program he called ClinfoTracker, developed in a multi-year collaboration with a software engineer named Tim Morris.
ClinfoTracker is a prompt and reminder system, which looks at who's coming into your clinic today and what ongoing problems and risks they have, and prepares cover sheets for their charts. It goes beyond telling you what the patient has, using evidence-based medicine to suggest what you should be doing about it - what to look for, what to ask, what to suggest, and so on. It goes beyond what the primary practice doc knows about the patient from past experience, using an elegant rule-based system component to augment simple reminders with heuristics that represent best practices and up-to-the-minute research findings. In this way the family doc can apply not just his or her own experience and wisdom, but that of the faculty of a tertiary/quaternary care center, and of the fund of knowledge under continuous development by the larger community of clinical translational researchers worldwide.
You, the primary practice doc, can look at the cover sheet for fifteen seconds before you enter the examining room, and you will be significantly better prepared for the visit than you ever would by usual practices, of which there are two main varieties: either walking into the examining room without ever looking at the chart, trusting your memory and the patient's to bring relevant issues to the fore, or walking into the room with eyes on the chart and keeping them there through much of the patient visit. Either of the current approaches tend to focus on the presenting problem, which is then dealt with symptomatically at worst, or at best with its etiology and prognosis as the limit of the visit context.
It's 10:53 AM, and you are standing outside the examining room of Mr. Baxter, a 59-year old patient recently assigned to your practice by his HMO. Mr. Baxter is here because of a bad case of sinusitis, so it's easy to forget (as if you ever knew) that he is a Type 2 diabetic who needs to have his eyes and extremities looked at and to be asked if he is checking his blood sugar regularly. If he also comes from genetic stock with a propensity for thyroid cancer, the visit also represents an opportunity to take 15-30 seconds to check for its early signs as well, an opportunity likely to be missed in the typical rushed clinic visit.
Dr. Green and his colleagues in our health system's community-based family practice centers have proven empirically that ClinfoTracker significantly reduces the chance of such missed opportunities for preventive medicine. He is now in the process of setting up a larger trial in the context of a statewide practice-based research network, a trial supported in part by the NIH Roadmap contract on which I work. A technology transfer deal is also in the works that will ultimately take this concept into the mainstream world of family practice. (More details on that when I have them in hand...)
So back to Carol's ideas about the poten