Friday, March 1, 2013

PatientsLikeMe Is Building A Self-Learning Healthcare System - Forbes

PatientsLikeMe Is Building A Self-Learning Healthcare System - Forbes:

Patient Advocacy sites, and social media such as twitter can be used for population health study such as the study being done at Harvard Medical School (Elysa Weitzman MD)  Social media is gaining credibility if authored by authorities and academia

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Thursday, February 28, 2013

Population Studies using Social Media

 

Physicians are using Social Media to study Populations.

The engagement of Social Media and Population Health by Harvard Medical School Assistant Professor Elyse Weitzman M.D. 

The presentation was sponsored by OREILLY Media, a niche electronic publishing firm is an American media company established by Tim O'Reilly that publishes books and Web sites and produces conferences on computer technology topics. n 1992, O'Reilly Media published one of the first popular books about the Internet, Ed Krol's Whole Internet User's Guide and Catalog.[1] O'Reilly Media also created the first web portal, the Global Network Navigator ("GNN") in 1993; it was sold to AOL in 1995, one of the first large transactions of the dot-com bubble.

 

Goal is how to engage populations and cohorts patients, children and adolescents. Communities according to disease, not just young demographic.

Working with 2Diabetes (online community-virtual) of individuals and families with diabetes..international….run by Diabetes Hand Foundation.

Individuals with most helpful information find one another in online communities. Much less expensive than classical population studies. “Goldmine” of treatments, side effects and questions. Peer-Peer information is unstructured, but can be organized with software. Open loop vs closed loop system.

2Diabetes software authorizes a personal health record controlled by  the individual. It is interactive similar to informed consent and transparency.

Diabetes management, tracking GIS maps for HgA1C. along with social status. Software also allow observation of regional  information, de-identified, with several different graphic presentations.  The information of the individual is overlayed against the regional or state level.

Social Media is an alternative means of gathering population data other than telephone survey, door-door interviews.

Despite skeptics who are naysayers about the use of social media in medicine, Professor  Weitzman proves its utility for population studies.  And the fact that OREILLY MEDIA sponsored this presentation says it all.

Social Media for Senior Citizens

 

Senior citizens often are interested in technology, however by it’s very nature it tends to discourage them.  New tech often is more complex by its very nature, especially in the Windows world. Apple became  successful with well engineered hardware married to a keep it simple mantra for its software.  They also thought out of the box, with iPhone, and iPad.

Jitterbug (a simple flip phone) catering to older patients provides a minimalistic approach in a flip cell phone with large numbers and buttons.

 

Attribution given to: “Techcrunch”

Smartphone design and apps are about to catch up with Fujitu’s Stylistic S-01 .

 

ANDROID BUT NOT AS YOU KNOW IT

Moving on to the software, this is where the phone really stands out from the Android crowd, thanks to a simplified custom UI that foregrounds key functions, tucks away complexity and does a spot of thoughtful hand-holding — with help buttons and guides and even a phone manual included on the device. The homescreen is divided up into large, clearly labelled icons that decrease in size as you scroll down to reach functions that are likely to be accessed less.

The Fujitsu S-01 form is easy to grip, and works well for arthritic hands, the touch screen requires more force to activate it, allowing the user to feel more in control, and not be subject to errors due to fine tremors..

All it needs are a Facebook app, a Twitter client, and Google apps with larger icons.

This device could greatly increase the use of mobile apps among seniors.

Fujitsu is releasing the phone in Europe (France) first.    Mention was made of the Telecom/Orange carrier that will carry the S-01 , and was found at the World Mobile Congress for a hands on demonstration.

Now Fujitsu is not the first to enter the senior mobile space. Other established players include Emporia, which basically makes simplified feature phones, and Doro, which makes a mix of devices (including dabbling in tablet software)

 

HIT & BROADBAND NEEDS

 

Why decisions from the top are often incorrect.  About ten years ago (a century in terms of Internet technology the Federal government committed to spreading broadband across the rural landscape to include and engage more people.

Congress and it’s largesse, along with considerable pork-barrel funded this effort without looking into the finer details…Heads should roll in whatever branch of the U.S. Government signed the checks.  Hopefully an Inspector General can sort this out.

Let’s move over to West Virginia:

High end Cisco Router…$ 20,000 USD installed in rural one room library  Here is a story that every citizen should cry about.  It also points out how vendors game the grant system. (Feds should not announce how much money is to be granted, until after the bidding takes place.)

Attribution given to arsTechnica , an internet publication devoted to technology.

Marmet, West Virginia is a town of 1,500 people living in a thin ribbon along the banks of the Kanawha River just below Charleston. The town's public library is only open Thursdays, Fridays, and Saturdays. It's housed in a small building the size of a trailer, which the state of West Virginia describes as an "extremely small facility with only one Internet connection." Which is why it's such a surprise to learn the Marmet Public Library runs this connection through a $15,000 to $20,000 Cisco 3945 router intended for "mid-size to large deployments," according to Cisco.

SPECIAL REPORT   (click)

West Virginia officials are accused of overspending at least $5 million of federal money on such routers, installed indiscriminately in both large institutions and one-room libraries across the state. The routers were purchased without ever asking the state's libraries, cops, and schools what they needed. And when distributed, the expensive routers were passed out without much apparent care. The small town of Clay received seven of them to serve a total population of 491 people... and all seven routers were installed within only .44 miles of each other at a total cost of more than $100,000. (yes, that was .44 miles, ie less than 1/2 mile apart.

In other words, the project has been a stellar example of what not to do and how not to do it

In total, $24 million was spent on the routers through a not-very-open bidding process under which non-Cisco router manufacturers such as Juniper and Alcatel-Lucent were not "given notice or any opportunity to bid." As for Cisco, which helped put the massive package together, the legislative auditor concluded that the company "had a moral responsibility to propose a plan which reasonably complied with Cisco's own engineering standards" but that instead "Cisco representatives showed a wanton indifference to the interests of the public in recommending using $24 million of public funds to purchase 1,164 Cisco model 3945 branch routers."

A million here, a million there

The routers in question were purchased as part of a much larger grant from the Broadband Technology Opportunities Program (BTOP), which passed out several billion dollars to help upgrade broadband networks across America as part of President Obama's initial stimulus package in 2009. West Virginia's cash was meant to wire up the many "community anchor institutions" such as libraries, schools, police, and hospitals across the state with Internet access delivered over fiber-optic lines.  Instead of "right-sizing" the routers for their intended destinations, the state group of officials charged with implementing the grant decided they would make things easy by purchasing the exact same router and installing it everywhere, even in the most rural locations they planned to reach.

(This was a widespread problem; the report notes no capacity or user needs surveys were ever done before the money was spent). Instead, the team simply ordered 77 Cisco 3945 routers at a cost of $20,661 apiece—that's one $20,000 router for every 13.7 state police employees—and sent them off to the police. (Each router can handle several hundred concurrent users.)

What was the grant team thinking?

The legislative auditor was also apparently quite peeved by this entire investigation. The auditor's office sent off a fairly testy e-mail to Cisco noting that the 3945 routers were not appropriate for most West Virginia deployments—even according to Cisco's own literature.

The auditor asked one of the legislature's network specialists if he would even want a 3945 router; the man said no because "it greatly exceeds the Legislature's needs." And yet somehow more than 1,000 of them had been sent to the very furthest, most rural corners of the state.

Debarment

The State Purchasing division should determine whether Cisco's actions in this matter fall afoul of section 5A-3-33d of the West Virginia Code, and whether the company should be barred from bidding on future projects.

The report finds plenty of blame to go around. The ultimate cause of the fiasco, it says, was the fact the grant implementers did not conduct a capacity or use study before spending $24 million. They also used a "legally unauthorized purchasing process" to buy the routers, which resulted in only modest competition for the bid. Finally, Cisco is accused of knowingly selling the state larger routers than it needed and of showing a "wanton indifference to the interests of the public."

As for that $5+ million the state could have saved, it would have paid for 104 additional miles of fiber.

A word to the wise….All those planning and implementing HIT, HIX and/or EMR deployments need a watchdog to prevent abuse of the HITECH ACT.

Wednesday, February 27, 2013

Alzheimer’s: The Coming Tsunami

 

Join us in a Demonstration of Alzheimer’s Disease

The statistics are frightening. And while this video does not truly represent Alzheimer’s disease it does show the effects of poor vision, hearing, sensory deprivation, neuropathies and auditory hallucinations.

Great Challenges attempts to examine the challenge and possible solutions

By 2020 there will be 43 million Americans over 65 and 15 million over 85 (double the figures of 1980). Almost certainly, we are facing an unprecedented number of mentally impaired citizens.

Not only will this impact the elderly, but their children who must care for them in the face of their very own challenges, in some cases still raising there own children Long term care facilities will be overwhelmed with the need, and the economics require creative thinking.

Perhaps society as a whole must care for it’s aging population by a rotating care giver community. Smaller community homes with 6-10 residents cared for by local families, and friends in addition to professional care-givers.

We have little choice but to prepare as best we can, not live in denial and think out of the box for solutions.

At today’s rate healthcare is 17% of the GDP, and even with cost constraints, the Affordable Care Act and Accountable Care Organizations, it could skyrocket.

People are uncomfortable speaking about death or imminent death…yet we must.

Did the eskimos know something we don’t?  The popular legend that the Eskimos put their old people on ice floes and set them adrift is wrong in detail, but it's not terribly far off in the broad strokes.

In good times, a healthy old person (or child or disabled person) was almost never killed or abandoned merely for being a burden. In the few recorded cases where younger family members did kill their elders without cause, they suffered social stigma, the severest punishment available in traditional Eskimo culture, which was essentially anarchic.

In hard times, older Eskimos often felt they were a burden, and asked their younger relatives to kill them.

None of this is especially comforting when your kids start making noise about putting you in the Shady Rest and how much better it would be than an ice floe. I can only suggest pointing out the economic realities: Even the Eskimos didn't do away with elders who were still providing free room and board.

Hmmmm, maybe I shouldn’t ask my sons to move out…….just yet.

 

Introduction to the Panton Principles

 

Openness and transparency along with patient-centric healthcare go hand in hand.  The copyright rules have changed, with new categories for electronic publishing and a stratification has taken place in copyright notices.  One size no longer fits all.  I call this the Reverse-Spandex theory. Copy right law has been restrictive however it was tailored for previous generations and forbid any reproduction without the author/publisher permission.  Today a Creative Commons License is ubiquitous in electronic publications, to encourage dissemination of information.

The Panton Principle should be familiar to physicians and scientists.  For physicians who are not engaged in clinical or scientific publishing, it may not be well known, but it has great significance for patient-centric medicine and in blogging about health care, and social media

Creative Commons Attribution (the short version) (the legal version).

Please watch the video: (courtesy of The Open Knowledge Foundation)

http://mirrors.creativecommons.org/presskit/buttons/88x31/png/by-nc-sa.eu.png  FAQs

In its simplest form, if the document has the Creative Commons Attribution icon you may use it without fear as long as  you give attribution to its original author.

Openness not only applies to government, but to health care, data bases, and other archived data from many scientific journals as well.

The CCA has and will accelerate the transfer of information, just as social media is accomplishing #hcsm #healthreform #glevin1

 

Will-Virtual-Assistants-Propel-the-Future-of-Medicine-Infographic.jpg (700×3047)

Will-Virtual-Assistants-Propel-the-Future-of-Medicine-Infographic.jpg 

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AAFP Suggests Delaying, Reining in Meaningful Use Stage Three Requirements -- AAFP News Now -- AAFP

AAFP Suggests Delaying, Reining in Meaningful Use Stage Three Requirements -- AAFP News Now -- AAFP:

Push back from the medical community......MU stage III will increase cost to providers to upgrade their EMRs

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7 Nutrients That Cancer-proof Your Body

7 Nutrients That Cancer-proof Your Body:

Yes Virginia, there are steps you can use to reduce your risk of Cancer.  In addition to these listed in the article:

1. Use UV blocker on your skin
2..Reduce your fat intake
3. Control your weight
4. Avoid toxic compounds, and regions that have an increase rate of cancers
5. Live in the far east
6. Do not smoke

In a time when we are hearing how much technology will help your health, the simple things still matter the most.

Men....Despite what CDC said about routine PSA testing for Prostate Cancer, doctors have refuted this advice..Listen to your doctor.

Women:  If you have a family history of Cervical Cancer, or Breast Cancer get a Pap smear once a year, and have a breast examination, as well as a BRCA test.




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Tuesday, February 26, 2013

HIPAA Security Rule

HIPAA Security Rule:  This Special Publication discusses security considerations and resources that may provide value when implementing the requirements of the HIPAA Security Rule.

http://csrc.nist.gov/publications/nistpubs/800-66-Rev1/SP-800-66-Revision1.pdf

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HIPAA Compliant Products Must Secure Protected Health Information

HIPAA Compliant Products Must Secure Protected Health Information:

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HIPAA ?  Not so on many consumer laptops.... It is overkill !

Monday, February 25, 2013

EHR users unhappy, many switching | Healthcare IT News

EHR users unhappy, many switching | Healthcare IT News: "EHR users unhappy, many switching"

Meaningful use is challenging many providers with the requirement of reporting and adding new information in their current EMR.  M.U. Stage I has been implemented, Stage II deadline is near or passed, and Stage III which is the most intrusive will be due next year (2014)

In addition to those requirements Clinical Decision Making will be the mantra for the remainder of this decade. The development of affordable Natural Language Processing will empower medical practices to integrate this aid.

For most MDs this will assist and accelerate the process by conifrming evidence based medicine and suitable references.  This may reduce medico-legal incidents.  It will also empower the addition of physician extenders.

HTE recommends that potential EMR users, and/or those considering making a switch to postopone a change at this time.  Most of the new requirements are not yet available in current systems. Potential upgrades should be verified from current vendors. Our experience has been that many vendors who promise upgrades do not deliver.  Clinical Decision Making may be available as a separate program or as a new module for your present EMR.  The most functional CDM is integrated and capable of extracting information from you current system. This reduces error and time as well as affording transparency and seamless behind the scene functionality.


Sunday, February 24, 2013

Once is Enough

 

My apologies for yesterday’s redundant content.  I am not sure what happened..must have been when I copied and pasted from my word editor into the blog… Face is red, blog is read three times….They say you have to read something three times to learn it. So that is my excuse.