Key Trends in the Future of Medicine: E-Patients, Communication and Technology

English: Watson demoed by IBM employees. (Photo credit: Wikipedia)

 

From the 25 October 2012 post at Blogroll

 

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Robots replacing doctors?

I’ve given hundreds of presentations and I teach at several universities about the use of social media in everyday medicine and I always highlight the importance of 1) doctor-patient relationship in person, and 2) good communication skills for doctors, but if I try to think ahead, I have to agree with Vinod Khosla that technology can replace 80% percent of the work of doctors.

Khosla believed that patients would be better off getting diagnosed by a machine than by doctors. Creating such a system was a simple problem to solve. Google’s development of a driverless smart car was “two orders of magnitude more complex” than providing the right diagnosis.

IBM’s Watson is just the perfect example here. They have been working closelywith oncologists at Memorial Sloan-Kettering Cancer Center in New York in order to see whether Watson could be used in the decision making processes of doctors regarding cancer treatments. Watson doesn’t answer medical questions, but based on the input data, it comes up with the most relevant and potential answers and the doctor has the final call. This is an important point as it can only facilitate the work of doctors, not replacing them…

..So what should we expect to see in the next decades? I think we will see amazing developments in many areas, except medicine in which small and slow steps will mark the way towards a more transparent healthcare system in which decision trees are available for everyone, online content and social media are both curated, patients are empowered, doctors are web-savvy, and collaborative barriers are gone forever. A new world in which medical students are trained to be able to deal with the rapidly evolving technologies and e-patients.

 

A great related graphic at http://envisioningtech.com/envisioning-the-future-of-health.pdf

(WordPress was not responding when an upload was attempted)

 

 

 

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Vinod Khosla: Technology Will Replace 80 Percent of Docs

An astonishing proposal.

Yes, computer algorithms are great tools, but they are just that, tools. These tools are only as good as the data and algorithms they include. Our understanding of diseases and diagnosing is not static. Hence these tools will always be imperfect.
Furthermore, I do not believe the workings of the human body can be reduced to algorithms. Individuals are more than the sum of their parts. The relationship between diseases/conditions and wellness is a bit more nuanced than “solving” a problem. Case in point is the relationship of microbes in the gut and how they affect our immune system.

This article so far has drawn 60 comments..many very worth the time of reading.

From the 31 August 2012 post at The Health Care Blog

 I recently viewed health care through the lenses of a technology entrepreneur by attending the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I was inspired to hear from Andy Grove, former CEO of Intel, listen to Thomas Goetz, executive editor of Wired magazine, and Dr. Tom Lee, founder of One Medical Group as well as ePocrates.

Not surprising, the most fascinating person, was the keynote speaker, Vinod Khosla, co-founder of Sun Microsystems as well as a partner in a couple venture capital firms.

“Health care is like witchcraft and just based on tradition.”

Entrepreneurs need to develop technology that would stop doctors from practicing like “voodoo doctors” and be more like scientists.

Health care must be more data driven and about wellness, not sick care.

Eighty percent of doctors could be replaced by machines.

Khosla assured the audience that being part of the health care system was a burden and disadvantage.  To disrupt health care, entrepreneurs do not need to be part of the system or status quo. He cited the example of CEO Jack Dorsey of Square (a wireless payment system allowing anyone to accept credit cards rather than setup a more costly corporate account with Visa / MasterCard) who reflected in a Wired magazine article that the ability to disrupt the electronic payment system which had stymied others for years was because of the 250 employees at Square, only 5 ever worked in that industry.

Khosla believed that patients would be better off getting diagnosed by a machine than by doctors. Creating such a system was a simple problem to solve. Google’s development of a driverless smart car was “two orders of magnitude more complex” than providing the right diagnosis. A good machine learning system not only would be cheaper, more accurate and objective, but also effectively replace 80 percent of doctors simply by being better than the average doctor. To do so, the level of machine expertise would need to be in the 80th percentile of doctors’ expertise.

Is it possible technology entrepreneurs can disrupt health care? He challenged any doctor in the room to counter his points.

Silence.

Was it because everyone agreed? Were the doctors in the room simply stunned? Was there a doctor in the house? And where did he get that 80 percent statistic?…

Related articles

• Why I Disagree With Vinod Khosla About Digital Health — And Hope He Succeeds Brilliantly(Forbes)

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• Vinod Khosla: Technology Will Replace 80 Percent of Docs (thehealthcareblog.com)
• Topol says machines will be vital to healthcare transformation, new doc-patient partnership (medcitynews.com)
• Sun daddy: ‘Machines will replace 80 per cent of doctors’ (go.theregister.com)
• Vinod Khosla: Maintain the Silicon Valley Vision (iamvictorio.us)

Enabling Personalized Medicine through Health Information Technology: Advancing the Integration of Information

Enabling Personalized Medicine through Health Information Technology: Advancing the Integration of Information

From the Brookings Institute Executive Summary

With federal officials pursuing the goal of a personal human genome map under $1,000 in five years (White House, 2010), it is possible to envision a future where treatments are tailored to individuals’ genetic structures, prescriptions are analyzed in advance for likely effectiveness, and researchers study clinical data in real-time to learn what works. Implementation of these regimens creates a situation where treatments are better targeted, health systems save money by identifying therapies not likely to be effective for particular people, and researchers have a better understanding of comparative effectiveness (President’s Council of Advisors on Science and Technology, 2010).

Yet despite these benefits, consumer and system-wide gains remain limited by an outmoded policy regime.  Federal regulations were developed years before recent advances in gene sequencing, electronic health records, and information technology.  With scientific innovation running far ahead of public policy, physicians, researchers, and patients are not receiving the full advantage of latest developments.  Current policies should leverage new advances in genomics and personalized medicine in order to individualize diagnosis and treatment.  Similarly, policies creating incentives for the adoption of health information technology should ensure that the invested infrastructure is one that supports new-care paradigms as opposed to automating yesterday’s health care practices.

To determine what needs to be done, a number of key leaders from government, academia, non-profit organizations, and business were interviewed about ways to promote a better use of health information technology to enable personalized medicine.  The interviews focused on policy and operational issues surrounding interoperability, standards, data sharing protocols, privacy, predictive modeling, and rapid learning feedback models.

This paper outlines the challenges of enabling personalized medicine, as well as the policy and operational changes that would facilitate connectivity, integration, reimbursement reform, and analysis of information.   Our health system requires a seamless and rapid flow of digital information, including genomic, clinical outcome, and claims data.  Research derived from clinical care must feed back into assessment in order to advance care quality for consumers.  There currently are discrete data on diagnosis, treatment, medical claims, and health outcomes that exist in parts of the system, but it is hard to determine what works and how treatments differ across subgroups.  Changes in reimbursement practices would better align incentives with effective health care practices……

A related commentary…

A commentary featured in the January 19 issue of The Journal of the American Medical Association (JAMA) from AHRQ Health IT grant recipient, Alex Krist, M.D. calls for the design of a patient-centered health information system that goes beyond the Personal Health Record.  Krist explains that in order for technology to be used, a system should be designed to help patients access health information, interpret data from multiple sources and serve as a tool to facilitate action.  Select to access the abstract.
(For suggestions on how to get this article for free or at low cost, click here)

Related articles

• ‘Digital Divide’ Appears To Exist In Adoption Of Online Personal Health Records

March 28, 2011 4:00:00 PM EDT Share

Despite increasing Internet availability, the ‘digital divide’ (disparities in access to technology) appears to exist among primary care patients adopting an online personal health record, according to a report in the March 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. “The personal health record (PHR) is an Internet-based set of tools that allows people to access and coordinate their lifelong health information,” the authors write as background information in the article..

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Health Information Technology Resources from NN/LM

The National Network of Libraries of Medicine (NN/LM), Greater Midwest Region has a Web page devoted to health information technology resources. It includes links to pdf files of the presentations at the December 2010 meeting – “EHRs and Librarians: A Symposium”.

From the web page

Health information technology (Health IT or HIT) describes the management and secure exchange of health information among consumers, providers, government entities, and insurance agencies. Electronic Health Records (EHRs) are a special focus of HIT. EHR’s can assist in maintaining an accurate picture of a patient’s health and to more securely share information between doctors. Using an EHR can replace paper medical records to maintain your health information.

Electronic Health Records (EHRs) and Personal Health Records (PHRs)

In December 2010, the GMR held a meeting called “EHRs and Librarians: A Symposium” before the fall RAC meeting in December 2010. Below are pdf files of the presentations.

Regional Extension Centers – David Sweet

Summary: Overview about what Regional Extension Centers (RECs) are doing to assist health professionals with implementation of electronic health records; what AHIMA is doing related to RECs, and possible roles for librarians.

Using New Digital Resources to Promote and Understand PHRs – Allison Vance

Summary: Learn about AHIMA’s consumer education campaign, my Personal Health Record (myPHR), and the various digital resources available to librarians interested in assisting patients and community members with learning more about PHRs and larger health literacy issues.

Implementation of a Patient Portal and MedlinePlus Connect in a Low-Income Population – Maxine Rockoff, Ph.D.

Summary: The Institute for Family Health, a network of Federally Qualified Health Centers in Manhattan, the Bronx, and the Mid-Hudson Valley, has had an electronic medical record (EMR) since 2002. In 2008, the Institute implemented the patient portal for its EMR. This talk will present research findings to date from focus groups, a Health IT Readiness Survey, usability studies, a survey of providers & staff, and a statistical analysis of patients who received access codes and those who didn’t. The talk will also describe the process of developing MedlinePlus Connect with the National Library of Medicine, as well as some preliminary information on the classes developed for patients to teach them how to use these tools.

MedlinePlus Connect: Linking Patients to Health Information – Joyce Backus

Summary: Overview and background for developing MedlinePlus Connect, a new service from the National Library of Medicine that allows electronic health records (EHR) systems to link users to information in MedlinePlus. MedlinePlus Connect delivers information about conditions and disorders, health and wellness, and prescription and over-the-counter medications to patients, families, and health care providers when it is needed. MedlinePlus Connect accepts requests for information on diagnoses (problem codes) and medications. For problem codes, MedlinePlus accepts ICD-9-CM and SNOMED CT CORE. For medications, MedlinePlus Connect accepts RXCUIs and NDCs. The API for this service conforms to the HL7 Context-Aware Knowledge Retrieval (Infobutton) Knowledge Request URL-Based Implementation specification.

The GMR has set up a listserv to continue the conversation about EHRs and PHRs. To subscribe to EMR-GMR, send the command SUBSCRIBE EMR-GMR BARACK OBAMA to listserv at uic.edu, replacing “Barack Obama” with your first and last name. Make sure the subject line is left blank.

HIT Resources

AHRQ

AHRQ National Registry Center for Health IT

AHIMA

American Health Information Management Association

Beacon Community Program

Beacon Communities will focus on specific and measureable improvement goals in the three vital areas for health systems improvement: quality, cost-efficiency, and population health.

MyPHR

MyPHR – Resources for seniors, parents, the chronically ill and more.

Health and Data Standards

Health Information Technology and Data Standards at NLM

HealthIT

The Office of the National Coordinator for Health Information Technology

HRSA Health Information Technology

U.S. Department of Health and Human Services, Health Resources and Services Administration

Overview EHR Incentive Programs

Centers for Medicaare and Medicaid Services

Regional Extension Centers (RECs)

Explanation of the the Regional Extension Center Program

Health Information Technology Resources from NN/NLM

The National Network of Libraries of Medicine (NN/LM), Greater Midwest Region has a Web page devoted to health information technology resources. It includes links to pdf files of the presentations at the December 2010 meeting – “EHRs and Librarians: A Symposium”.

From the web page

Health information technology (Health IT or HIT) describes the management and secure exchange of health information among consumers, providers, government entities, and insurance agencies. Electronic Health Records (EHRs) are a special focus of HIT. EHR’s can assist in maintaining an accurate picture of a patient’s health and to more securely share information between doctors. Using an EHR can replace paper medical records to maintain your health information.

Electronic Health Records (EHRs) and Personal Health Records (PHRs)

In December 2010, the GMR held a meeting called “EHRs and Librarians: A Symposium” before the fall RAC meeting in December 2010. Below are pdf files of the presentations.

Regional Extension Centers – David Sweet
Summary: Overview about what Regional Extension Centers (RECs) are doing to assist health professionals with implementation of electronic health records; what AHIMA is doing related to RECs, and possible roles for librarians.

Using New Digital Resources to Promote and Understand PHRs – Allison Vance
Summary: Learn about AHIMA’s consumer education campaign, my Personal Health Record (myPHR), and the various digital resources available to librarians interested in assisting patients and community members with learning more about PHRs and larger health literacy issues.

Implementation of a Patient Portal and MedlinePlus Connect in a Low-Income Population – Maxine Rockoff, Ph.D.
Summary: The Institute for Family Health, a network of Federally Qualified Health Centers in Manhattan, the Bronx, and the Mid-Hudson Valley, has had an electronic medical record (EMR) since 2002. In 2008, the Institute implemented the patient portal for its EMR. This talk will present research findings to date from focus groups, a Health IT Readiness Survey, usability studies, a survey of providers & staff, and a statistical analysis of patients who received access codes and those who didn’t. The talk will also describe the process of developing MedlinePlus Connect with the National Library of Medicine, as well as some preliminary information on the classes developed for patients to teach them how to use these tools.

MedlinePlus Connect: Linking Patients to Health Information – Joyce Backus
Summary: Overview and background for developing MedlinePlus Connect, a new service from the National Library of Medicine that allows electronic health records (EHR) systems to link users to information in MedlinePlus. MedlinePlus Connect delivers information about conditions and disorders, health and wellness, and prescription and over-the-counter medications to patients, families, and health care providers when it is needed. MedlinePlus Connect accepts requests for information on diagnoses (problem codes) and medications. For problem codes, MedlinePlus accepts ICD-9-CM and SNOMED CT CORE. For medications, MedlinePlus Connect accepts RXCUIs and NDCs. The API for this service conforms to the HL7 Context-Aware Knowledge Retrieval (Infobutton) Knowledge Request URL-Based Implementation specification.

The GMR has set up a listserv to continue the conversation about EHRs and PHRs. To subscribe to EMR-GMR, send the command SUBSCRIBE EMR-GMR BARACK OBAMA to listserv at uic.edu, replacing “Barack Obama” with your first and last name. Make sure the subject line is left blank.

Links to Health Information Technology Resources are also given

Electronic medical records not always linked to better care in hospitals, study finds

From the December 23, 2010 Eureka News Alert

Use of electronic health records by hospitals across the United States has had only a limited effect on improving the quality of medical care, according to a new RAND Corporation study.

Studying a wide mix of hospitals nationally, researchers found that hospitals with basic electronic health records demonstrated a significantly higher increase in quality of care for patients being treated for heart failure.

However, similar gains were not noted among hospitals that upgraded to advanced electronic health records, and hospitals with electronic health records did not have higher quality care among patients treated for heart attack or pneumonia.

The findings, published online by the American Journal of Managed Care, are part of a growing body of evidence suggesting that new methods should be developed to measure the impact of health information technology on the quality of hospital care…..