Tuesday, August 7, 2012

Voice of the Doctor - August 10

This week I will be joined by Clint McClellan (Twitter @clintmc1) who is Sr. Dir. of Strategic Marketing at Qualcomm Life and the President and Chairman of the Continua Health Alliance. HE and I will be talking about the Continua Health Alliance which is a non-profit, open industry organization of healthcare and technology companieswho are collaborating to improve personal healthcare.They are establishing a system of interoperable personal connected health solutions that will help empower everyone to enageg in their own personal health wellness amangement. Take a look at their vision video here

He and I will be discussing some fo the examples and soltuions in the personal health space and how these have eveolved from personal smartphones to dedicated gateways and what opportunities will open up for application developers?

 

There are three ways to tune in:

• Stream the show live – click the Listen Live Now to launch our Internet radio player.

• You can also call in. A few minutes before our show starts, call in the following number:  Call: 1-559-546-1880; Enter participant code: 840521#

• HealthcareNOWradio.com is now on iTunes Radio!  Stream the show live – you’ll find this station listed under News/Talk.

Monday, August 6, 2012

Larry Weed's Grand Rounds at Emory University in 1971

Amazing Larry Weed, MD's (Father of the Problem Orientated Medical record and key innovator in Problem-Oriented Medical Information System (PROMIS) )video is still available but here it is on youtube

Interesting to see how he effectively highlights the need for a well-organized problem lists for clear and sound clinical thinking. His thoughts are still relevant today and he is still engaged in the medical records arena (Lawrence Weed, father of the Problem Oriented Medical Record, looks ahead

His original article "Medical Records that Guide and Teach" (N Engl J Med. 1968;[11]278:593-600) from 1968 is still sadly behind a paywall but this more recent interview Interview with Lawrence Weed, MD—The Father of the Problem-Oriented Medical Record Looks Ahead from the Permanente Journal  and the pdf.

Worth taking the time to listen to - 50 years on....!

Friday, July 27, 2012

Moon Landing Anniversary: Pictures From Historic Apollo 11 Misson (PHOTOS)

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Anniversary of the Apollo 11 Landing on the moon set in motion with these words


First, I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the earth. No single space project in this period will be more impressive to mankind, or more important for the long-range exploration of space; and none will be so difficult or expensive to accomplish.

Sadly I do not think we have the same vision necessary to take the next giant leap

Thursday, July 12, 2012

Higgs Boson Particle and Field Explained

Not exactly medical but an area of great interest for me and one that is so fundamental to our world I thought worth talking about. If you want to get a sense of science and how little we still don't know or understand I recommend you read 

 

A Short History of Nearly Everything - Bill Bryson - available here and in digital form eBook and audio. This form the opening paragraph

Welcome. And congratulations. I am delighted that you could make it. Getting here wasn't easy, I know. In fact, I suspect it was a little tougher than you realize. To begin with, for you to be here now trillions of drifting atoms had somehow to assemble in an intricate and intriguingly obliging manner to create you. It's an arrangement so specialized and particular that it has never been tried before and will only exist this once. For the next many years (we hope) these tiny particles will uncomplainingly engage in all the billions of deft, cooperative efforts necessary to keep you intact and let you experience the supremely agreeable but generally underappreciated state known as existence. 

Worth sharing since there is a lot of interest right now following the announcement on July 4, 2012 at CERN that "CERN experiments observe particle consistent with long-sought Higgs boson"
The core of the announcement is a discovery of the heaviest boson to date at 125GeV with a 5 Sigma signal (translation - pretty sure it is an accurate reading...1 sigma means the results could be random fluctuations in the data, 3 sigma counts as an observation and a 5-sigma result is a discovery)

The results are preliminary but the 5 sigma signal at around 125 GeV we’re seeing is dramatic. This is indeed a new particle. We know it must be a boson and it’s the heaviest boson ever found,” said CMS experiment spokesperson Joe Incandela. “The implications are very significant and it is precisely for this reason that we must be extremely diligent in all of our studies and cross-checks

So what does it all mean (or how do I understand this without becoming an expert in particle & quantum physics and quantum

The history of the the Higgs Boson dates back to Peter Higgs prediction of a mass-generating Boson that was eventually given his name. Fast forward and we have been on the hunt for this elusive particle in large part because the detectors were either unable to see them at the energy levels or create sufficient energy in the collisions to generate the particle or evidence for the particle. But the Large Hadron Collider (LHC) stepped up the game and in 2011 we saw data suggestive of evidence of the particle and on Jul 4 CERN confirmed the data was even more convincing.

So what is the Higgs Boson - this page offers the top 5 winners to the competition in 1993 to produce an answer that would fit on one page to the question

‘What is the Higgs boson, and why do we want to find it?’

This explanation (<4 minuets) provides a good basic understanding of the underlying particle and physics

This animation shows the time lapse of the data as it evolved over time
And as the data was captured they applied this process to determine what they were looking at:

Monday, June 18, 2012

Method of Clinical Documentation and its Relationship to Quality

So there was a lot of interest in the paper published in JAMIA

Method of electronic health record documentation and quality of primary care published on JAMI this month. A quick summary

They evaluated 18,569 primary care visits, 234 doctors in 2007-08

Note taking Breakdown
62% of free-text notes
29% structured documentation
9% mainly dictated their notes
Quality Measures
15 coronary artery disease and diabetes measures
assessed 30 days after visit
Quality of care was worse on 3 outcome measures for doctors who dictated notes
 anti platelet medication, tobacco use documentation (22% vs 36%) and diabetic eye exam

 

Their conclusion:

EHR-assessed quality is necessarily documentation-dependent, but physicians who dictated their notes appeared to have worse quality of care than physicians who used structured EHR documentation.

My Conclusions:

I don't follow that logic - what they appeared to measure was the quality of the documentation not the quality of care? The measures are measures of documentation not of quality of care or clinical outcome.

It was not clear to me if that data might have been in the documents but was not identified (extracted) to if they reviewed all the documents and abstracted that data to determine if the data was missing or not. 

The study was carried out some time ago (2007 - 2008) - 4 years is an eternity in technology advancement. The iPhone was only launched in January 2007....look what that has done to the mobile world and telephones.

As I noted in my most recent VoiceoftheDoctor Radio Show with Dr Ruthann Litman, Dr Sidney Litman and Dr David Eibling it is the integration of solutions in a seamless way that will be successful and is measured by physician satisfaction. Turns out some doctors like dictating, some like using the keyboard and mouse, some like using speech recognition - and in the case study they are presented, some like to have a scribe/librarian/medical specialist do their keyboard interaction under their direction

The overall capture of quality elements was not great so we have not licked this problem yet (well not in 2008 anyway)

The ability to offer all methods but allow for the capture of these elements using technology is available today. This was nicely articulated in a piece just recently in HIT consultant in an interview with Carina Edwards - Understanding Clinical Language Understanding.  

The Reliant Medical Group (formerly the Fallon Clinic) did a study presented at HIMSS in 2010 comparing quality of notes and showed an increase in the quality of notes with a hybrid approach of speech over pure EHR entry and dictation. In many respects I would suggest as similar study and results..just a different interpretation

 

I maintain that choice for clinicians is the key to success - offering them the right tool that fits their personal requirements and needs adn that includes all variations of documentation capture with NLP and Clinical Language Understanding to provide the bridge between narrative content and structured data essential for the intelligent management of patients and their care

 

June Show Highlights on VoiceoftheDoctor

June 15

Speaking with Ruthann Lipman, DO from the Department of Otolaryngology, Millcreek Community Hospital and David Eibling, MD, FACS from the Department of Otolaryngology, University of Pittsburgh and VA Pittsburgh who are presenting a paper at Human Factors and Ergonomics Society (HFES) this October titled: 

"Re- engineering the Healthcare Team: Meeting the needs of Providers with Information Specialists"

June 22

Joel Selzer (@jbselz), the CEO Ozmosis will be joining me to discuss Social Media in Healthcare. Ozmosis has created a tool set that allows clincinas to engage in a secure environment allowing for easy collaboration and bringing Social media into the healthcare world

We have a list of doctors to follow on twitter and this list of docs and a listing of HIT folks who are influential in #hcsm in celebration of of Social Media Day. Certainly one of the leaders in this space - University of Maryland Medical Center has really shown what can be achieved. Even the US Army has gone created a guide for social media

Army Social Media Handbook 2012
View more documents from U.S. Army

June 29

Will round up the news from the past week including dicussion on these two papers that have created quite a stir

Escaping the EHR Trap from the NEJM (Jun 14), and

Method of EHR Documentation and Quality of Primary Care from JAMIA (May)

 

Join me on every Friday at 2:30 ET on VoiceoftheDoctor

There are three ways to tune in:

• Stream the show live – click the Listen Live Now to launch our Internet radio player.
• You can also call in. A few minutes before our show starts, call in the following number:  Call: 1-559-546-1880; Enter participant code: 840521#
• HealthcareNOWradio.com is now on iTunes Radio!  Stream the show live – you’ll find this station listed under News/Talk.