Sunday, August 16, 2009

Progress along developmental tracks for electronic health records implementation in the United States

(Health Research Policy and Systems 2009, 7:3)

David W Hollar email School of Medicine, The University of North Carolina, Chapel Hill, USA

Received: 19 September 2007
Accepted: 16 March 2009
Published: 16 March 2009


Abstract

The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States.


The electronic version of this article is the complete one and can be found online at: http://www.health-policy-systems.com/content/7/1/3

Friday, November 14, 2008

Infovell Reborn as DeepDyve to Take on Google, Yahoo, Microsoft

By Clint Boulton

Google now tracking flu trends via search

by Josh Lowensohn
November 11, 2008 2:52 PM PST

Google on Tuesday unveiled a new site to track the progress of the common cold.

Using the same keyword tracking technology found on Google Trends, it keeps an eye on people searching for queries involving the word "flu" and tracks them both by date and location.

What makes the technology so fascinating is that its data set goes back to 2003, and has been cross-referenced with the last several years of survey data from the Centers for Disease Control and Prevention (CDC). Google says that because its own system is based on a constant flow of searches as opposed to surveying techniques it's able to provide results one to two weeks faster than the CDC.

The same trending technique could be used in tandem with other organizations to track contagious viruses or threats besides the common cold, including AIDS, bird flu, and Africanized honey bees.

One limitation of the current system is that it does not track worldwide flu traffic. There is, however, quite a bit to discover from data from years prior--especially when you get several years that stack up on top of each other with similar rises and falls during certain parts of the year. According to Google's chart, we're about three weeks from hitting the heavy season, which goes until early January.

Google Flu Trends tracks flu activity across the United States.

(Credit: CNET Networks)

Friday, July 18, 2008

A Health 2.0 Overview, Through the Eyes of a New Diabetic

Written by Richard MacManus / November 26, 2007 7:36 PM /

Last Monday I found out from my doctor that I have Diabetes (probably Type 1; I need more tests to confirm), which basically means high blood sugar. It was quite a surprise, as I have no family history of diabetes and it is relatively uncommon to get Type 1 diabetes in your 30's. However, I soon discovered that diabetes affects more than 240 million people worldwide. So it is something a lot of people have. Indeed, chances are you know of someone with it or you may even have it yourself. Because it is so widespread, there is a lot of web data, social networking options and even web apps that cater to people with diabetes.

In this post, I'm somewhat selfishly going to review the diabetes sites and apps I found across the Web. But this post also serves, I hope, as an introduction to the more general topic of 'Health 2.0' - a.k.a. healthcare that uses the Internet. Over the weekend, Frank Gruber posted an excellent round-up of health 2.0 resources on the Web. Frank pointed out that the big sites, like Web MD and HealthLine, are the resources most used. But there are a lot of newer sites and apps that offer a more modern, Web 2.0 approach. He also noted that both Microsoft and Google are making moves in health 2.0. For example see our story earlier this year on Microsoft acquiring MedStory.

Defining Health 2.0

As with Web 2.0, there is a lot of debate about the meaning of the term 'health 2.0'. According to the Health 2.0 conference blog, their definition "is currently focusing on user-generated aspects of Web2.0 within health care but not directly interacting with the mainstream health care system." This means things like search, communities, and tools. As yet Health 2.0 user-generated content has not been connnected to the wider health care system - which, according to the Health 2.0 conference organizers, hasn't even adopted Web 1.0 yet!

Search

The first thing you might do if you discover you have diabetes, is do some Web searches on it. In my case my doctor and specialist had already explained the basics of the condition to me: it is fairly easily managed, via testing your blood a few times a day and injecting insulin maybe a couple of times a day (it varies by person). Also you must drastically cut your sugar intake in food and drink, and exercise moderately. There is no cure at this point for diabetes, so this routine must be followed indefinitely. So I was told all that, but still I was curious to find out everything I could... so, to the Web search engines I went!

A Google search is where I started; and at the top of the first page of results is the Wikipedia definition. This is a very thorough and long page, explaining what diabetes is and pointing to over 50 external references. A lot of people still complain about the Wikipedia as a source of reliable information, but as a starting point on diabetes it is exemplary.

My next port of call was a specialist health search engine. Frank mentioned Healia in his post, a health search engine that gives you filtering options. In my tests, it didn't really throw up much new info that I needed. WebMD had better info, but it wasn't presented very attractively.


Healia

Another 'vertical search' option for health is Kosmix, which has a kind of search-portal for many different verticals - one of which is diabetes. Now this is more like it! There are guides, images, Q&A, videos, "trusted sources", news, a forum, and more - all very nicely presented and easy to access. Even the ads were relevant to diabetes. There are a lot of areas to explore in this portal from Kosmix, making it the best search resource I found on the subject. But it will depend on what you're looking for - in my case, variety and good presentation are key factors to help me explore this new condition I have.


Kosmix Health

For more info on health search engines, see of course our network blog AltSearchEngines. Editor Charles Knight wrote a post in June reviewing health search engines (including a list of them) - his conclusion was that WebMD was best, but he also recommended revolutionhealth , CognitionSearch , Healthline , among others. TauMed is another one I've come across that I like. Finally, check out the Great Debate on health search engines on ASE.

Health 2.0 Blogs

Search is all very well for finding information, but what if you're after a more personal connection - or social groups.

The Health 2.0 Blog is a great starting point for healthcare on the Internet. It's a community blog that started in November. There's also an accompanying wiki and Facebook group.

The Diabetes Mine blog is a more personal day-to-day reflections blog about diabetes, by Amy Tenderich. The most recent post is very relevant to me - it's about being diagnosed with Type 1 in your mid-30's!

Another great site for diabetics is dLife, an attractive portal of info and forum options. It recently launched an aggregator for diabetes blogs, Blogabetes [via ScienceRoll].


dLife

There are many more blogs related to health and technology - check out the blogrolls of the above sites, or a list such as this one.

Social Networks

So what can social networks provide for diabetics? As to be expected, there are a number of Facebook groups about Diabetes - over 500 of them in fact! The biggest is 'Find a Cure for Juvenile Diabetes', which has 5,470 members. I joined up to a few of these groups, but I wanted something more.

I eventually found Tu Diabetes, an online community for people with diabetes that was created in March 2007 by Manny Hernandez using Ning. Manny describes it as a place "where the members help each other out, educate ourselves and share the steps we take every day to stay healthy while living with this very serious condition." One person described Tu Diabetes as "like 'MySpace' on insulin"! The site recently reached 1,400 members and it is a great example of a niche social network, as the below introductory video from Manny explains:



Diabetes Web Apps

SugarStats is an app that allows you to track, monitor and share your blood sugar levels "and other key statistics" online. It is based out of Hawaii and was founded by Marston Alfred, who was diagnosed with Type 1 Diabetes over 15 years ago. Normally diabetics have a paper journal in which they log the blood tests we are required to carry out 3-4 times a day. SugarStats has potentially very useful aggregation, graphing and trending tools, plus you can share your stats with relatives or other diabetics. SugarStats also has a mobile version - even Twitter integration!! For more reasons why online diabetes tracking is better than the paper-based version, see this post on the SugarStats blog.


SugarStats

There is a free and premium version from $8.29 per month (with extra features such as Food/Carb Tracking & Graphs, and SSL security). I've signed up to the free version to try it out, but I can see myself upgrading if it works well for me. Overall, SugarStats is an excellent use of web 2.0 to enhance healthcare treatment.

Health 2.0 Events

Getting back to health 2.0 in general, in recent years health 2.0 conferences and events have sprung up. There was a BarCamp-like event called HealthCamp at the end of last year (no sign of a follow-up event though). The Health 2.0 Conference was held on September 20th, 2007 in San Francisco. There's some good coverage of this event on the Diabetes Mine blog.

The next Health 2.0 conference is 3-4 March, 2008 in San Diego, and the topic is "Connecting Consumers & Providers". For more information see www.health2con.com.

Conclusion

This is a pretty indulgent post really - basically I needed to do research into diabetes management for my own purposes, and I have blogged what I discovered. But beyond that, I hope this post gives you a good idea of what is available on the Web when it comes to healthcare.

There are a lot of people much worse off than me, both in terms of diabetes (it's much tougher for children to cope with) and other health problems that people endure. Also it's still early stages in "health 2.0" - i.e. for some the Web may be of little use. But the Web is increasingly enhancing healthcare - certainly it is very useful with a condition such as diabetes, which is common worldwide and is something that can be managed on a daily basis.

I'm sure I've missed some health 2.0 and/or diabetes resources, so please add in the comments. Also if you want to discuss how the Web has helped you (or not) with a health issue you've experienced, then feel free to leave a comment.


Source: ReadWriteWeb
http://www.readwriteweb.com/archives/health_20_overview_diabetes_web.php

Wednesday, May 21, 2008

Google makes health service publicly available

By RACHEL METZ, AP Business Writer
Mon May 19, 10:24 PM ET

NEW YORK - Google's online filing cabinet for medical records opened to the public Monday, giving users instant electronic access to their health histories while reigniting privacy concerns.

Called Google Health, the service lets users link information from a handful of pharmacies and care providers, including Quest Diagnostics labs. Google plans to add more.

Similar offerings include Microsoft Corp.'s HealthVault and Revolution Health, which is backed by AOL co-founder Steve Case.

Google Health differentiates itself from the pack through its user interface and things like the public availability of its application program interface, or API, said Marissa Mayer, the Google executive overseeing the service.

Mary Adams, 45, a Cleveland Clinic patient who participated in the Google Health pilot, said that she was initially concerned about the privacy of her medical information.

Still, she felt safe enough to enroll and has been using the service for about six months, linking it with an online health management tool from the Cleveland Clinic and adding information on prescriptions and doctors to her online profile.

"I hate pieces of paper lying around my house, so I love the fact that i can log on with my normal Google login info and see everything at a glance," she said, adding that with its public availability she'll try to get her sister to use it.

The service, still a non-final "beta" version, does not include ads. But Mayer said Google doesn't plan to start placing them to support the site. A search box on Google Health pages leads to standard Google search results pages, where there are advertisements.

Besides importing records from providers, users can enhance their password-protected profiles with details such as allergies and medications, they can search for doctors and they can locate Web-based health-related tools.

Mountain View-based Google Inc. views its expansion into health records management as logical because its search engine already processes millions of requests from people trying to find information about injuries, illnesses and recommended treatments.

Before this public launch, Google stored medical records for a few thousand patient volunteers at the nonprofit Cleveland Clinic.

The health venture provides fodder for privacy watchdogs who believe Google already has too much about the interests and habits of its users in its logs of search requests and its vaults of e-mail archives.

Pam Dixon, executive director of the World Privacy Forum, said services like Google Health are troublesome because they aren't covered by the Health Insurance Portability and Accountability Act, or HIPAA.

Dixon's group issued a cautionary report on the topic in February on such third-party services.

Passed in 1996, HIPAA set strict standards for the security of medical records. Among other things, the law requires anyone seeking a patient's records by subpoena to notify the patient and give the patient an opportunity to fight the request.

By transferring records to an external service, patients could unwittingly make it easier for the government, a legal adversary or a marketing concern to obtain private information, Dixon said.

"We are in uncharted territory here. A privacy policy, I don't think, is enough to protect what needs to be protected in a doctor-patient record," Dixon said.

Mayer said, however, that users medical records "are generally speaking as safe with Google as they would be with a HIPAA-regulated entity."

During a webcast Monday, she said users' health information is stored at Google's "highest level of security" on computers that are more secure than those used for the company's search functions.

Mayer said in an interview with The Associated Press that Google will not aggregate users' health information across services so activity on the health service will not show up in search results.


Source: Yahoo News
On the Net:http://www.google.com/health

Sunday, November 4, 2007

Getting grandpa wired

By Linda Marsa
Published: October 12 2007

Although Carol Roberts’s 77-year-old mother is active and mentally sharp, she suffers from a seizure disorder that requires close monitoring. Many people in her position would move in with family or into an assisted living facility. “But she didn’t want to lose her independence”, Roberts says.

Luckily, there is an alternative: the GrandCare System, which uses strategically placed sensors to record motion in key spots of the older woman’s home, such as the bathroom, kitchen, entryway and bedroom. Roberts can then check the information on her personal computer, keeping tabs on her mother around the clock.

“This way, she can live in her own space and I don’t worry,” she says.

The system, which costs $2,395 plus $49 a month, is just one of many innovative technologies developed in recent years to help a new generation of seniors. These range from remote-controlled lighting and floor sensors to more elaborate set-ups integrating webcams and videoconferencing systems with the internet. Scientists at universities and corporate research labs are meanwhile experimenting with the next wave of gadgets to track whether seniors are taking their medicine, to help with simple household tasks, such as cooking, and to detect mobility problems and medical emergencies.

The goal is to enable the elderly to live safely and independently at home for longer. For their adult children, the point is peace of mind.

The movement even has a name: “ageing in place”. And it is gathering momentum thanks to some important demographic trends. Over the next two decades the ranks of the “oldest old”, those aged 85 and up, are expected to balloon and, in 2011, the oldest members of the baby boom generation will turn 65. This advancing age wave will place an enormous burden on healthcare systems at a time when there are growing shortages of doctors, nurses and careworkers. Assisted living and skilled nursing facilities can’t be built fast enough to accommodate everyone and, even if they could, the costs would be astronomical.

“Corporations and government policy makers realise that as the boomers age, the costs won’t be sustainable if we continue to do business the way we’re doing it right now,” says Majd Alwan, director of the Center for Ageing Services Technologies in Washington, DC.

He and other observers think the solution is to create an entirely new paradigm of care, making it possible for seniors to remain in familiar surroundings until they die. “There is an intrinsic value to the home, where the individual has a sense of accomplishment and a level of comfort that they will never replicate by moving,” says Peter Bell, executive director of the US’s National Ageing in Place Council.

New technology is paving the way and we’ve come a long way from the electronic pendants with panic buttons the elderly can press in case of an emergency. Home automation, from specialist companies such as UK-based ABB, is one area of growth. “To date, the technology has mainly been associated with high-end audio-visual systems but, for the elderly or those with disabilities, smart controls offer massive benefits,” says ABB’s Gareth Rowlands. Tasks such as running bath water to the right temperature can be controlled via voice memos or remote “clickers” and dangerous scenarios, such as water over-flowing from a bath or sink, can be prevented with alarms.

There are also several monitoring and videoconferencing systems now on the market, including not only GrandCare but also AttentiveCare, AT&T’s Remote Monitor, Quiet Care and Home Guardian. Costs are reasonable, ranging from about $200 for a no-frills sensor network to about $2,000 for more complex systems. Because these products have come on the market within the past two years, their use isn’t widespread. “But they should become more popular, especially as the systems become more integrated,” Alwan says.

Deirdre and Steve Downham are early adopters, having installed an AtteniveCare system in the home of her 87-year-old mother, Olga Zaffos. A webcam hooked up to a PC with a flat panel television monitor in Zaffos’s living room transmits images through a broadband internet connection to a dedicated computer set up in her daughter and son-in-law’s nearby home. They can tell when she’s accidentally left the front door open and, whenever she wants to chat, she simply sits down in front of the camera. The computer is set up to flash reminders about taking medication and to receive messages, including family photos, the arrival of which is signalled by a distinctive ring recognisable even to people suffering from severe dementia.

“I check on her several times a day just to make sure she’s okay,” Steve Downham says.

The system, which costs $200 to set up, plus $600-$800 for off-the-shelf equipment and $60 for the monthly subscription, was devised by three brothers after their mother, who lived hundreds of miles away, was diagnosed with Alzheimer’s disease. The family stepped up in-home care as her condition deteriorated but the monitoring and videoconferencing system allowed her to continue living on the family farm in rural Arkansas until she died of cancer in 2003 at age 86.

“I had coffee with her every morning and got her day started,” says Ken Nixon, one of the brothers and now chief executive of the Oklahoma City-based Caregiver Technologies, which makes AttentiveCare. “It made such a difference in my life and in the life of my mom because it kept her engaged and made her feel valuable.”

Remote Monitor ($199 for a starter kit, plus $9.95 a month) also uses webcams to watch over various rooms as well as motion sensors that register when certain doors open. It can even turn house lights on and off and check if someone left a coffee pot on the stove.

Quiet Care ($199 for a basic package, plus $99.95 a month for monitoring) uses five to 10 sensors positioned throughout the home – near the bedroom door, bathroom, refrigerator door or family room – to track movement. The results are input into a computer programme that maps behaviour patterns. If there is any change in daily habits, such as when a person gets out of bed or how much time he or she spends in the kitchen or bathroom, the system will send out an alarm.

And Home Guardian, developed at the University of Virginia and set to be released next year, works in a similar way, analysing footstep patterns to detect problems. Inside a book-sized box, which sits on the floor, is a sensor that measures tiny vibrations, a microprocessor that learns a person’s normal walking habits and a software programme that can spot changes. If a person falls, or begins limping or shuffling, both possible symptoms of Parkinson’s disease or arthritis, the device fires off an electronic message to a PC, which is then transmitted to a monitoring service or the caregiver.

The systems aren’t foolproof: experts worry that they can provide a false sense of security. There are privacy concerns too. “Some seniors have used a hanky to cover the camera,” Alwan says.

Still, he and others think they are better than the alternatives. “Privacy is relative and most feel it’s an acceptable price to pay to avoid being institutionalised.”

Researchers are now hard at work on even more high-tech tools to help the elderly at home. From the Aware House laboratory at the Georgia Institute of Technology, there is the Digital Family Portrait, a monitoring system that keeps family members informed about their elderly relative’s activities, health status and possible problems by creating a “visualisation” of the person’s day as they move through the house. Dude’s Magic Box is meanwhile designed to help seniors keep in contact with their grandchildren. Youngsters put an item, such as a pet hamster, in the box, where a photo is taken. Dude, a cartoon character, pops up on the screen and asks if he should send the picture, then transmits the image to a computer screen at grandma or grandpa’s home. “Both of these devices are designed to make the senior who is living alone feel less isolated and reassure their children that they’re okay,” says Elizabeth D. Mynatt, a computer scientist at Georgia Tech.

Intel’s Health Research and Innovation Group is also working on new devices, such as “presence lamps”, which are set up in the homes of seniors and caregivers and light up when either person is home. “It comforts people to know that someone is around if they need help,” says lab director Eric Dishman. Another gadget, dubbed “caller ID on steroids”, is a computer plugged into a telephone, which holds information about the key people in an elderly person’s social network; when they call, a name pops up on-screen, along with a photo and a word or two to say who they are, helping jog the memories of those with dementia. “This gives people enough confidence to answer the phone and engage in a conversation,” Dishman says.

While all the new technologies are still in their infancy, they are important first steps toward coping effectively with an aging population. “The overall thrust is to increase the quality of life and of care that seniors receive in their home and ease the burdens on their families and on society in general,” Alwan says.

This is an edited version of an article that first appeared in the Los Angeles Times

Tuesday, October 30, 2007

Microsoft Acquires Hospital IT Software From GCS




GCS offers several health-care IT products that run on Windows, including software that automates patient record keeping, billing, regulatory compliance, and clinical workflows.

Continuing its push into systems and software that promise to modernize the provisioning of health care, Microsoft (NSDQ: MSFT) said Monday that it has acquired a number of assets from Global Care Solutions -- a Bangkok-based developer of computer software used in hospitals.

Microsoft said it would take on an unspecified number of GCS employees as a result of the deal. Financial terms were not disclosed.

GCS offers several health-care IT products that run in the Microsoft Windows environment, including software that automates patient record keeping, billing, regulatory compliance, and clinical workflows. The software is designed to run atop Windows Server 2003 and SQL Server 2005.

GCS developed its software in cooperation with Bangkok's Bumrungrad hospital, which treats more than 1.2 million patients per year. In a statement, Bumrungrad CEO Mack Banner said the use of GCS technology has helped the hospital reduce average patient waiting times to just 17 minutes.

"The GCS software is a key to our service delivery, medical quality, and financial performance," said Banner.

Microsoft sees as an opportunity the fact that a growing number of health-care organizations around the world are turning to IT to reduce costs and comply with increasingly complex government regulations.

Earlier this year, the company acquired Medstory Inc. -- a developer of search engines that provide health information over the Web -- with an eye to building out its recently formed Health Solutions Group. Last year, Microsoft bought out clinical software maker Assyxxi.

Not only does health care represent a lucrative market for Microsoft, it fits with chairman Bill Gates' growing interest in tackling issues beyond computer technology. The Bill & Melinda Gates Foundation has to date contributed millions of dollars to the fights against AIDs, malaria and other diseases.