News&Views

November 30, 2008

Do Not Resist…

Engage with grace slide…talking about DNR status with family and friends during the holiday season, according to Engage With Grace: The One Slide Project. The project’s goal is to ignite public interest in this difficult discussion. Their marketing is e-perfect: the project was introduced at last month’s Health 2.0 Conference by software developer Alexandra Drane, who related her inspiring family story. Word-of-mouth publicity is generated through the project’s interactive Web site and a rally of blog postings. To spread the word beyond the Web, they ask every professional lecturer, whatever the topic of their presentation, to close their talk with a final slide (see left), which lists five end-of-life questions designed to engage reflection and thoughtful discussion. The mainstream newspaper The Boston Globe published a front page article on the project last Wednesday, Talking Turkey About Death which is freely available online.



October 9, 2007

Microsecurity on Microsoft’s HealthVault?

Filed under: — mlazoff

Last week, Microsoft unveiled HealthVault, the highly promoted collection of next-generation (Web 2.0) consumer health-related projects. Online now is a personal health records (PHR), which allows for traditional data storage within a consumer-controlled portal through which Microsoft-partnered doctors, clinics and hospitals can, with patient permission, also view the PHR and communicate information and test results back to the patient. According to a New York Times article from October 4th, Microsoft Rolls Out Personal Health Records, “The organizations that have signed up for HealthVault projects with Microsoft include the American Heart Association (AHA), Johnson & Johnson LifeScan, NewYork-Presbyterian Hospital, the Mayo Clinic and MedStar Health, a network of seven hospitals in the Baltimore-Washington region. The partner strategy is a page from Microsoft’s old playbook. Convincing other companies to build upon its technology, and then helping them do it, was a major reason Windows became the dominant personal computer operating system.” The article provides examples of several corporate collaborations: an online blood pressure management tool created by Microsoft and the AHA where data can be entered by patient or physician; a glucose monitoring tool for diabetics who use Lifescan meters; and how patients within partnered healthcare systems can receive and store test results, such as their EKGs. 

A second site feature provides access and storage facilities to selected consumer health information using their clustering HealthVault search engine, now in beta testing. Microsoft states that all searches are anonymous. The results page includes Sponsored Results. For more information, see Microsoft Debuts HealthVault, an article posted the same day on Digital Healthcare and Productivity Web site.

Privacy issues on PHRs and associated features are addressed. According to the article, ”Microsoft’s privacy principles have impressed Dr. Deborah Peel, chairwoman of the Patient Privacy Rights Foundation, a nonprofit group. In terms of patient control, and agreeing to outside audits, ‘Microsoft is setting an industry standard for privacy,’ said Dr. Peel.”

A news release on the Foundation’s Web site announces that Microsoft “sought advice” from the Foundation in preparing HealthVault and that Dr. Peel appeared with Microsoft at the press conference announcing its launch. ThePrivacyPlace.org, a multi-institution academic research technical privacy center without known relationship to Microsoft, today posted an article on their Web site questioning Is The Vault Really Protecting Your Privacy? ”When the Health Insurance Portability and Accountability Act (HIPAA) was enacted, we did not envision that private software firms would eventually want to create databases for our health records. As a result, HealthVault and other PHR systems are not subject to the same privacy and security laws to which traditional medical records are subject to in the United States because they are not ‘covered entities’ as specified in the HIPAA…Microsoft appears to have sought the counsel of physicians [Dr. Peel] who believe that patient consent is the best indicator of privacy protections. Unfortunately, most physicians do not understand the subtleties buried within healthcare privacy statements within the context of the software that implements those statements…The hype surrounding HealthVault’s privacy protections among those in the medical community must be balanced with the reality of the information security and privacy practice expressed in its public privacy statements.”



August 28, 2007

A Health and Human Blog

Filed under: — mlazoff

Earlier this month, Department of Health and Human Services’ Secretary Mike Leavitt started his own blog. In his first entry, Leavitt describes the blog as an experiment that might not last the month due to “time management considerations” — yet since then, he has written volumes about his current trip through Africa. All entries are edited and thoughtful, even though much is also self-promotional, as expected. Almost as interesting are the comments (moderated, of course).



July 9, 2007

Web Developers iPhoning In

Filed under: — mlazoff

iPhone physicians looking for ways to extend the smartphone’s clinical functionality may appreciate Apple’s Optimizing Web Applications and Content for iPhone. Web site or Web-based applications can be developed using Apple’s browser Safari Web kit engine, then accessed using the iPhone (or any Web-accessible device that uses Safari, including desktop computers).  



February 13, 2007

Ranking Relevancy

Filed under: — mlazoff

A new interface for Medline searches, ReleMed ranks citations based on the proximity of search terms to one another in adjoining or nearby sentences, brings up selected sentences from the article with the search terms highlighted, and links to the PubMed citation. Read more about it in Relemed: Sentence-level Search Engine With Relevance Score for the Medline Database of Biomedical Articles from last month’s BioMedCentral open access journal, BMC Medical Informatics and Decision Making. ReleMed is a gift from Mir Siadaty, MD at the Department of Public Health Sciences, University of Virginia School of Medicine.



January 30, 2007

The NEPSI Challenge

Physicians who already signed up for the free Web-based e-prescribing software eRx NOW, provided by the National e-Prescribing Patient Safety Initiative (NEPSI), will begin receiving their free software tomorrow (January 31). According to their online FAQs, NEPSI  is a coalition of large corporations led by Allscripts and including Dell, Google, Microsoft, Intel, SureScripts, among many others. NEPSI sponsors are investing $100 million over the next five years to provide free Allscripts’ e-prescribing software to every U.S. physician as a way to jumpstart the use of e-prescribing software, and eventually electronic medical records, to reduce preventable medication errors and overall health care costs. NEPSI says,”We are not trying to lock providers into a one-vendor solution – we have a solution that works with any Electronic Health Record, Personal Health Record or practice management system from any vendor certified by the Certification Commission on Healthcare Information Technology (CCHIT).” For more information from NEPSI, see the press release from earlier this month.

From ”Coalition Offers Doctors Free Electronic Prescriptions,” an article posted two weeks ago on Ziff-DAvis’ eWeek: “The [NEPSI] system will be able to transmit prescriptions electronically to over 95 percent of the nations’ pharmacies. Two of the health insurance companies in the coalition, Aetna and WellPoint, said that they would provide incentives for physicians to write electronic prescriptions. Another coalition member, Sprint Nextel, is offering free pocket PC phones to doctors who sign up early…The initiative is offering a free Web-based system that would instantly check prescriptions for interactions with other medications (powered by a database provided by Wolters Kluwer Health) and would also check how much a patient or plan would have to pay for a drug. Google is providing a custom search engine to help physicians find relevant information for themselves or patients. Patient information will be stored remotely so that it will not be compromised if a doctors’ phone or computer is stolen.” 

This is not the first such effort. The article recalls how, in 2004, one coalition member—health insurer giant Wellpoint—invested $42 million in an effort to provide free e-prescribing software. “Doctors took the free stuff, but did not use it for the intended purposes. Since then, however, health IT evangelists have made large headways to create more positive attitudes toward health IT. ”

That same year, a second e-prescribing initiative involving many of the same NEPSI founders, Cafe Rx, also dissolved. Digital Healthcare & Productivity’s article, Free ePrescribing S/W Initiative Stirs Interest and Debate, goes into greater detail regarding Cafe Rx and quotes several competitors who speculate regarding NEPSI’s ulterior motives, along with replies from Glen Tullman, Allscripts CEO. “Tullman is clear that neither Google nor anyone else will mine data collected as part of the eRx NOW program and use the results for marketing purposes. ‘Patients and physicians will have unique access to all the information…Google will have no access to data we receive as part of the electronic prescribing process.’ Other questions raised about the e-prescribing program focus on accessibility of patient demographics and drug formularies. Notably absent from the list of NEPSI sponsors and supporters was RxHub, a joint venture of major pharmacy-benefit management companies that provides real-time electronic connectivity to patient-specific formulary and drug-benefit information. Tullman acknowledges that many users would have to find a third party to link the prescribing software to existing practice management and billing systems, but says that eRx NOW follows established standards to make the link. ‘We’re happy to interface with any practice management system.’ Tullman also addressed the formulary question by saying that Allscripts has access to eligibility and preferred-drug lists of more than 95 percent of payers nationwide via SureScripts and through the company’s own business relationships. He said that Allscripts was having discussions with RxHub and with practice management vendor Per-Se Technologies—now a part of McKesson due to an acquisition that closed last week—to find ways to pre-populate eRxNOW.”



October 27, 2006

e-ducation

Several new archived teleconferences and webinars at American Medical Informatics Association (AMIA) e-Learning Center, along with new upcoming course offerings. Some are free, others are discounted for AMIA members. Alas, no CME credit.



August 29, 2006

iTreo

Filed under: — mlazoff

The Palmdoc Chronicles, a longstanding blog that updates physicians on new PDA hardware and software, gives instructions on how to receive medical podcasts on a Treo. PalmDoc is a self-described, “40 something year old Physician who specialises in Hemonc & Stem cell Transplantation.”



August 18, 2006

InfomORcials

Filed under: — mlazoff

From the August 14th issue of Newsweek, Lights! Camera! Incision! describes a free resource offering live and archived instructional operating room procedures, all professionally filmed with narration. OR-Live.com was created 6 years ago for a physician/surgeon market, but according to the article, “In the last year, Webcast viewership has more than doubled from 62,000 to 131,000 per week—and consumers make up 60 percent of the audience.” There are dozens of upcoming live events and hundreds of archived surgeries available, particularly on the newer procedures in cardiology, orthopedics, OB-GYN and pediatrics. Content is broad but selective. For example, a search for “appendectomy” found no videos; “ASD [atrial septal defect] repair” returned three OR-Live videos on the new transcatheter repair of ASDs from two adult and one pediatric hospital; “knee repair” returns 172 hits, most referencing the same videos of total knee replacement surgeries—both full and minimally invasive, and also several cartilage restoration procedures. The site founder describes its funding as PBS-type corporate sponsorship, but the Newsweek article suggests otherwise: the pharmaceutical and medical device companies, some employed or installed during the operations, use surgeons and patients “chosen to showcase optimal results.” 

When I accessed the site, I was unable to identify the source of funding for individual videocasts prior to actually viewing the videocast. The ones I viewed reminded me of educational promotions of hospital staff/resources and medical devices, basic CME fare (though none is offered, so there are no ACCME accreditation safeguards, such as they are); it seems that most hospital-sponsored programs are patient-oriented while most medical device-sponsored programs are directed at physicians. Features include not only narrated video clips but also automated slide shows and user interactivity. Multimedia quality using RealPlayer (the site links to free download) is excellent. OR-Live.com is owned by Internet broadcasting for healthcare company slp3D, Inc whose Web site states, “All slp3D solutions are designed to generate tangible Return on Investment in the form of increased revenue and brand awareness.” Some patients clearly love this kind of patient education and may appreciate a referral to view a particular operation or discussion, but average patients who stumble upon the site without prior knowledge are not likely to identify the promotional bias (especially without the source of funding clearly noted) or place an individual procedure into therapeutic perspective.  



August 10, 2006

YouTooTube

Filed under: — mlazoff

The potential of YouTube for something more than creative narcissismhomemade music videos, get well video cards and documentary promotions: patient education is showcased by five video clips (on using asthma inhalers and spacer devices, on blood sugar testing, and cervical cancer screening) from Builth & Llanwrtyd Medical Practice, a surgical practice in rural Mid Wales, UK. Spanish-speaking patients, and those who appreciate more artistic ventures, will appreciate Como Usar Su Inhalador and How to Recognize and Treat Fever in Children by amateur filmmaker Nathanial Smith with a team of Penn med and nursing students in Guatemala, a local family, and the local Hosptitalito Atitlan, for the Tzu’tujil people of the area—and now, the whole world.



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