Stories about: electronic medical records

Turning medicine inside out: It’s all about the data

(Mike Deal aka ZoneDancer/Flickr)

From the ashes of the demise of Google Health may yet rise a health care information system that really works — for doctors and patients alike. And let’s not forget caregivers – those responsible for the health of their children or aging parents. They need all the help they can get.

Interviewed last week for CommonHealth, WBUR.org’s health blog, Ken Mandl of the Children’s Hospital Informatics Program (CHIP) argues that Google’s effort fell short on a key ingredient: data. Mandl co-founded Children’s Hospital Boston’s open-source patient-controlled record, Indivo, and wants to see a world where medical data flows unfettered – brings real value. Here’s how he put it to CommonHealth:

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Application building for dummies: Filling unmet medical needs

Photo: fdecomite/Flickr

What do you invest in if you’re a venture capitalist looking for the next big thing? I’d invest in a company that makes it easy to create your own healthcare mobile apps. Think: the WordPress of health care applications.

I believe this is an important unmet need in medicine. As a market analyst specializing in healthcare IT, I’ve supported physicians who have an idea for an application and are trying to make it a reality. Their goals vary widely, ranging from improved communication with patients to enhanced health data analytics for decision support to streamlined workflow using administrative shortcuts.

All of these disparate ideas face a common bottleneck: the physician’s inability to quickly embody an idea as a software prototype.

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Innovation on inpatient floors: 21st century white boards

Our old white board (patient names erased for privacy)

Imagine walking into your first day of work, being introduced to a new colleague and hearing, “Here’s the person who’s going to help you solve your problem.” I was a new Project Manager in Patient Care Operations at Children’s Hospital Boston. This brief introduction to Carlos, a Patient Service Associate on 9 South, marked the beginning of a year-long journey.

The problem Carlos laid out is common in hospitals, where multiple information systems, people and tools function in a fractionated, inefficient manner, culminating in a finished product that takes a village to maintain. It’s the problem of keeping the unit’s large, white dry-erase board up to date 24/7.

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Advanced computing meets healthcare: Disruptive changes to come

(alikins/Flickr)

The recent Bio-IT World meeting featured some exciting forecasts about disruptive healthcare advances from advanced computing technology. We’re closer than ever to process streamlining, artificial intelligence and combining the best ideas from other industries. Many themes I like to blog about — clinical decision support, data visualization, patient-entered health data — were addressed provocatively in the talks. Here are some trends I’m watching.

•    New data visualization systems will increase scientific productivity. Keynote speaker Bryn Roberts of Hoffmann-La Roche demoed a futuristic, multi-touch tool for reviewing and designing compound molecules,

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Disease management meets intelligent design

At a conference in Texas a couple of years ago, I found myself – as at all good national conferences — talking to a colleague from my own institution. As we browsed the poster session, we talked about our respective work.

Eugenia Chan works in the Developmental Medicine Center at Children’s Hospital Boston, where I’m an emergency physician and health services researcher. I told Eugenia about The Online Advocate, a Web-based system I’d been developing for the past eight years. It screens patients and families for health-related social problems, provides feedback and helps them find services in their area that can assist them.

Eugenia was excited about bringing The Online Advocate to her patients.“This is really great, and I want to use it,” she said. “But I have another idea that I would like to explore with you.”

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Shadowing ADHD with web-based tools

This is how  it used to be when I saw a child with attention-deficit hyperactivity disorder: “You know, Dr. Chan, I really don’t think the medicine’s working,” the parent would tell me. “I just don’t see any difference in his behavior.”

“Well, the medicine has probably worn off by the time you see him at home,” I’d say. “What does his teacher think?”

“She hasn’t called me, so I assume there hasn’t been any trouble.” Then: “Oh—I was supposed to give her that questionnaire to fill out, wasn’t I?  I’m so sorry, I totally forgot.”

As a developmental-behavioral pediatrician specializing in ADHD, I used to have this conversation with parents at almost every single follow-up visit, leaving me frustrated.

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Using health-records technology to bring value

The shelves that used to hold Children's Hospital Boston's paper medical records now stand empty.

What does paperlessness mean? It’s about helping patients, says Daniel Nigrin, Chief Information Officer at Children’s Hospital Boston. This approach helps explain why he was named one of the InformationWeek Healthcare 25, a short list of leaders driving the healthcare IT revolution.

“The integration of a patient’s data has to be one of the topmost national priorities,” Nigrin says. “It will eventually lead to better care, and hopefully a reduction in cost.”

This need is becoming critical as healthcare reform rolls out and primary-care practices become patients’ medical homes, integrating information from

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Disruptive innovation in healthcare IT: Spreading it to the masses

Photo: Paul Anderson/Creative Commons

The term disruptive innovation – introduced by Harvard Business School’s Clayton Christensen in a 1995 article  — has been used by technology-development stakeholders to describe radical innovations and their implications for market entry strategies. Christensen describes the term on his website:

“An innovation that is disruptive allows a whole new population of consumers access to a product or service that was historically only accessible to consumers with a lot of money or a lot of skill.”

Last week I heard Christensen speak at an event hosted by Vodafone,

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Visualizing medical data: The da Vinci touch

What would Leonardo da Vinci devote his energy to if he were alive today? I am pretty sure that he would be at a hospital. He would take advantage of data of all types — genetic, vital signs, symptoms — all streaming from patients like notes on sheet music, to seek a better understanding of the human person. And likely he would present this information in a way that appeals to the senses, drawing us to examine the information landscape and revealing the action steps we need to take to improve human health.

da Vinci’s sketch book drawings investigated human physiology to the extent that was possible in his time. da Vincis of our day, with more sophisticated tools, are poised to understand the human body at a new level. I can imagine Leonardo delighting at the level of granularity offered by our technology — the sequencing of the genetic code, for example. He would want to make sense of this information. I imagine that he’d be studying informatics and techniques for graphic visualization of data to support his quest to portray human physiology.

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Fragmented care: a hospitalist’s dilemma

Without records, every patient is a black box (Image: Pedro Vera/Flickr)

Recently, I was admitting a patient to the general pediatrics service who was followed by several specialists from different hospitals, required a number of medications and was quite ill. We were obliged to start treatment immediately given the severity of his illness, but unfortunately, this was his first visit to Children’s Hospital Boston and none of his records were available to us.

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