tag:blogger.com,1999:blog-85347146806373972592012-01-12T15:51:05.175-05:00Healthcare from the perspective of a clinician encompassing both the capture of the clinical viewpoint as well as the technology to help clinicians capture knowledge at the point of care The thoughts expressed are my own and do not necessarily represent those of NuanceNick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.comBlogger1281100tag:blogger.com,1999:blog-8534714680637397259.post-15061697419263715342012-01-12T15:51:00.001-05:002012-01-12T15:51:05.229-05:00<div class='posterous_autopost'><div style="font-size: 15px;">The CDC has released the top causes of death&nbsp;<a href="http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf">list</a>. 14 of the top 15 have not changed much in years but Homicide finally got pushed out by&nbsp;pneumonitis.</div><p /><span style="font-size: 15px;">1. Heart Disease</span><div style="font-size: 15px;">2. Cancer<br />3. Lower respiratory diseases;&nbsp;<br />4. Stroke and related cerebrovascular diseases;&nbsp;<br />5. Accidents (unintentional injuries);&nbsp;<br />6. Alzheimer's disease;&nbsp;<br />7. Diabetes;&nbsp;<br />8. Kidney diseases;&nbsp;<br />9. Influenza and pneumonia;&nbsp;<br />10. Suicide;&nbsp;<br />11. Septicemia;&nbsp;<br />12. Chronic liver disease and cirrhosis;&nbsp;<br />13. Hypertension and related renal disease;&nbsp;<br />14. Parkinson's disease; and&nbsp;<br />15. Pneumonitis due to solids and liquids.</div><p /><div style="font-size: 15px;">The good news is that overall the death rates from these causes has dropped&nbsp;including for heart disease, cancer, stroke, and chronic lower&nbsp;respiratory disease and the oft quoted infant mortality rate also declined to an all time low of 6.14 (per 1000 births).</div><div style="font-size: 15px;">Life expectancy increased by 1 month to 78 years and 8 months</div><p /><div style="font-size: 15px;">Not clear if the trends will continue or even improve over time...and it will be interesting to see i the healthcare changes have a positive impact on these measurements</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/top-killers">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-1506169741926371534?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-37067046551309228232012-01-06T13:46:00.001-05:002012-01-06T13:46:28.174-05:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <img alt="Media_httpstatic1cons_beuig" height="162" src="http://getfile8.posterous.com/getfile/files.posterous.com/drnic/JfAlmdADpnFzADEHnwxDqfdunvlaiysgbEqmFJxuayepxskBoirhxhDxmeCj/media_httpstatic1cons_BEuiG.jpg.scaled500.jpg" width="240" /> </div> <div class="posterous_quote_citation">via <a href="http://consumerist.com/2012/01/hospital-ceo-thinks-its-perfectly-ok-to-show-patients-records-to-newspaper.html">consumerist.com</a></div> <p>Seems there is much more to this story than first meets the eye. THe HIPAA regulations unintended consequences include the price that healthcare providers pay to suffer claims such as this made with either “no comment” or “disagree and if they follow the letter of the law are unable to comment because of patient privacy regulations. </p><p>Is patient privacy....patient privacy…….no matter the consequences or are there times and ways to address issues without jeopardizing patient privacy and patient information. </p><p>THere is no easy answer but it does expose another instance where we create regulations with good intentions but end up with unfortunate and undesirable consequences</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/hospital-ceo-thinks-its-perfectly-ok-to-show">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3706704655130922823?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-86952939672366291102012-01-03T09:03:00.001-05:002012-01-03T09:03:34.189-05:00<div class='posterous_autopost'><iframe allowfullscreen="true" src="http://www.nuance.com/videoplayer/videoplayer.asp?w=640&amp;n=Nuance_video_640_360_v3_DD&amp;h=390&amp;fileType=MP4&amp;p=healthcare/healthcareVideos/&amp;autoPlay=false" frameborder="0" height="390" width="640"></iframe><div>Find out more&nbsp;<a href="http://www.nuance.com/landing-pages/healthcare/yourvoice/">here</a></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/your-voice-now-understood-giving-the-doctors">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-8695293967236629110?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-27827895491971368112011-12-20T16:08:00.001-05:002011-12-20T16:08:13.283-05:00<div class='posterous_autopost'>What is HealthIT from the Discovery Channel <br />Part 4 <p /> <embed name="flashObj" pluginspage="http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash" src="http://c.brightcove.com/services/viewer/federated_f8/271530267" type="application/x-shockwave-flash" height="412" flashvars="videoId=1281658134001&amp;playerId=271530267&amp;viewerSecureGatewayURL=https://console.brightcove.com/services/amfgateway&amp;servicesURL=http://services.brightcove.com/services&amp;cdnURL=http://admin.brightcove.com&amp;domain=embed&amp;autoStart=false&amp;" width="486" base="http://admin.brightcove.com"></embed> <p /> <a href="http://discoveryhealthcme.discovery.com/patiented/patiented.html">http://discoveryhealthcme.discovery.com/patiented/patiented.html</a> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/what-is-healthit-part-4">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2782789549197136811?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-69345220656427092432011-12-06T08:06:00.001-05:002011-12-06T08:06:27.862-05:00<div class='posterous_autopost'>What is HealthIT from the Discovery Channel <br />Part 3 <p /> <embed name="flashObj" pluginspage="http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash" src="http://c.brightcove.com/services/viewer/federated_f8/271530267" type="application/x-shockwave-flash" height="412" flashvars="videoId=1283461365001&amp;playerId=271530267&amp;viewerSecureGatewayURL=https://console.brightcove.com/services/amfgateway&amp;servicesURL=http://services.brightcove.com/services&amp;cdnURL=http://admin.brightcove.com&amp;domain=embed&amp;autoStart=false&amp;" width="486" base="http://admin.brightcove.com"></embed> <p /> <a href="http://discoveryhealthcme.discovery.com/patiented/patiented.html">http://discoveryhealthcme.discovery.com/patiented/patiented.html</a> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/what-is-healthit-part-3">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6934522065642709243?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-77352556226052479512011-12-05T08:05:00.001-05:002011-12-05T08:05:35.801-05:00<div class='posterous_autopost'><div>In an interesting response to a problem of getting the word out&nbsp;</div><p /><div>&gt;&gt;&gt;&gt;<span style="font-size: 15px; color: rgb(64, 64, 64); font-family: Trebuchet MS, Verdana, sans-serif; line-height: 19px;">Despite these compelling findings, an audit of UK hospitals in 2011 showed that, of 412 trauma patients who were ill enough to need a blood transfusion and therefore be eligible for tranexamic acid treatment, only 12 (3%) received the drug. The implementation rate in low-income and middle-income countries could well be lower still. The CRASH-2 trial results were published in this journal, widely reported in the international media, and presented at many trauma and intensive care conferences. How else could researchers reach out to practising clinicians and make them aware of this life-saving treatment?</span></div><div><span style="font-size: 15px; color: rgb(64, 64, 64); font-family: Trebuchet MS, Verdana, sans-serif; line-height: 19px;">&lt;&lt;&lt;&lt;&lt;</span></div><p /><div><a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61760-1/fulltext#close=1">http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61760-1/fulltext#close=1</a><p /></div><div>Despite the compelling evidence implementation and uptake is low so the team came up with a "viral" video to get the word out.&nbsp;</div><div>&gt;&gt;&gt;&gt;&gt;</div><div style="font-family: Trebuchet MS, Verdana, sans-serif; font-size: 13px; color: rgb(64, 64, 64); line-height: 19px;"><div class="ja50-ce-para" style="margin-bottom: 2em;">An enterprising idea that the CRASH-2 team rolls out today involves an adaptation of the concept of viral marketing—ie, a compelling&nbsp;<a href="http://crash2.lshtm.ac.uk/" class="ja50-ce-inter-ref" target="_blank" style="text-decoration: underline; color: rgb(0, 83, 158);">video</a>&nbsp;that internet users pass on to their online contacts. Drawing on the elements that tend to increase sharing (humour, surprise, emotion), the collaborators made a stop-motion animation in which a clay trauma victim, blood squirting heartily from a gaping hole in his abdomen, happily avoids imminent exsanguination by means of a timely injection. The video ends with an invitation to view the CRASH-2 trial results<span style="color: rgb(0, 0, 0); font-family: Helvetica; line-height: normal; font-size: 17px;">&lt;&lt;&lt;&lt;&lt;</span></div></div><p /><div>Expect more activities like this in the future</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/social-media-to-educate-clinicians">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-7735255622605247951?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-48085509589558893452011-11-30T10:25:00.001-05:002011-11-30T10:25:11.412-05:00<div class='posterous_autopost'>What is HealthIT from the Discovery Channel <br />Part 2 <p /> <br /><embed name="flashObj" pluginspage="http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash" src="http://c.brightcove.com/services/viewer/federated_f8/271530267" type="application/x-shockwave-flash" height="412" flashvars="videoId=1281658135001&amp;playerId=271530267&amp;viewerSecureGatewayURL=https://console.brightcove.com/services/amfgateway&amp;servicesURL=http://services.brightcove.com/services&amp;cdnURL=http://admin.brightcove.com&amp;domain=embed&amp;autoStart=false&amp;" width="486" base="http://admin.brightcove.com"></embed> <p /> <a href="http://discoveryhealthcme.discovery.com/patiented/patiented.html">http://discoveryhealthcme.discovery.com/patiented/patiented.html</a> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/what-is-healthit-part-2">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4808550958955889345?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-84500818747592988162011-11-22T17:15:00.001-05:002011-11-22T17:15:25.096-05:00<div class='posterous_autopost'>Soem interesting video presentation on HealthIT and Informatics from the Discovery Channel <p /> Part 1: <br /><embed name="flashObj" pluginspage="http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash" src="http://c.brightcove.com/services/viewer/federated_f8/271530267" type="application/x-shockwave-flash" height="412" flashvars="videoId=1281658133001&amp;playerId=271530267&amp;viewerSecureGatewayURL=https://console.brightcove.com/services/amfgateway&amp;servicesURL=http://services.brightcove.com/services&amp;cdnURL=http://admin.brightcove.com&amp;domain=embed&amp;autoStart=false&amp;" width="486" base="http://admin.brightcove.com" /> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/what-is-healthit-part-1">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-8450081874759298816?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-84062188818829805892011-11-16T23:40:00.001-05:002011-11-16T23:40:12.562-05:00<div class='posterous_autopost'><div class='p_embed p_image_embed'> <a href="http://getfile2.posterous.com/getfile/files.posterous.com/drnic/VqbD38ve10e3U3uKv3vQ9Pmtz7e9gibI3HhcDYYVhOGiyH2n8ZGUES75iF7E/IMG_1445.jpeg"><img alt="Img_1445" height="341" src="http://getfile3.posterous.com/getfile/files.posterous.com/drnic/Acm39ZwvyZb7nbYnU4fkYTundv3k29e1UVB30NpWSAjpZdEZiu1h7gy6HUj0/IMG_1445.jpeg.scaled.500.jpg" width="500" /></a> </div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/wisdom-from-the-dalai-lama">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-8406218881882980589?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-32121460696288436282011-11-16T10:13:00.001-05:002011-11-16T10:13:26.633-05:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <blockquote><div> <h3>Bank Of America Just Had The Ultimate Social Media Fail</h3> <div> <div> <div> <a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#">Julia La Roche</a> <span>|</span> <span>Nov. 15, 2011, 10:54 AM</span> <span>|</span> <span title="views">61,418</span> <span>|</span> <a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#comments"></a> <a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#comments">49</a> </div> <div> <ul> <li> <div> <span><a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#">A</a></span> <span><a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#">A</a></span> <span><a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#">A</a></span> </div> </li> <li> <a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#">&nbsp;</a> </li> <li> </li> <li> </li> <li> <span style="line-height: 1; vertical-align: baseline; display: inline-block; text-align: center;"><span style="padding-top: 0px !important; padding-right: 0px !important; padding-bottom: 0px !important; padding-left: 0px !important; margin-top: 0px !important; margin-right: 0px !important; margin-bottom: 0px !important; margin-left: 0px !important; text-indent: 0px !important; display: inline-block !important; vertical-align: baseline !important; font-size: 1px !important;"><span><a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#"><span>in</span><span><span></span><span>Share</span></span></a></span></span><span style="padding-top: 0px !important; padding-right: 0px !important; padding-bottom: 0px !important; padding-left: 0px !important; margin-top: 0px !important; margin-right: 0px !important; margin-bottom: 0px !important; margin-left: 0px !important; text-indent: 0px !important; display: inline-block !important; vertical-align: baseline !important; font-size: 1px !important;"><span><span><span><span>683</span></span></span></span></span></span> </li> <li> <span></span> </li> </ul> </div> </div> <div> <div> <p>This makes you wonder if <a href="http://www.businessinsider.com/blackboard/bank-of-america">Bank of America</a>, which is currently axing 30,000 of its staff globally, already cut their social media team.</p> <p>Or if they don't already have a social media team, they should really consider getting one after this social media fail.&nbsp;</p> <p>It's been just a week since <a href="http://www.businessinsider.com/blackboard/google">Google</a> Plus started allowing for <a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#" rel="nofollow" style="font-weight: normal; font-size: 100%; text-decoration: underline; border-bottom-color: rgb(0, 100, 0); border-bottom-style: solid; padding-bottom: 1px; color: rgb(0, 100, 0); background-color: transparent; border-bottom-width: 0.1em;"><span style="background-color: transparent; font-size: inherit; font-weight: inherit; border-bottom-width: 2px; border-bottom-style: solid; border-bottom-color: transparent; color: rgb(0, 100, 0);">companies</span></a> to have pages on the social networking site and it looks like someone already beat Bank of America to the punch, <a href="http://idealab.talkingpointsmemo.com/2011/11/bank-of-americas-google-plus-page-appears-brandjacked.php">according to Carl Franzen at Talking Points Memo</a>.</p> <p>BofA's Google Plus profile bashes the already embattled Charlotte, North Carolina-based bank. The page, which is no longer available, features unflattering pictures of former CEO <a href="http://www.businessinsider.com/blackboard/ken-lewis">Ken Lewis</a> and mocking wall posts.</p> <p><a href="http://nakedsecurity.sophos.com/2011/11/15/bogus-bank-of-america-google-plus-page-attacks-their-reputation/">One wall post said</a>, "Living under a tarp? I am too. My TARP is much bigger, however, and billions of dollars more expensive."</p> <p>It's possible that the page could have been created by the bank initially and then later hacked.&nbsp;</p> <p>However, according to <a href="http://nakedsecurity.sophos.com/2011/11/15/bogus-bank-of-america-google-plus-page-attacks-their-reputation/">Chester Wisniewski at the IT security blog NakedSecurity</a>, the page was likely created by a group that tricked Google into thinking they were Bank of America.&nbsp;</p> <p>We've included a screen shot below. [via <a href="http://idealab.talkingpointsmemo.com/2011/11/bank-of-americas-google-plus-page-appears-brandjacked.php">TalkingPointsMemo</a>]</p> <p></p><table width="200"><tr><td><div><img src="http://static5.businessinsider.com/image/4ec2885eecad049e6f00002b/bofa-google-plus.jpg" border="0" height="372" alt="BofA Google Plus" width="500" /></div><p>Image: <a href="http://idealab.talkingpointsmemo.com/2011/11/bank-of-americas-google-plus-page-appears-brandjacked.php">TalkingPointsMemo</a></p></td></tr></table><p></p> </div> </div> </div> <p> Please follow <a href="http://www.businessinsider.com/clusterstock">Clusterstock</a> on <a href="http://twitter.com/#!/clusterstock">Twitter</a> and <a href="http://facebook.com/businessinsider.clusterstock">Facebook</a>. <br />Follow Julia La Roche on <a href="http://twitter.com/SallyPancakes">Twitter</a>. <br /><a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#">Ask Julia A Question &gt;</a> </p> <div> <div> Tags: <a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#">Wall Street</a>, <a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#">Bank of America</a>, <a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#">Google </a>, <a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#">Social Media</a> | <a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11#">Get Alerts for these topics »</a> </div> </div> <h4>Advertisement:</h4> <div> <div> <div style=""><img src="http://ox-d.businessinsider.com/w/1.0/ri?ts=0c2lkPTQwOHxhdWlkPTg0Mzl8cGlkPTIyMjR8YWlkPTEyMDEyNnxwdWI9NTY0fGxpZD03MjA1Mnx0PTV8cmlkPTY0NWU2OGM1LWQ0ODktNDBhMS05YmZlLTUxNzJkMDdiZTdmZnxvaWQ9MTc5MjF8Ym09QlVZSU5HLkdVQVJBTlRFRURWT0xVTUVHT0FMfHA9MTAwMHxwYz1VU0R8YWM9VVNEfHBtPVBSSUNJTkcuQ1BNfHJ0PTEzMjE0NTU1MjB8cHI9MTAwMHxhZHY9OTQ0Mg&amp;cb=81345243" height="1" width="1" /></div> </div> </div> </div></blockquote><div class="posterous_quote_citation">via <a href="http://www.businessinsider.com/bank-of-america-google-plus-page-2011-11">businessinsider.com</a></div> <p>The power of social media - few hospitals or healthcare facilities have any focus on this area (building a web site and running and e-mail server does not count). <br />The University of Maryland Medical Center (<a href="http://www.umm.edu/)">http://www.umm.edu/)</a> springs to mind as one of the leaders in this area with an impressive outreach and connection. I'm not sure what or how they staff it but am willing obey its built into every area and not confined to one or two social media job functions. </p><p>For those hospitals considering Social Media - this presentation on slideshare is a good foundation on why this is important and what it can do for your facility and originates from the University of Maryland: </p><p /><div style=""> <strong style="display: block; margin: 12px 0 4px;"><a href="http://www.slideshare.net/edbennett/hospitals-social-media" title="Hospitals &amp; Social Media" target="_blank">Hospitals &amp; Social Media</a></strong> <iframe scrolling="no" marginheight="0" marginwidth="0" src="http://www.slideshare.net/slideshow/embed_code/1275273" frameborder="0" height="355" width="425"></iframe> <div style="padding: 5px 0 12px;"> View more <a href="http://www.slideshare.net/" target="_blank">presentations</a> from <a href="http://www.slideshare.net/edbennett" target="_blank">Ed Bennett</a> </div> </div> <p>This is not just some passing fad. It is messy and this troubles many facilities and executives as it is hard to control and manage but that is just part of our future engagement with our staff, patents and colleagues around the country and indeed world. </p><p>This train has left the station - get on board or get left behind</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/get-on-board-the-social-media-train-or-get-le">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3212146069628843628?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-90396453580424520872011-11-11T18:50:00.001-05:002011-11-11T18:50:00.186-05:00<div class='posterous_autopost'><div><a href="http://itunes.apple.com/us/app/dragon-express/id458613689?ls=1&amp;mt=12"><div class='p_embed p_image_embed'> <img alt="Id458613689" height="175" src="http://getfile0.posterous.com/getfile/files.posterous.com/drnic/ezaEZVvoET00az2J2XZNWjCGJoxjqbJjqdprV1sgDvsTIBZ8rRRTT3ltWcfM/id458613689.png" width="175" /> </div> </a>Dragon express was released this week at an amazing introductory price of $49.99. Great news for people wanting to try out Dragon on their Mac and for anyone who wants to effectively speech enable their applications especially social media.</div><p /><div>The App store has made the ease of purchase an installation a breeze and finding the app and installing is as simple as clicking the Dragon Express Logo&nbsp;<div class='p_embed p_image_embed'> <img alt="Pastedgraphic-2" height="18" src="http://getfile7.posterous.com/getfile/files.posterous.com/drnic/UxqyyTC2Kl6J873YR9HGQgcBxw6V3Inz6NVJfn91eQRQznJsenGpFob6MV1D/PastedGraphic-2.tiff.converted.jpg" width="18" /> </div> or this&nbsp;<a href="http://itunes.apple.com/us/app/dragon-express/id458613689?ls=1&amp;mt=12">link</a>&nbsp;(which will take you to the web page and open up your App Store).</div><p /><div>Watch the application in action&nbsp;with Peter Mahoney - the Dragon Dictator</div><div><iframe allowfullscreen="true" src="http://www.youtube.com/embed/1IYvfzNoyxI" frameborder="0" height="315" width="420"></iframe></div><p /><div>There has been good coverage &nbsp;from&nbsp;<a href="http://gigaom.com/apple/get-a-taste-of-siri-on-os-x-with-nuances-dragon-express/">GigOM</a>,&nbsp;<a href="http://arstechnica.com/apple/news/2011/11/dragon-express-offers-lion-users-lower-cost-speech-to-text.ars">Ars Technica</a>,&nbsp;<a href="http://www.macworld.com/article/163522/2011/11/dragon_express_mac_transcription_for_less.html">MacWorld</a>&nbsp;and&nbsp;<a href="http://www.cultofmac.com/129153/dragon-express-brings-siri-like-speech-to-text-to-your-mac/">Cult-of-theMac</a>&nbsp;to mention a few and has done well in the App store rankings reaching #8 (behind 7 apple applications and one other "Growl"). Not bad for the first day</div><p /><div><div class='p_embed p_image_embed'> <a href="http://getfile1.posterous.com/getfile/files.posterous.com/drnic/ST5Lreoo2Iyqv1sE0UHXede0H7kw9YwmauedE43LxJL0EAhhu1HVgQ7HmYWF/PastedGraphic-1.png"><img alt="Pastedgraphic-1" height="291" src="http://getfile2.posterous.com/getfile/files.posterous.com/drnic/17rVkR53a4V4u5dxKI6cfVXk1pE1X9SO3wSGWxQDSAEsvtXPt1a5Q4CmPT5D/PastedGraphic-1.png.scaled.500.jpg" width="500" /></a> </div> </div><div>Let me know what you think and how you get on with the application</div><p></p><p><div class='p_embed p_image_embed'> <a href="http://getfile5.posterous.com/getfile/files.posterous.com/drnic/0xyopBKS29vbw0CaUZjK4rOXmSNKS1FeYPpbXAske7Bcw5ElgL47dtkFsxRh/mzl.tjipblwm.800x500-75.jpeg"><img alt="Mzl" height="313" src="http://getfile6.posterous.com/getfile/files.posterous.com/drnic/I8qIP9zPMLNJy83lXhywn1J9AXeCq9180LBgr0pswyvFBG09DWhfjt2Am8al/mzl.tjipblwm.800x500-75.jpeg.scaled.500.jpg" width="500" /></a> <a href="http://getfile1.posterous.com/getfile/files.posterous.com/drnic/vQ5L4heuqT8Qn8scxrv5GxKHkkmG3STbhafyjwJiEcAvFjyyk3Q788m2SXbB/mzl.tyxiywwx.800x500-75.jpeg"><img alt="Mzl" height="313" src="http://getfile2.posterous.com/getfile/files.posterous.com/drnic/41x1fHCfSNzImho4zoEcgDK7ymnRd1oUHu0pcQxKFhAxqDAoKCySSC01GmGZ/mzl.tyxiywwx.800x500-75.jpeg.scaled.500.jpg" width="500" /></a> <div class='p_see_full_gallery'><a href="http://drnic.posterous.com/dragon-express-available-now-in-the-app-store">See the full gallery on Posterous</a></div> </div> </p> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/dragon-express-available-now-in-the-app-store">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-9039645358042452087?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-62447094726775125552011-11-09T14:33:00.001-05:002011-11-09T14:33:24.052-05:00<div class='posterous_autopost'>Brian Dolan thinks so:<div><a href="http://mobihealthnews.com/13860/siri-iphones-new-personal-health-assistant/">http://mobihealthnews.com/13860/siri-iphones-new-personal-health-assistant/</a></div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div>Based on our own in-house testing here at MobiHealthNews, Siri in its current form could be helpful to both patients and healthcare providers alike. After asking&nbsp;Siri a number of questions, we were surprised how she answered some and that she was able to answer others.</div><p /></blockquote>And even for coding in OCD-9<div><div style=""><div class='p_embed p_image_embed'> <a href="http://getfile7.posterous.com/getfile/files.posterous.com/drnic/2sI3OK4dugrpa9owsQv5xvS8veQLvQXJ0HuehhqOKQ2j8PSvfalcvF4fNpAh/heartfailure.jpg"><img alt="Heartfailure" height="375" src="http://getfile8.posterous.com/getfile/files.posterous.com/drnic/VH16vqGRG1ye0uEPrBSccYD0Tdg6XGK9K2quLlMKJghFO2Hl22tkeakICWF4/heartfailure.jpg.scaled.500.jpg" width="500" /></a> </div> </div></div><p /><div style="">For health and diet</div><p /><p /><div style="">Release a product and people will find new and unimagined ways to use it. We are only just starting to scratch the surface of the potential</div><p /><p /><p></p><p><div class='p_embed p_image_embed'> <a href="http://getfile3.posterous.com/getfile/files.posterous.com/drnic/mGO8F083htUl1LEMmB6AemD9IcXE5w13puMYjMonEEeT1oUwVKg9nKWaWz5Q/coke.jpg"><img alt="Coke" height="375" src="http://getfile5.posterous.com/getfile/files.posterous.com/drnic/NJ2kqlTEnEG6CTUkDx3wNt70eGUMJCjXZ1a7upDssMmrAKYMkCREXBqBYj8p/coke.jpg.scaled.500.jpg" width="500" /></a> <a href="http://getfile9.posterous.com/getfile/files.posterous.com/drnic/C1636cmjgtvn903RlVh1B9bxBC3iTFQ23Sb3QFe02WEEHMaUGIGrdWtwKvuJ/weightloss.jpg"><img alt="Weightloss" height="375" src="http://getfile0.posterous.com/getfile/files.posterous.com/drnic/JyikwWZCSy8hBlnqhv2uChv0hUurE4lQHeX8vEvKjJGVaYsjIFIJp48cAP2l/weightloss.jpg.scaled.500.jpg" width="500" /></a> <div class='p_see_full_gallery'><a href="http://drnic.posterous.com/is-siri-the-new-personal-health-assistant-and">See the full gallery on Posterous</a></div> </div> </p> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/is-siri-the-new-personal-health-assistant-and">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6244709472677512555?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-19050515851448239722011-11-08T08:53:00.001-05:002011-11-08T08:53:45.874-05:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <img alt="Media_httpstatic5busi_dvqoa" height="638" src="http://getfile2.posterous.com/getfile/files.posterous.com/drnic/xxJxoIcteotBkskdFbhhHFvdFwzDfBCxrfusFtFygBGkkrxtewpxfCjqckCj/media_httpstatic5busi_Dvqoa.png.scaled500.png" width="450" /> </div> <div class="posterous_quote_citation">via <a href="http://www.businessinsider.com/the-one-chart-you-need-to-see-to-understand-mobile-2011-11?utm_source=%23frankguillen&amp;utm_medium=twitter&amp;utm_campaign=FrankGuillen+Buzz">businessinsider.com</a></div> <p>The "Blue Ocean" (non-smart phones ripe for putting smart phones in the hands of users) is "huge". There remains much opportunity in the mobile market place but the penetration is increasing for Apple and Android with Android on a tear with its open-source strategy. <br />Mobiel devices are the mainstay of communication tools for people and as these increase in penetration and function voice integration and in particular the addition of intelligent interaction will become increasingly important and necessary. <br />I imagine the speech recognition business opportunity chart would look very similar offering the potential for a ver exciting and dynamic upcoming year. <br />Once again - its so great to be in a cool business that's growing so dramatically.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/the-one-chart-you-need-to-see-to-understand-m">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-1905051585144823972?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-83065264822603878912011-11-08T08:41:00.001-05:002011-11-08T08:41:23.639-05:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <a href="http://getfile9.posterous.com/getfile/files.posterous.com/drnic/xFBIAawJCtvhclxIhjxmCEecJbztxDopHtFtbrkFzvttblxuncpCEHwmFxFs/media_httpimagesintel_flJoB.png.scaled1000.png"><img alt="Media_httpimagesintel_fljob" height="419" src="http://getfile8.posterous.com/getfile/files.posterous.com/drnic/xFBIAawJCtvhclxIhjxmCEecJbztxDopHtFtbrkFzvttblxuncpCEHwmFxFs/media_httpimagesintel_flJoB.png.scaled500.png" width="500" /></a> </div> <div class="posterous_quote_citation">via <a href="http://www.freep.com/article/20111108/BUSINESS01/111080344/Improved-systems-vehicle-voice-recognition-coming">freep.com</a></div> <p>Cars that understand what you say....coming to a car near you. <br />Part of the ongoing push and the new age of speech recognition is the ability to understand what the driver asks for with interpretive system that include natural language processing (NLP) and some element of Artificial Intelligence (AI) to offer drivers a more conversational and useful interaction with their voice. A safer interaction that will be easier and faster.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/improved-systems-for-vehicle-voice-recognitio">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-8306526482260387891?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-2007656943133514752011-11-07T14:23:00.001-05:002011-11-07T14:23:26.198-05:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <img alt="Media_httpwwwadvisory_bccaj" height="110" src="http://getfile1.posterous.com/getfile/files.posterous.com/drnic/tElJiizCAHlyzeeaAyDJcdqduGlisFsDbaIIoHaxlkknpruvwgxGDvrmApJc/media_httpwwwadvisory_bCCaJ.png.scaled500.png" width="200" /> </div> <div class="posterous_quote_citation">via <a href="http://www.advisory.com/Daily-Briefing/2011/11/07/Will-physicians-fire-patients-to-meet-quality-measures">advisory.com</a></div> <p>In an interesting unanticipated effect the AHRQ has highlighted the potential for the government changes to encourage physicians <br />>>> <br />"... may "fire" noncompliant patients from their practices, push back against quality-improvement initiatives, and minimize patient empowerment efforts, CQ HealthBeat reports. Some physicians already are "firing" unvaccinated patients, noting that they pose a risk to others and reflect a lack of trust for physicians' medical advice. <br />Since there already appears to be some instances of this where patents are unvaccinated it may well extend to other groups and would certainly be classified as an unintended consequence.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/butterfly-effect-of-healthcare-quality-measur">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-200765694313351475?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-23045679392867848242011-11-01T12:48:00.001-04:002011-11-01T12:48:43.793-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <img alt="Media_httpwwwbusiness_mczce" height="544" src="http://getfile0.posterous.com/getfile/files.posterous.com/drnic/CEqrFrkAzGDvCccdIxxAIgBzvzDnfCDHzEetphgEdfwpAdECjcgzCxgHyvva/media_httpwwwbusiness_mCzcE.jpg.scaled500.jpg" width="326" /> </div> <div class="posterous_quote_citation">via <a href="http://www.businessnewsdaily.com/voice-recognition-natural-user-interface-mobile-devices-1940/">businessnewsdaily.com</a></div> <p>Voice is cool! Voice recognition and its most recent persona - the now well known Siri on the Apple 4S is a star and has really captured the imagination of the public..... something we have been working at for a number of years in the healthcare sector. <br />The key to the success is the natural language understanding that is baked in to the solution. We have seen the value of this with the Dragon Go Product in the Apple App store and the healthcare sector is getting medical intelligence built into their solutions in the form of Clinical Langauge Understanding (CLU) and the latest medical intelligence in the new product of Computer Assisted Physician Documentation (CAPD) <br />Instant information and interaction comes to healthcare documentation helping create high quality specific detailed clinical documentation first time.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/mobile-voice-recognition-is-going-to-rock-you">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2304567939286784824?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-56335204701609495252011-11-01T10:26:00.001-04:002011-11-01T10:26:03.099-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <img alt="" src="http://www.healthunbound.org/sites/default/files/imagecache/blogentry_top/speechcontext.png?t=1320067971" /> </div> <div class="posterous_quote_citation">via <a href="http://www.healthunbound.org/content/speaking-context-medical-language-models-and-mobile-dictation">healthunbound.org</a></div> <p>Speech recognition is an increasingly common interface - we interact with speech systems on the phone, using our phones and in our cars. But as Jonathan Dreyer points out in this piece - speech for general use is different to use in healthcare. In Healthcare it requires an appropriate context to attain the necessary levels of accuracy. <br />>>>What’s “humerus” to a clinician, and what’s “humorous” to a consumer are two very different things</p><p>Quite! So using the right versions tuned for the user and his domain - and int eh case of healthcare there are many different domains that can be applied for different specialties (Radiology, orthopedics, general surgery, general medicine...to mention just a few). With the right context and model applied medical speech recognition has become an integral part of clinical solutions and is becoming increasingly important in mobile applications where the keyboard interface is not always ideal or as easily accessible. </p><p>So while general speech recognition solutions are delivering real value to derive the same results in healthcare it is important not to fall into the trap of offering generic solutions that will work but generate too many errors to make them useable and worse will turn clinicians off the tools before they have even had a chance to experience the results that are possible today with the right tools for medical speech recognition </p><p>So if you are looking to integrate speech into your healthcare applications - use the right version that includes the relevant context and vocabulary models to at the outset and help create a positive experience for users from the beginning.</p></p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/speaking-in-context-medical-language-models-a">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-5633520470160949525?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-81461592162020466022011-10-26T11:02:00.001-04:002011-10-26T11:02:30.671-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <img alt="Media_http3bpblogspot_iyibc" height="320" src="http://getfile3.posterous.com/getfile/files.posterous.com/drnic/pqrrgBfxjnBqCpcAjhzpefhabxhuJBoEzrgytmDhCFhztzxGraeFybotAoxD/media_http3bpblogspot_IyIbC.jpg.scaled500.jpg" width="240" /> </div> <div class="posterous_quote_citation">via <a href="http://hcrenewal.blogspot.com/2011/09/sweet-death-that-wasnt-very-sweet-how_24.html">hcrenewal.blogspot.com</a></div> <p>In a detailed and extensive post on the hcrenewal blog that covers the pending case from Pittsburgh and the challenges relative to complexity of EMR systems, understanding the data including all the meta data that is gathered within these systems but not always available for review by clinicians. </p><p>The post is illuminating on so many levels delving into the case providing links to the court papers and documents and offering analysis of the sequence of events both prior to the tragic loss of Mr Samuel Sweet's life as well as the subsequent review and legal case. </p><p>Others can make their own minds up on the case - what is interesting is the detailed analysis and reference to actual data and documents for the EMR. It offers some window into the difficulties we face in practicing medicine in an increasingly complex arena and our increasing reliance and need to apply technology support the healthcare team deliver safe, appropriate and cost effective care to every patient, every time.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/how-emrs-can-detract-from-a-clear-narrative-a">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-8146159216202046602?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-84056737347941561542011-10-25T10:47:00.001-04:002011-10-25T10:47:25.520-04:00<div class='posterous_autopost'><p>The Siri application in the latest Apple Advert showing off the power of your voice</p> <p><iframe allowfullscreen="true" src="http://www.youtube.com/embed/lKN9vAelksQ" frameborder="0" height="315" width="560"></iframe></p> <p>&nbsp;</p> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/apple-siri-advert-speech-recognition-in-actio">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-8405673734794156154?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-59760846412640746462011-10-24T11:39:00.001-04:002011-10-24T11:39:47.182-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <blockquote><div> <p>Ben Goldacre, Saturday 31 October 2009, The Guardian.</p> <p>Every now and then it’s fun to dip into the world of politics and find out what our lords and masters are saying about science. <a href="http://www.theyworkforyou.com/debate/?id=2009-10-14b.322.2">First we find Brooks Newmark</a>, Conservative MP for Braintree, introducing a bill to reduce the age for cervical cancer screening to 20. The Sun has been running a campaign to lower the screening age, on the back of Jade Goody’s death at 28 from cervical cancer, and gathered 108,000 signatures on a petition. The Metro newspaper have commissioned a poll showing that 82% of 16 to 24-year olds in England agree with lowering the screening age.</p> <p><span></span>“Cervical cancer may be rare in women under 25,” says Mr Newmark: “but it is inexcusable to dismiss the cases that occur as negligible statistics.” Oh, statistics. “We have a vaccination programme that ends at the age of 18 and a screening programme that begins at the age of 25. That leaves young women between the ages of 18 and 25 caught in a medical limbo, eligible for neither vaccination nor screening.”</p> <p>Somebody should do something: an intuition which you will find at the bottom of many calls to extend screening programmes beyond the population in which they can provide useful information, and into low risk populations where they simply waste resources, or do more harm than good.</p> <p>If screening worked, you would expect to see a reduced incidence of cervical cancer diagnoses in people who have been screened, compared with people who have not been screened, in the 5 years after screening: because precancerous lesions will have been detected and dealt with before they got to a more advanced stage.</p> <p>In August 2009 the British Medical Journal <a href="http://www.bmj.com/cgi/content/abstract/339/jul28_2/b2968">published a large study</a> examining this very question. It found that screening was associated with an 80% reduction at age 64, 60% at age 40, and so on. But cervical screening in women aged 20-24 has<a href="http://www.bmj.com/cgi/content/full/339/jul28_2/b3005"> little or no impact</a> on rates of invasive cervical cancer in the following 5 years. Only the Liberal Democrat MP Evan Harris introduced these findings to the debate (with the rather excellent line: “The honourable Member for Braintree cited evidence from The Sun, so I want to refer to a recent edition of the <a href="http://en.wikipedia.org/wiki/British_Medical_Journal">British Medical Journal</a>”).</p> <p>Meanwhile <a href="http://www.theyworkforyou.com/debates/?id=2009-10-14b.412.0&amp;s=tredinnick+moon#g412.2">on the very same day</a> David Tredinnick, Conservative MP for Bosworth, stood up to speak on medicine. Scientists and doctors who doubt the efficacy of alternative therapies are superstitious, ignorant, and racially prejudiced, he explained. “It is no good people saying that just because we cannot prove something, it does not work… I believe that the Department needs to be very open to the idea of energy transfers and the people who work in that sphere.”</p> <p>He went on. “In 2001 I raised in the House the influence of the moon, on the basis of the evidence then that at certain phases of the moon there are more accidents. Surgeons will not operate because blood clotting is not effective and the police have to put more people on the street.”</p> <p>Where does this moon stuff come from? “I am talking about a long-standing discipline—an art and a science—that has been with us since ancient Egyptian, Roman, Babylonian and Assyrian times. It is part of the Chinese, Muslim and Hindu cultures… Criticism is deeply offensive to those cultures,” says Tredinnnick: “and I have a Muslim college in my constituency.”</p> <p>Any attempts to challenge Tredinnick’s ideas are based, he explains, on “superstition, ignorance and prejudice” by scientists who are “deeply prejudiced, and racially prejudiced too, which is troubling.” So I hardly dare to mention that Tredinnick tried and failed to claim <a href="http://www.telegraph.co.uk/news/newstopics/mps-expenses/5580983/MPs-expenses-David-Tredinnick-tried-to-claim-for-intimate-relationships-course.html">£125 in parliamentary expenses</a> for attending an intimate relationships course teaching how to “honour the female and also the male essence and the importance of celebrating each”, run by a homeopath.</p> <p>Meanwhile the flag-bearers for conservatism at the Spectator are now <a href="http://www.guardian.co.uk/environment/georgemonbiot/2009/jul/09/george-monbiot-ian-plimer">promoting climate change denialism</a>, as George Monbiot has pointed out, and <a href="http://www.guardian.co.uk/science/2009/oct/24/hiv-aids-link-denialist-spectator-events">Aids denialism</a>, under the tedious flag of “only starting a debate”, even in their print edition. And finally, the NextLeft blog <a href="http://www.nextleft.org/2009/10/help-can-anyone-find-tory-blogger-who.html?utm_source=Left+Foot+Forward+List&amp;utm_campaign=c30984d1b9-Left_Foot_Forward8_18_2009&amp;utm_medium=email">recently pointed out</a> that of all the top ten conservative blogs, every single one is sceptical about man-made climate change. It could be an interesting five years ahead.</p> </div></blockquote><div class="posterous_quote_citation">via <a href="http://www.badscience.net/2009/10/political-woo/">badscience.net</a></div> <p>Ben Goldacre from the Guardian does a great job of exposing the world of politics and politicians as they step into the world of science. <br />As always Ben does a great job of exposing the lack of science and data as some politicians jump onto a personal hobby horse. </p><p>As he points out in the attempt to introduce Cervical Cancer Screening he suggests that despite "Cervical Cancer being rare in women under 25" and suggesting we "do something". </p><p>The BMJ published a study in 2009 that did! And it demonstrated the value of screening in different age groups with "little or no impact" in the 20 - 24 age group. </p><p>Progress depends on data and introduction of new treatments, diagnosis and thinking should be based on scientific analysis of data and not on hunches. </p><p>The foundation of this is generating clinical data that can be analyzed and while our medical records are chocked full of data that remains locked in narrative blocks that are inaccessible to computer analysis without the extraction or abstraction of that information typically through manual steps </p><p><a href="http://www.connected-health.org/events/symposium-2011/view-agenda.aspx"><br />In a recent presentation at the Partners for Connected Health Symposium in Boston Last week Janet Dillione the Executive Vice President and General Manager, Healthcare Division, Nuance presented </a></p><p>The Voice of Healthcare, The Value of Understanding (Imperial) <br />- Janet Dillione, Executive Vice President and General Manager for Healthcare, Nuance Communications, Presented "The Voice of Healthcare, The Value of Understanding" that highlighted the potential for bridging this gap with technology that takes the narrative and turns it into clinically actionable data using advanced NLP technology; <a href="http://www.nuance.com/for-healthcare/resources/clinical-language-understanding/index.htm"> Clinical Language Understanding</a>. This is the first step on what will be a critical pathway to the future of medicine based on data and science.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/bad-science-politics-and-the-need-for-clinica">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-5976084641264074646?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-68911104799826485252011-10-20T19:57:00.001-04:002011-10-20T19:57:27.228-04:00<div class='posterous_autopost'>My news reader(Netnewswire) reports 27,773 unread feeds...<div><div class='p_embed p_image_embed'> <img alt="Pastedgraphic-1" height="60" src="http://posterous.com/getfile/files.posterous.com/drnic/x3q2sw96wTFjVEqlDI11fJgsn8KiKdgH0eXdPbp7eqYZzcmEZhpQT4nOTyF9/PastedGraphic-1.png" width="279" /> </div> </div><div>Yikes</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/impossible-to-keep-up-with-the-news">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6891110479982648525?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-58436724945450476212011-10-12T11:38:00.001-04:002011-10-12T11:38:37.153-04:00<div class='posterous_autopost'><div class='p_embed p_image_embed'> <a href="http://posterous.com/getfile/files.posterous.com/drnic/znsbsQv3xB9TSpmsXpNvXD3uNl9ecaW7IgjG1w5tFG7AVHTZZKn3kfAKU4nF/photo.jpg.scaled.1000.jpg"><img alt="Photo" height="373" src="http://posterous.com/getfile/files.posterous.com/drnic/uey8VIZon1DqzuXZPxy7CihTN3UL5cBlwZi1VhVgultEEbvyJU4gEU6DDxtw/photo.jpg.scaled.500.jpg" width="500" /></a> </div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/complexity-and-frequency-of-clinical-conditio">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-5843672494545047621?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-71703788988174125662011-10-11T10:53:00.001-04:002011-10-11T10:53:47.735-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <img alt="Media_httpwwwamaassno_gizgg" height="199" src="http://posterous.com/getfile/files.posterous.com/drnic/ncxEszvugHHuEGnJIJnmzsnovvilIbzbdovHgichcJvqdobBBlHmFfljCGhJ/media_httpwwwamaassno_gIzGG.jpg.scaled500.jpg" width="282" /> </div> <div class="posterous_quote_citation">via <a href="http://www.ama-assn.org/amednews/2011/10/10/prsa1010.htm">ama-assn.org</a></div> <p>Minimal progress in what is a challenging problem for healthcare facilities in preventing readmission of patients. Surgical patients fared the best with a 12.7% readmission rate which was unchanged but in the top 3 killer category Congestive Heart Failure remained a recalcitrant problem with 1 in 5 patients returning to hospital - up slightly from the previous years. <br />The good and bad news is the looming ICD10 coding requirements will increase the visibility of this failure in the care system. <br />Good news in the long term as to improve anything we have to be abel to measure it, the bad news that it will shine an uncomfortable spot light on failures in the coordination of care. <br />THe incentives are in place for facilities as the government steps up the pressure with penalties for facilities with readmissions for heart attacks, heart failure and pneumonia coming in 2012. But this is just the tip of the iceberg of incentives and penalties. <br />Fundamental to these changes is the need for clinical data and the ability to report on progress that can only be achieved with discreet data on all patients. Some of this will come from direct data entry but the vast majority is currently locked away in the narrative and bridging this gap without burdening the clinician with data entry tasks will be essential. </p><p>Recent advances in the ability to extract and tag discreet clinical data contained in the narrative has been shown and is emerging as key "must have" technology for providers. Increasingly this is being built on the foundation of speech recognition that has clearly reached the point of wide spread adoption and acceptance in the clinical community. Demonstration projects and solutions are already showing the ability to satisfy the data reporting requirements directly from dictated clinical reports using technology to extract the data instead of asking the clinicians to enter the data manually through forms and data entry tools. </p><p>These tools will be increasingly important as we are pushed along the path towards higher quality lower cost care which must be built on measurable clinical data for each and every patient seen and treated in the healthcare system.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/hospitals-make-almost-no-headway-in-cutting-r">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-7170378898817412566?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-75999886098907658352011-10-10T14:29:00.001-04:002011-10-10T14:29:49.255-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <blockquote><div><p>Patient advocacy groups are protesting the government’s shutdown of public access to data on malpractice and disciplinary actions involving thousands of doctors nationwide.</p><p>The National Practitioner Data Bank maintains confidential records that state medical boards, hospitals and insurance plans use in granting licenses or staff privileges to doctors.</p><p>Although records naming physicians aren’t available to the public, the data bank for many years provided access to its reports with the names of doctors and hospitals and other identifying information removed.</p><p>That changed Sept. 1 when the data bank removed these public-use files from its website. The action came shortly after it learned The Kansas City Star planned to use its reports.</p><p>The story, about doctors with long histories of alleged malpractice but who have not been disciplined by the Kansas or Missouri medical boards, was published on Sept. 4.</p><p>The Star linked anonymous data bank reports to a Johnson County neurosurgeon by matching its information to the contents of court records of malpractice cases. Journalists often use this technique to glean additional information about doctors from the data.</p><p>“We’ve seen (The Star’s) reporting and others that show your ability to triangulate on data bank data. We have a responsibility to make sure under federal law that it remains confidential,” said Martin Kramer, spokesman for the Health and Human Services Department’s Health Resources and Services Administration, the agency that oversees the data bank.</p><p>Kramer said his agency may make the public-use files available again after a “thorough analysis of the data field.” But that process probably will take at least six months and the files may not return in the same format as they had been.</p><p>Previously, the files could be downloaded from the data bank website as massive spreadsheets. Names of doctors were replaced by arbitrarily assigned practitioner numbers.</p><p>The ages of doctors and patients, as well as the dollar sums of malpractice payments, were presented as ranges, such as a doctor age 40 to 49, rather than as specific numbers.</p><p>The bank is not mandated to make public files immediately accessible on its website, but is required to respond to information requests. </p><p>“Whatever they do will probably make it more difficult to use the files in meaningful ways,” said Alan Levine, a health care researcher with Public Citizen’s Health Research Group, which advocates for patient safety</p><p>On Tuesday, Public Citizen sent a letter to the Health Resources and Services Administration objecting to the removal of the public-use files.</p><p>“The continued availability of this data is crucial to patient safety and research aimed at informed public policy decisions concerning malpractice, tort reform, peer review, and medical licensing. There simply is no substitute for the NPDB Public Use Data File if this vital research is to be continued,” the letter said.</p><p>The Association of Health Care Journalists also opposes removal of the files.</p><p>“We’re really disturbed by this,” said Charles Ornstein, president of the medical writer group. “We’ve seen our members do terrific work (with the files) that protects the public.”</p><p>Ornstein pointed to stories by the Hartford Courant in Connecticut and the Raleigh News &amp; Observer in North Carolina citing the data bank’s public use files as a source on doctors whom they named.</p><p> “If it were not for this information used by reporters, their stories would not have been as strong,” he said.</p><p>“Why are they picking on this (Star) article?” asked Lisa McGiffert, director of Consumers Union’s Safe Patient Project. Consumers Union, which wants greater public disclosure by the data bank, will be asking the agency to put its files back online, she said.</p><p>“This administration (of President Barack Obama) has been touting their position for open government,” she said. “I see this action as totally counter to that.”</p><p>Kramer said the data bank was alerted to The Star’s reporting by Robert Tenny, a physician the newspaper was reporting upon. In order to provide Tenny with an opportunity to respond, The Star notified Tenny’s lawyer on Aug. 16 of specific information it intended to publish, including several matters contained in the data bank.</p><p>In a letter Aug. 26, the bank’s director Cynthia Grubbs advised The Star that violations of data bank confidentiality provisions are subject to a civil monetary penalties. (Read the letter <a href="http://media.kansascity.com/smedia/2011/09/13/18/27/4IvBI.So.81.pdf">here</a>.) The Star, however, used only publicly available information from the Data Bank.</p><p>“A federal agency should not be intimidating reporters for using information that they put on their own website,” Ornstein said.</p><p>But Kramer said his agency must investigate any potential breaches of confidentiality.</p><p>“Once we became aware that this information may be made public, we had a responsibility to make sure that it remains confidential,” he said.</p></div></blockquote> <div class="posterous_quote_citation">via <a href="http://www.kansascity.com/2011/09/13/3140759/obamas-hhs-shuts-down-public-access.html">kansascity.com</a></div> <p>In an interesting development on open data access HHS removed public access to malpractice data that had previously been published online in anonymous form. <br />The Kansas City Star newspaper took the publicly available information and using well known and commonly used data matching techniques to link the data to individuals an in particular outing doctors with longstanding histories of alleged malpractice. This was followed by some strong arm tactics threatening the newspaper with legal action. </p><p>As the commentators note this is not welcome development and runs counter to the spirit of open government. It does not bode well for the proposed public rating system of healthcare facilities and clinical practice for patients.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/obamas-hhs-shuts-down-public-access-to-doctor">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-7599988609890765835?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-15693154839195639742011-10-10T12:42:00.001-04:002011-10-10T12:42:45.703-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <img alt="Media_httpstaticguimc_vfwbr" height="300" src="http://posterous.com/getfile/files.posterous.com/drnic/bwjvywbFzIxDoxgdgtJvqInGBzxJnIaEjIiDgufzfzqtuHAzieICsJkJgJnh/media_httpstaticguimc_vfwBr.jpg.scaled500.jpg" width="460" /> </div> <div class="posterous_quote_citation">via <a href="http://www.guardian.co.uk/technology/blog/2011/oct/10/apple-siri-voice-recognition?newsfeed=true">guardian.co.uk</a></div> <p>If you grew up in England and were technically inclined you will remember "Tomorrow's World" - it played live right before "Top of the Pops" <br />As the Guardian Article points out there was often mention of computers powered by voice...now with Apple's Siri that distant future looks closer than ever. <br />In fact the "KNowledge Navigator" video is pretty much implemented in Siri (albeit it took from 1987 to 2011 to get into general availability) <br />Tight now that future is looking even more exciting and more accessible.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/apples-siri-voice-recognition-sounds-like-tom">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-1569315483919563974?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-57177942006007236772011-10-10T11:08:00.001-04:002011-10-10T11:08:20.069-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <img alt="Media_httpwwwthisislo_dxbsx" height="200" src="http://posterous.com/getfile/files.posterous.com/drnic/AepJHGFgIGbAwIgrhchaIfkmCqHvIgvbkDkraJtriGrDdaqoqumDvHhmpclk/media_httpwwwthisislo_dxBsx.jpg.scaled500.jpg" width="300" /> </div> <div class="posterous_quote_citation">via <a href="http://www.thisislocallondon.co.uk/news/9291236.WHIPPS_CROSS__Cash_crisis_deepens_at_hospital/">thisislocallondon.co.uk</a></div> <p>NHS hospital asking employees to work for free in "extraordinary measures" <br />This seems wrong on so many levels and will undoubtedly affect some more than others.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/hospital-staff-offered-unpaid-leave-as-trust">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-5717794200600723677?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-65674623572776423332011-10-06T12:51:00.001-04:002011-10-06T12:51:02.745-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <a href="http://posterous.com/getfile/files.posterous.com/drnic/BheACbmhfnsCezAbvaephvcDsmyDoxyJeCqBHkzgCgxIwmgBmtkgGCzcpysd/media_httpcultofmaccu_davkz.jpg.scaled1000.jpg"><img alt="Media_httpcultofmaccu_davkz" height="278" src="http://posterous.com/getfile/files.posterous.com/drnic/BheACbmhfnsCezAbvaephvcDsmyDoxyJeCqBHkzgCgxIwmgBmtkgGCzcpysd/media_httpcultofmaccu_davkz.jpg.scaled500.jpg" width="500" /></a> </div> <div class="posterous_quote_citation">via <a href="http://www.cultofmac.com/121169/what-steve-jobs-means-to-silicon-valley/">cultofmac.com</a></div> <p>Awesome review of Steve Jobs with history and the his pathway through life. Interesting to note that he asked for some spare parts for a school project from William Hewlett (of HP fame) and received the parts and a summer job. Imagine how motivating that was. We need more of that today.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/what-steve-jobs-means-to-silicon-valley">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6567462357277642333?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-19307382764834873492011-09-28T11:37:00.001-04:002011-09-28T11:37:13.925-04:00<div class='posterous_autopost'>Nice piece on FastCompany&nbsp;<a href="http://www.fastcompany.com/1782571/former-apple-ceo-john-sculley-on-the-future-of-medical-technology">Former Apple CEO John Sculley On The Future Of Medical Technology And Health Care's Killer App</a>&nbsp;<div>As a trail blazer for original tablets in the 80's it must be gratifying to see the uptake of the iPad and it's competitors. In his mind not going to start with a single "killer app"</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div>I think that the health care industry is so complex that it doesn't necessarily start with a single killer app. You go back to the&nbsp;early days of the personal computer--when I joined the industry, we really didn't know what the killer app was going to be. All&nbsp;we knew was that it was going to be possible to create very low-cost, shrink-wrapped applications. It wasn't for several years&nbsp;until we understood that electronic spreadsheets, word processors, and eventually desktop publishing would become killer&nbsp;apps.</div></blockquote><p /><div>But some combination of a solutions integrated and focused on ease of use. The technology has reached a point of penetration and ease of use that makes adoption that much easier in healthcare</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div>So the intimidation of technology is no longer the issue now that it was just a few years ago.</div></blockquote><p /><div>I'd add one thing - the disruptive technology must include ease of interaction and data capture that does not inhibit adoption and as highlighted in this piece on MedScape&nbsp;<a href="http://www.medscape.com/viewarticle/747436">EHR Voice Recognition: An End to the 'No Eye Contact' Problem</a>&nbsp;which highlights the significant contribution of effectively speech enabling EHRs to</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div>allows for maintenance of the doctor-patient relationship by minimizing the attention paid to the&nbsp;laptop computer inevitably and uncomfortably sitting between a physician and patient when using the point-and-click method</div></blockquote><div><br />The same is true with other healthcare technology that can interfere with the clinician-patient interaction. As John Sculley said: "<i>You combine those conditions and it creates an opportunity for entrepreneurs&nbsp;to come in and find disruptive solutions</i>."</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/former-apple-ceo-on-future-of-medical-technol">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-1930738276483487349?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-86031592041191402062011-09-23T08:39:00.003-04:002011-09-23T08:39:58.580-04:00<div class='posterous_autopost'>This piece of news is mind blowing - CERN scientists identified sub atomic particles traveling at a speed greater than the speed of light........<div>I need to repeat that:</div><div style="font-size: 16px;">CERN scientists identified sub atomic particles traveling at a speed greater than the speed of light.</div><p /><div>Here's the&nbsp;<a href="http://static.arxiv.org/pdf/1109.4897.pdf">paper</a>&nbsp;and live conference today&nbsp;<a href="http://indico.cern.ch/conferenceDisplay.py?confId=155620">Friday Sep 23 at 16:00 Zurich time</a></div><p /><div>This is "crazy" result could upend our understanding of our universe more than we have seen with previous revolutionary theories (Copernicus, Galileo, Einstein.....)&nbsp;</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/speed-of-light-no-longer-a-maximum">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-8603159204119140206?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-23535200839068568402011-09-23T08:39:00.001-04:002011-09-23T08:39:54.615-04:00<div class='posterous_autopost'>This piece of news is mind blowing - CERN scientists identified sub atomic particles traveling at a speed greater than the speed of light........<div>I need to repeat that:</div><div style="font-size: 16px;">CERN scientists identified sub atomic particles traveling at a speed greater than the speed of light.</div><p /><div>Here's the&nbsp;<a href="http://static.arxiv.org/pdf/1109.4897.pdf">paper</a>&nbsp;and live conference today&nbsp;<a href="http://indico.cern.ch/conferenceDisplay.py?confId=155620">Friday Sep 23 at 16:00 Zurich time</a></div><p /><div>This is "crazy" result could upend our understanding of our universe more than we have seen with previous revolutionary theories (Copernicus, Galileo, Einstein.....)&nbsp;</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/speed-of-light-no-longer-a-maximum">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2353520083906856840?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-1827180518857032412011-09-20T09:25:00.001-04:002011-09-20T09:25:31.930-04:00<div class='posterous_autopost'>In a nice expose on the need for speech recognition on mobile devices:&nbsp;<a href="http://www.fiercemobilehealthcare.com/story/accurate-speech-recognition-mhealths-holy-grail-docs/2011-09-13">Accurate speech recognition: mHealth's Holy Grail for docs</a>&nbsp;on Fierce Mobile Health &nbsp; covers off the need for the inclusion of speech in the mHealth future. As they discovered<p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div>Doctors constantly tell me how much they love their iPhones and Android tablets, but they also complain about the difficulty of data&nbsp;input. Few find the touchscreen keyboard handy for inputting notes or updating their comments about patient progress. Most use the&nbsp;devices as data viewers.</div></blockquote><div><p /><div>Offering up&nbsp;MedMaster Mobile as a good example of integrating speech into a mobile healthcare application&nbsp;and speaks to the power and value that speech recognition brings to mobile devices in&nbsp;healthcare to ensure usability and quality data capture.</div></div><p /><div>The article includes a good list of checkpoints when considering speech for the mobile platform including</div><div><ul><li>Voice quality - The primary consideration in getting good results</li><li>Connectivity - if you rely on cloud based services you need a reliable good quality connection</li><li>Accuracy - with good voice quality will achieve the right results</li><li>Editing - one of the more challenging aspects is an easy way to edit any mistakes that do occur</li></ul></div><div>So Speech Recognition is&nbsp;the secret ingredient to making mobile devices catch-on with clinicians and will transition these great mobile devices from cool but limited practical application to rock solid mobile tool set for mHealth</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/mhealth-holy-grail">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-182718051885703241?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-66083114149648684502011-09-08T12:55:00.001-04:002011-09-08T12:55:52.773-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <blockquote><div> <p>Congratulations! You've committed to an EMR, which is an accomplishment in itself. But the hardest part is still to come: getting it to work.</p> <p>From failing to plan to skipping out on training, many mistakes can be made during the implementation process. And although they may not be as juicy as wrath, envy or lust, the Seven Deadly Sins of EMR implementation could wreak just as much havoc. </p> <p>Steve Waldren, MD, director of the American Academy of Family Physicians' Center for Health IT, and Rosemarie Nelson, principal of the MGMA Consulting Group, gave us the worst sins providers can commit during EMR implementation.</p> <p><b>[See also: <a href="http://www.healthcareitnews.com/news/7-deadly-sins-emr-implementation?topic=08#">Top 5 worst EMR myths</a>.]</b></p> <p><strong>&nbsp;1. Not doing your homework</strong>:&nbsp; Avoiding supplier problems means background research and thorough evaluations of vendors and products. And beware: vendors tend to make promises they can't keep. According to Waldren, it's important to get the specifics down on paper. "Often, a doctor will ask if [an EMR] can do this or that, and a vendor will say yes. Then, they're surprised when in reality, it doesn't. Doctors need to make sure all expectations are met in writing."<br /> <strong><br /> 2. Assuming the EMR is a magic bullet</strong>: It's important to remember the EMR is a conversion, not an upgrade. Although the system will save you time and money in the long run, Waldren warns it isn't an instant fix to issues in the workplace. "Most people think an EMR solves problems," he said. "But an EMR will only amplify problems that already exist in the practice." <br /> <strong><br /> 3. Not including nurses in the planning stages</strong>: Nelson says doctors tend to think a new EMR is all about them. "They don't think about how much the nurse preps the chart, how often the nurse presents information to them, and how much the nurse handles patients over the phone," she said. Having nurses involved from the beginning avoids future conflicts, and considering their thoughts on product selection and implementation will only help with workflow. "[The implementation] needs to be done with the support of staff; everyone needs to be involved," added Waldren. </p> <p><em><strong>CONTINUED&nbsp;ON&nbsp;NEXT&nbsp;PAGE</strong></em></p> </div></blockquote><div class="posterous_quote_citation">via <a href="http://www.healthcareitnews.com/news/7-deadly-sins-emr-implementation?topic=08">healthcareitnews.com</a></div> <p>Nice highlight of some major faux pas on EHR implementation - I especially like Rosmarie Nelson's comment on forgetting nurses #3: "doctors tend to think an EMR is all about them"....quite </p><p>Other great points including training (and actually attending!), trying to replicate existing processes - business process reengineering was a catch phrase for a number of years and has dropped off from regular use but applies to all EMR implementations. </p><p>But perhaps most of all "Assuming the EHR is the magic bullet". I have said this before but worth re-itertaing...implementing an EHR is the first step in a journey that while it will have some interim destinations will continue to be a voyage of ongoing discovery. And that train has left..you are either on the train or watching from the station as the train leaves.</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/the-7-deadly-sins-of-emr-implementation-healt">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6608311414964868450?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com1tag:blogger.com,1999:blog-8534714680637397259.post-85120388663659388982011-08-18T09:48:00.001-04:002011-08-18T09:48:29.889-04:00<div class='posterous_autopost'><div>Once exposed to the realities of practical and sustainable healthcare delivery physicians are quick to&nbsp;regret not learning more about the business side of medicine at medical school. In a posting on Kevin.MD "<a href="http://www.kevinmd.com/blog/2011/08/doctors-understand-business-side-medicine.html">How can doctors understand the business side of&nbsp;medicine?</a>" Michelle Mudge-Riley echos a frequent sentiment amongst her colleagues</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div>One thing I regret is not taking advantage of the Masters degree in Health Administration program at my medical school. At the time,&nbsp;I was focused solely on medicine and on being a doctor. I didn’t think the business side of medicine was all that important. In fact, I&nbsp;didn’t consider the business side of medicine at all.</div></blockquote><p /><div>While individuals may regret decisions on career pathway (the grass often appears greener on the on the other side of the fence) the article cited from the New England Journal of Medicine from February this year&nbsp;<a href="http://www.nejm.org/doi/full/10.1056/NEJMp1009202">Advancing Medical Education by Teaching Health Policy</a>&nbsp;makes the point that there has been a push for additional teaching as part of the medical student curriculum on health policy and health systems (from 1995) but more than 15 years later less than 50% of medical students "<i>believed they'd been appropriately educated about topics such as medical economics and health care systems.</i>"</div><p /><div>The science of Medicine is increasingly complex but so is the healthcare systems - new treatments need to be assessed not just from a clinical standpoint but an economic one. Comparing the effectiveness of treatments requires an understanding of economics and the practicalities of budgeting but the information and the skills have for too long been lacking in healthcare education and in day to day clinical practice. Patients and clinicians have been disconnected from the consequences of expenditure with third party payers responsible for managing costs. Much like the European Debt crisis where sudden access to inexpensive debt and limited immediate consequences of the use of debt created an unsustainable position or as one commentator put it &nbsp;</div><div>"It was if Greece received an American Express Black (Centurion Card)&nbsp;<span style="font-size: 12px;"><div class='p_embed p_image_embed'> <img alt="Url" height="199" src="http://posterous.com/getfile/files.posterous.com/drnic/agkKDnmeQ0VKDwLogwH11bEohUSVqezsxEoBa5ck4leZVPvYQr4TrgAm8GfU/url.jpeg" width="320" /> </div> &nbsp;but was not responsible for the charges".</span></div><p /><div><span style="font-size: 12px;">Clinicians remain handicapped with the the medical curriculum that still lacks inclusion of foundational knowledge and&nbsp;</span><span style="font-size: 12px;">fails to develop the necessary analytical skills that would equip the key decision maker with all the tools to help navigate the complex adjunct economic decision making process that must be a part of sustainable clinical medicine.</span></div><p /><div><span style="font-size: 12px;">I applaud the proposed additions to the medical curriculum that includes the addition of&nbsp;</span>four domains:</div><div><ul><li>health care systems and principles,</li><li>health care quality and safety,</li><li>value and equity, and</li><li>health politics&nbsp;and law</li></ul></div><div>&lt;img src="<div class='p_embed p_image_embed'> <img alt="" src="http://www.nejm.org/na102/home/ACS/publisher/mms/journals/content/nejm/2011/nejm_2011.364.issue-8/nejmp1009202/production/images/small/nejmp1009202_t1.gif" /> </div> "&gt;</div><p /><div>The downside is the additional information that is loaded into an already packed and expanding course. The other&nbsp;unfortunate consequences of these changes and the increasing variability between healthcare systems is the diminishing nature of international equity. Medicine used to be one of several professions that offered graduates opportunities to travel the world and work in other countries. This ease of international movement has already diminished as these systems, processes and curriculum have diverged making international experience harder for the newer graduates</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/physicians-regret-not-learning-business-skill">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-8512038866365938898?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-28793858075038453942011-08-15T15:38:00.001-04:002011-08-15T15:38:02.381-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <blockquote><div> <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#"> <img title="" src="http://www.infoworld.com/sites/infoworld.com/files/imagecache/blogger_header/cringely_hdr_blog09_0.jpg" height="63" alt="" width="500" /><p> </p></a> <div>August 15, 2011</div> <h3>MotoGoo, Motoogle, or Googola -- a big deal any way you slice it</h3> <h3>Google just bought Motorola Mobility for $12.5 billion. Cringe isn't sure the Googlers will know what to do with it</h3> <div>By <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#" rel="author">Robert X. Cringely</a> | <a href="http://www.infoworld.com/" target="_blank">InfoWorld</a></div> <a href="http://www.twitter.com/ifw_cringely">Follow @ifw_cringely</a> <div> <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#">Print</a> <span>|</span> <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#disqus_thread" title="Jump to the comments of this posting.">1 Comment</a> <p> </p></div> <span></span><p>And I thought August was going to be a slow news month. That just changed, thanks to Google and <a href="http://www.infoworld.com/d/mobile-technology/google-buys-motorola-mobility-125-billion-169838" target="_blank">its blockbuster $12.5 billion acquisition of Motorola Mobile</a>.</p> <p>All I can say is wow. Game on for real this time, Apple. See ya later, RIM. Helloooo, Microsoft? Can you hear me down there? Don't worry, we'll send some pods down to rescue you ... eventually.</p> <p><strong>[ Also on InfoWorld: Neil McAllister asks <a href="http://www.infoworld.com/d/the-industry-standard/are-googles-best-days-behind-it-168900?source=fssr">whether Google's best days are in the past</a>. | For a humorous take on the tech industry's shenanigans, subscribe to <a href="http://www.infoworld.com/newsletters/subscribe?showlist=infoworld_cringely&amp;source=ifwelg_fssr">Robert X. Cringely's Notes from the Underground newsletter</a> and follow <a href="http://twitter.com/ifw_cringely" target="_blank">Cringely on Twitter</a>. ]</strong></p> <p>As for HTC, Samsung, and LG: Hey, you had some good times with Android, but you knew it was never meant to last. Right?</p> <p>This is an epic day for more than just business reasons. Motorola is one of a handful of companies responsible for creating the industry that pays my mortgage, and I don't mean blogging. And its history with cellphones is equally storied.</p> <p>Until the iPhone came along, Motorola pretty much defined mobile phones, starting with the original DynaTAC in 1983, the first flip phone (the StarTac), and the first looks-so-cool-I-must-have-it fashion phone (the Razr). Then came the ill-fated Rokr and a long sojourn in the handset desert, followed by a recent comeback, thanks in large part to a a series of snazzy -- and some not so snazzy -- Android phones.</p> <p>Sadly, I have one of the less snazzy ones: the Motorola Cliq, which is underpowered and overburdened with a godawful Blur "social interface" that does nothing but drain battery life and annoy me. I blame T-Mobile, not Motorola, for this monstrosity. Short of Google also buying a mobile carrier (like Sprint, which seems to be standing in the corner waiting for somebody to ask it to dance), I'm not sure GooMoto would be able to do anything to fix that.</p> <p>More than mobile phones, though, this is really about tablets. <a href="http://www.infoworld.com/d/mobile-technology/tablet-deathmatch-apple-ipad-2-vs-motorola-xoom-837">Motorola Mobility makes the Xoom</a>, the first tab to run Android 3.0 and still the worthiest contender to the iPad's throne. Google wants to get into the PC 3.0 business in a big way and figures it might as well own the whole schmear.</p> <div> <div><p /><div><a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#">next page ›</a>&nbsp;</div><div><span>1</span><span><a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#" title="Go to page 2">2</a></span></div></div> <div>Tags: <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#">cringely</a>, <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#">android</a>, <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#">intellectual property</a>, <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#">m&amp;a</a>, <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#">smartphones</a>, <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#">tablets</a>, <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#">Great Googley Moogley</a>, <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#">Motorola Mobility</a></div> <div> <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#">Print</a> <span>|</span> <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15#disqus_thread" title="Jump to the comments of this posting.">1 Comment</a> <p> </p></div> </div> </div></blockquote> <div class="posterous_quote_citation">via <a href="http://www.infoworld.com/t/cringely/motogoo-motoogle-or-googola-big-deal-any-way-you-slice-it-169870?source=IFWNLE_nlt_notes_2011-08-15">infoworld.com</a></div> <p>Googola...! Blockbuster deal and blockbuster implications as Cringe puts it "Game on"!</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/motogoo-motoogle-or-googola-a-big-deal-any-wa">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2879385807503845394?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-48671643094676501072011-08-15T15:35:00.001-04:002011-08-15T15:35:33.836-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <blockquote><div> <p>Health care providers over the years have raised a number of objections to electronic health records -- they cost too much, disrupt practices already pressed for time and fail to mesh with the way medical offices work.</p> <div> <h5><b>Learn more about using speech recognition technology</b></h5> <p><a href="http://searchhealthit.techtarget.com/tip/How-to-purchase-implement-a-medical-speech-recognition-system">How to purchase, implement a medical speech recognition system</a></p> <p><a href="http://searchhealthit.techtarget.com/news/2240017006/Meditab-speech-recognition-software-help-hospital-cut-paper-trail">Meditab, speech recognition software help hospital cut paper trail</a></p> </div> <p>But there's an even more fundamental digital challenge -- some doctors don't want to busy their fingers on a keyboard. Indeed, <a href="http://searchhealthit.techtarget.com/news/2240035407/As-one-doctor-quits-over-EHR-use-experts-lament-opportunities-missed">manual data entry can be a barrier to EHR acceptance</a>. Physicians may well prefer to document patient encounters in the traditional style, dictating notes and using a transcription service.</p> <p>Against this backdrop, <a href="http://searchhealthit.techtarget.com/healthitexchange/meaningfulhealthcareinformaticsblog/speech-recognition-in-healthcare/">speech recognition technology</a> offers doctors another way to fill out a patient’s electronic chart. Speech recognition systems, which may be installed on premise or accessed remotely, translate speech into text. The technology is already well established in health care, with radiology departments at the forefront.</p> <p>The new twist is speech recognition technology's potential to become a widely used front end to an EHR system.</p> <p>Reid Conant, M.D., an emergency medicine physician who practices at Tri-City Medical Center in Oceanside, Calif., believes speech recognition lies at the cusp of broader <a href="http://searchhealthit.techtarget.com/tutorial/EHR-implementation-tutorial-From-vendor-selection-to-maintenance">EHR implementation</a>. Tri-City uses Nuance Communications Inc.'s Dragon Medial Enterprise Network Edition, which integrates with the hospital’s Cerner Corp. EHR system.</p> <p>"We are still on the steep part of the curve," Conant said of the adoption rate.</p> <p>Industry experts cite three reasons why speech recognition technology's role in EHR systems could be poised for growth.</p> <ul> <li>Accuracy has improved significantly, which means doctors spend less time cleaning up notes.</li> <li>EHR vendors are integrating voice recognition into their systems.</li> <li>The federal government’s meaningful use initiative has expanded EHR adoption beyond early adopters. Potentially less tech savvy mass-market users may embrace voice as an alternative to the hunt-and-peck school of data entry.</li> </ul> <p>That said, the technology faces a few obstacles. Voice dictation entered as unstructured text may present problems when it comes to extracting data for reporting and analysis. Vendors, however, aim to employ natural language processing to tag key clinical data for later retrieval.</p> <p><b>Appeal of speech recognition technology: Talk, don't type</b></p> <p>Steven Zuckerman, M.D., a neurologist with a solo practice in Baton Rouge, La., discovered keyboarding wasn't his forte when he adopted EHR. "I quickly figured out that I would not be the greatest typist in the world," he explained.</p> <p>Zuckerman began exploring voice input several years ago, working with Nuance's Dragon 7. The initial experience proved somewhat frustrating.</p> <p>"When I first started trying it out, the accuracy wasn't at the point where it was particularly efficient," he said, noting the many corrections that had to be made following the voice-to-text conversion.</p> <p>Zuckerman retried speech recognition technology a few years later with Dragon 9. He has been using the software ever since.</p> <p>Improvements in accuracy have swayed other physicians, Conant noted. He often encounters clinicians who previously tried voice input but balked at the amount of correction required. The latest generation of the technology changes minds.</p> <p>"They see it and they are shocked," Conant said. "They realize they can dictate three or four detailed paragraphs of medical decision making and it is nearly perfect."</p> <blockquote> <div> <div> <div> <p><span>[Clinicians] realize they can dictate three or four detailed paragraphs of medical decision making and it is nearly perfect.</span></p> <p>Reid Conant, M.D., emergency medicine physician, Tri-City Medical</p> </div> </div> </div> </blockquote> <p>Keith Belton, senior director of product marketing for Nuance's health care division, noted that Dragon 7, released in 2003, had 80% out-of-the-box accuracy -- that is, before a user trains the software to recognize his or her specific speech pattern. Version 10, the product included in Network Edition, features out-of-the-box accuracy in the mid to high nineties, he added.</p> <p>Gregg Malkary, managing director of Spyglass Consulting Group, a mobile health IT consulting firm, acknowledged that the technology has improved significantly compared to where it stood several years back. But issues still remain with the level of accuracy, he said. Some providers may question the actual time savings of voice recognition if they still have to dive back into a document to check for accuracy.</p> <p>As Malkary put it, "Is 90% good enough, or do I really need 99.9%?"</p> <p><b>Speech recognition technology on board within EHR systems</b></p> <p>Such concerns don't seem to have limited adoption at Tri-City. Use of voice in clinical documentation began in the emergency department in 2007 and has continued to spread. Wound care and workers' compensation doctors started using speech recognition technology about six months ago, Conant noted. Tri-City's hospitalists and subspecialty doctors will go live with voice in October.</p> <p>The experience of earlier users encouraged more doctors to try voice. "They are seeing their colleagues using Dragon and are requesting the application," Conant said.</p> <p>But doctors don't necessarily have to ask for speech recognition technology to have it at their disposal, as it is increasingly becoming a built-in feature of EHR systems. <a name="OLE_LINK1">Greenway Medical Technologies Inc</a>., for example, has agreed to integrate M*Modal’s cloud-based speech recognition technology into its EHR.</p> <p>Similar deals may follow. Don Fallati, senior vice president of marketing at M*Modal maker Multimodal Technologies Inc., said other EHR vendors have contacted M*Modal to discuss integration. He sees a precedent for this type of link-up in radiology, where speech is already deeply embedded in picture archiving and communications systems (PACS) and radiology information systems (RIS).</p> <p><a href="http://searchhealthit.techtarget.com/news/2240016839/Epocrates-plans-mobile-SaaS-EHR-system-for-solo-physicians">Epocrates Inc.</a>, meanwhile, plans to integrate Nuance speech recognition technology into its forthcoming EHR system, currently in beta. Dr. Thomas Giannulli, chief medical information officer at Epocrates, said the product will feature speech alongside other data entry options such as point-and-click menus.</p> <p>The arrival of voice as a standard EHR feature coincides with the government's push for wider EHR adoption. The federal <a href="http://searchhealthit.techtarget.com/Briefing-Getting-meaningful-use-money-in-five-not-so-easy-steps">meaningful use</a> program, which runs through 2015, offers financial incentives to doctors and hospitals deploying EHR systems.</p> <p>Raj Dharampuriya, M.D., chief medical officer and co-founder of EHR vendor eClinicalWorks LLC, said Washington's incentives have pushed the EHR market into more of a mass adoption phase.</p> <p>"We're seeing more physicians come on board that are not as computer savvy," Dharampuriya said. "Voice provides a very nice phasing into EHRs."</p> <p><b>Data mining as next wave of speech recognition technology</b></p> <p>Doctors may find voice recognition useful as an EHR input tool, but vendors aim to push the technology farther. When physicians compile text narratives via voice, they end up with unstructured data that proves hard to tap for meaningful nuggets of information. Companies such as M*Modal and Nuance work to address this issue through <a href="http://searchcontentmanagement.techtarget.com/definition/natural-language-processing-NLP">natural language processing</a>.</p> <p>Pairing speech with EHR marks a stage one deployment of speech recognition technology, Fallati said. He said M*Modal’s "speech understanding" technology takes the voice-entered narrative and translates it into a searchable document. The document can then be mined for purposes such as quality reporting.</p> <p>Nuance, for its part, pursues "clinical language understanding" -- an offshoot of natural language processing. The idea is to mine structured data from free-form text and tag the key clinical elements such as medications and health problems.</p> <p>Zuckerman, the Baton Rouge neurologist, believes current developments in speech will eventually lead to the self-documenting office visit. He envisions exam rooms set up to selectively record the relevant details as doctor and patient verbally interact.</p> <p>"We're not close to that yet, but that would be great," he said.</p> <p><i>John Moore is a Syracuse, N.Y.-based freelance writer covering health IT, managed services and cloud computing. Let us know what you think about the story; email</i> <a href="http://searchhealthit.techtarget.com/news/2240039521/Speech-recognition-technology-making-its-way-into-EHR-systems#"><i><a href="http://searchhealthit.techtarget.com/news/2240039521/Speech-recognition-technology-making-its-way-into-EHR-systems/mailto:editor@searchhealthit.com">editor@searchhealthit.com</a></i></a>.</p> <div> <strong>Related Topics:</strong> <a href="http://searchhealthit.techtarget.com/resources/Organizing-health-care-staff-and-networks">Organizing health care staff and networks</a>, <a href="http://searchhealthit.techtarget.com/resources/Clinical-decision-support-systems">Clinical decision support systems</a>, <a href="http://searchhealthit.techtarget.com/resources/Electronic-health-record-systems">Electronic health record systems</a>, <a href="http://searchhealthit.techtarget.com/tags">VIEW ALL TAGS</a> </div> <br /> <div> <h4>Dig Deeper</h4> <div> <div> <ul> <li style=""> <div> <h4>People who read this also read...</h4><ul> <li><a href="http://searchtelecom.techtarget.com/definition/3G">What is 3G (third generation of mobile telephony)? - Definition from Whatis.com</a></li> <li><a href="http://searchsap.techtarget.com/definition/SAP">What is SAP? - Definition from Whatis.com</a></li> <li><a href="http://searchnetworking.techtarget.com/definition/TCP-IP">What is TCP/IP (Transmission Control Protocol/Internet Protocol)? - Definition from Whatis.com</a></li> <li><a href="http://searchcloudcomputing.techtarget.com/definition/cloud-computing">What is cloud computing? - Definition from Whatis.com</a></li> <li><a href="http://searchsqlserver.techtarget.com/definition/database">What is database? - Definition from Whatis.com</a></li> </ul> </div> </li> </ul> </div> </div> <div> <div> <ul> <li style=""> <div> <h4>Related glossary terms</h4> <p>Terms for Whatis.com - the <a href="http://whatis.techtarget.com">technology online dictionary</a></p> <ul> <li><a href="http://searchhealthit.techtarget.com/definition/definition-p-e">definition p e</a></li> <li><a href="http://searchhealthit.techtarget.com/definition/national-provider-identifier-NPI">national provider identifier (NPI)</a></li> <li><a href="http://searchhealthit.techtarget.com/definition/laboratory-information-system">laboratory information system</a></li> <li><a href="http://searchhealthit.techtarget.com/definition/CHIME">CHIME (College of Healthcare Information Management Executives) </a></li> <li><a href="http://searchhealthit.techtarget.com/definition/health-informatics">health informatics</a></li> <li><a href="http://searchhealthit.techtarget.com/definition/National-Quality-Forum-NQF">National Quality Forum (NQF)</a></li> <li><a href="http://searchhealthit.techtarget.com/definition/Biosense">Biosense</a></li> <li><a href="http://searchhealthit.techtarget.com/definition/CMIO">CMIO (Chief Medical Information Officer) </a></li> </ul> </div> </li> </ul> </div> </div> <div> <a href="http://searchhealthit.techtarget.com/news/2240039521/Speech-recognition-technology-making-its-way-into-EHR-systems#" style="display: inline-block;"><span></span>Show me more</a> </div></div> </div></blockquote> <div class="posterous_quote_citation">via <a href="http://searchhealthit.techtarget.com/news/2240039521/Speech-recognition-technology-making-its-way-into-EHR-systems">searchhealthit.techtarget.com</a></div> <p>Speech an integral part to an EHR implementation and the good news is increasing numbers of the EHR vendor community are integrating the technology - it's no longer an add on <br />And the good news is the narrative is no longer the barrier to actionable codified data as Clinical Language Understanding bring Medical Intelligence to the desktop using free form narrative dictation generating clinically actionable data</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/speech-recognition-technology-making-its-way">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4867164309467650107?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-34121617892764407602011-08-15T00:51:00.001-04:002011-08-15T00:51:53.100-04:00<div class='posterous_autopost'><span style="font-size: 15px;">Hormone Replacement Therapy (HRT), Helicobacter Pylori are just a couple of the well known instances where apparent intransigence of the medical community prevented advancement in medical treatments. Turns out we get things wrong on both sides of the coin. Ben Goldacre highlighted some research in the&nbsp;New England Journal of Medicine in his piece&nbsp;</span><a href="http://www.guardian.co.uk/commentisfree/2011/jul/15/bad-science-studies-show-we-get-things-wrong" style="font-size: 15px;">Studies of studies show that we get&nbsp;things wrong</a><span style="font-size: 15px;">&nbsp;and in the study&nbsp;</span><p /><blockquote class="webkit-indent-blockquote" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 40px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-size: 15px;"><div>the remaining 51 were very interesting&nbsp;because they were, essentially, evenly split: 16 upheld a current practice as beneficial, 19 were inconclusive, and crucially, 16 found&nbsp;that a practice believed to be effective was, in fact, ineffective, or vice versa.</div></blockquote><div style="font-size: 15px;"><br /><div>In fact in the case of HRT the limited data initially available was the best at the time and it was not until the large randomized trial showed the increased risk of heart attacks in patients taking HRT (a rise of 29%) that new information helped shape new treatments. As for Helicobacter Pylori - the cause of gastric ulcers - the ten years from</div><p /></div><blockquote class="webkit-indent-blockquote" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 40px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-size: 15px;"><div><div><div>"the&nbsp;first&nbsp;murmur of a research finding to international guidelines recommending antibiotic treatment for all patients with ulcers"</div></div></div></blockquote><div style="font-size: 15px;"><div><div><br /><div>May seem like a long time but assembling the trials, ensuring the safety and validating the data takes time. So while the time taken for general adoption of treatments things are not quite as bad as the conspiracy theories suggesting resistance to change and progress.</div></div></div></div><p /><div style="font-size: 15px;">So the questions is will the increased access to large amounts of validated structured and encoded clinical data that can be compared and reconciled against patients and outcomes result in less time to get effective treatments to patients and even the potential to identify new treatments, links and causation. As far back as 1986 "<a href="http://www.csd.uwo.ca/courses/CS9626a/papers_files/Swanson.pdf">Fish oil, Raynaud's syndrome, and undiscovered public knowledge</a>" demonstrating the ability to link Fish Oil and the potential at reducing or treating Raynaud's disease. With the addition of clinically actionable data the potential to apply this as medical intelligence offers tremendous hope in accelerating the medical advancements and validating treatments faster and more effectively</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/studies-show-we-get-things-wrong">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3412161789276440760?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-46251419127213685232011-08-08T12:49:00.001-04:002011-08-08T12:49:49.478-04:00<div class='posterous_autopost'><div>Study from Kaiser in the US showed an increase in asthma in children with mothers exposed on one occasion to an increased magnetic field<p /><a href="http://www.medpagetoday.com/Pediatrics/Asthma/27935?utm_source=share&amp;utm_medium=mobile&amp;utm_campaign=medpage%2Biphone%20app">Critics Slam Asthma Risk, Magnetic Fields Link</a><p />UK group debunks the study with lack of controls and accounting for other well known factors. Let's hoe the media picks up on this as quickly as they pick up on this study</div><div>Carry on, situation normal</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/debunking-magnetic-field-exposure-and-asthma">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4625141912721368523?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-68869325557585605252011-08-08T08:48:00.001-04:002011-08-08T08:48:20.301-04:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <div class='p_embed p_image_embed'> <img alt="Media_httpwwwradiolog_nginl" height="175" src="http://posterous.com/getfile/files.posterous.com/drnic/stnipzuFAcrCquDFdpjiwpitnpikbsvpEIsCdopffxdwshkEddgbgFpolcih/media_httpwwwradiolog_nGinl.jpg.scaled500.jpg" width="200" /> </div> <div class="posterous_quote_citation">via <a href="http://www.radiologytoday.net/archive/rt0811p24.shtml">radiologytoday.net</a></div> <p>Dr Watson coming to Healthcare hoping to help bring the latest information to the medical decision making of the clinician</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/from-jeopardy-to-medical-diagnosis">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6886932555758560525?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-37611203081910347762011-07-15T16:49:00.001-04:002011-07-15T16:49:14.897-04:00<div class='posterous_autopost'>In a great review by Mark Hagland: "<a href="http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=349DF6BB879446A1886B65F332AC487F&amp;nm=&amp;type=Blog&amp;mod=BlogTopics&amp;mid=67D6564029914AD3B204AD35D8F5F780&amp;tier=7&amp;id=5B3186E65E4D4526B1D7684625232678&amp;WA_MAILINGLEVEL_CODE=">CMIOs at the Hot Center: Planets Seen Aligning at AMDIS</a>" he highlights the&nbsp;he annual Physician-Computer Connection Symposium, held&nbsp;in Ojai (Pronounced oh high) Valley Inn and Spa in Ojai, Calif. that I also had the pleasure of attending. A busy 2 1/2 days of learning, meeting, talking, eating and fantastic surroundings for running with the added benefit of running into old colleagues and friends).<p /><div>Although&nbsp;Farzad Mostashari, M.D could nto be there in person he did manage to take the time to join the group by telephone and provide his insight on the latest developments included the much tweeted comment "</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div><i>"ICD10 is a firm data don't expect a delay"</i></div></blockquote><div><br /><div>and for those of you watching this trend this comment will give pause for thought</div><p /></div><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div><div><i>ICD-10 is reported to be less of an IT issue and more of a physician documentation issue.</i></div></div></blockquote><div><p /><div>Which will make many clinicians shudder at the thoughts of increased regulatory and coding mandates to comply with in what is already a time challenged and complex environment...they will be looking for technical help and that will be driven in large part by the cohort of current and emerging CMIOs.&nbsp;</div><div>As Mark puts it<p /></div></div><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div><div><div><div>CMIOs, as well as other physician and clinician informaticists, are in a more central&nbsp;position than ever before in terms of our need for them to help lead clinical transformation of healthcare. Indeed, it’s unimaginable how we as a&nbsp;society might achieve the “new healthcare”—one with improved patient safety, care quality, patient and family satisfaction, clinician effectiveness,&nbsp;cost-effectiveness, accountability, and transparency—without CMIOs and their fellow physician and clinician informaticists. In short, the levels of&nbsp;responsibility set to land in CMIOs' laps are potentially staggering.</div></div></div></div></blockquote><div><div><div><p /><div>There is increasing focus in the US and interestingly now on the other side of the pond where EHI has launched an<a href="http://www.ehi.co.uk/news/primary-care/6973/ehi-launches-ccio-campaign"> CCIO (Chief Clinical Information Officer) Campaign</a>&nbsp;that recently received&nbsp;<a href="http://www.ehi.co.uk/news/acute-care/7022/lord-howe-supports-ehi-ccio-camp">executive support</a>&nbsp;from Lord Howe from the British government.&nbsp;</div></div></div></div><p /><div>As Mark puts it CMIOs are at the center of an exciting time and will be an essential part of the equation to bringing the healthcare system, clicking and screaming, into the 21st Century. I'm proud to be part of this group and look forward to an exciting and fun ride</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/straight-outta-ojai-cmios-part-of-planet-alig">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3761120308191034776?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-9518021190534148552011-06-30T11:43:00.001-04:002011-06-30T11:43:59.173-04:00<div class='posterous_autopost'> In a report from the National Journal:&nbsp;<a href="http://www.nationaljournal.com/healthcare/report-5-percent-of-people-account-for-half-of-u-s-health-care-spending-20110627">Report: 5 Percent of People Account for Half of U.S. Health Care&nbsp;Spending</a>&nbsp;a small minority of patients generate 50% of the costs of care in the US:<div><br /><div><div><ul class="MailOutline"><li>~50% &nbsp;of the U.S. population accounted for only 3.1 percent of all expenditures</li><li>10 percent of the population hogged 63.6 percent of&nbsp;all health spending</li><li>Top 5 &nbsp;percent of the population accounted for 47.5 percent of all spending,&nbsp;and</li><li>Top 1 percent accounted for&nbsp;20.2 percent.</li></ul></div><p /></div></div><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div><div><div>While the average person incurred about $233 in costs in 2008 for health care services, those in the top half of spending cost insurers, the government, or&nbsp;themselves $7,317. The top 1 percent cost $76,476.</div></div></div></blockquote><p /><div>Much of the higher costs is linked to older patients with patients over 55 making up the largest proportion of the higher spending group but chronic conditions contribute significantly with&nbsp;<i>people with at least one chronic health condition were two to four times more likely to have spending in the top 5 percent group.</i></div><p /><div>The analysis revealed the high spend group had a much higher incidence of preventable chronic disease including</div><p /><div><ul class="MailOutline"><li>&gt;50% of the high spend group had high blood pressure</li><li>&gt; 1/3 had high cholesterol</li><li>&gt;1/4 had diabetes</li></ul></div><p /><div>Focusing on preventative healthcare and targeting preventable disease before it becomes high cost is critical to curbing cost and improving health.</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/5-of-us-population-responsible-for-50-healthc">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-951802119053414855?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-47607816668320142852011-06-29T08:21:00.001-04:002011-06-29T08:21:56.046-04:00<div class='posterous_autopost'>Troubling developments when the medical profession starts offering untested therapies <p /> Doctors offer unapproved stem cell therapies <br /><a href="http://usat.ly/kCyYJC">http://usat.ly/kCyYJC</a> <p /> Is this r rally the way forward in medicine? <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/doctors-offer-unapproved-stem-cell-therapies">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4760781666832014285?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-33914545420098932132011-06-28T11:49:00.001-04:002011-06-28T11:49:26.207-04:00<div class='posterous_autopost'>80% of the planet have a cell phone - the latest challenge creating an artificial intelligence that can diagnose patients better than board certified doctors<div><iframe allowfullscreen="true" src="http://www.youtube.com/embed/4OT3bDiMWK0" frameborder="0" height="510" width="853"></iframe></div><p /><div>Burt Rutan (chief of Scaled Composites) astronaut&nbsp;Brian Binnie&nbsp;managed to show the world that space travel was possible in October 2004 with SpaceShipOne's second flight</div><div><iframe allowfullscreen="true" src="http://www.youtube.com/embed/i2dZbVPS7Zs" frameborder="0" height="510" width="640"></iframe></div><div>into suborbital space within five days of the first flight</div><div><iframe allowfullscreen="true" src="http://www.youtube.com/embed/LXNkUNP75-Q" frameborder="0" height="510" width="640"></iframe></div><div>thanks in no small part to eh Ansari X-Prize foundation challenge</div><p /><div>The foundation is setting up many other prizes with the Tricoder Prize targeting healthcare accessibility through mobile platform diagnostics</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div>mobile solution that can inexpensively diagnose patients by combining expert systems and&nbsp;medical point-of-care data—such as lab-on-a-chip or wireless sensors, provide a recommended course of treatment, and upload all relevant data to the cloud.</div></blockquote><p /><p /><div>Coming to a phone near you......</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/the-doctor-is-alwasy-in">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3391454542009893213?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-7128967348291415712011-06-05T12:00:00.001-04:002011-06-05T12:00:11.970-04:00<div class='posterous_autopost'><span style="font-size: 16px;">A recent article in the NY Times&nbsp;</span><a href="http://www.nytimes.com/2011/05/24/health/24doctors.html?_r=1&amp;pagewanted=all" style="font-size: 16px;">When Doctors Are Called to the Rescue in Mid-flight</a><span style="font-size: 16px;">&nbsp;on inflight emergencies brought a flood of memories back for me. The landscape has changed dramatically from the first time I got involved in an "inflight" emergency.</span><div style="font-size: 16px;">In the the first incident that I can recall it was only just inflight. I was accompanied by two nurse friends (Sarah and Wendy) I had worked with at my hospital as we escorted a group of terminally sick children on a trip of a lifetime to Disney from the United Kingdom. We were on the final leg returning home and the plane (this was PanAm) had left the gate in Miami. I had spotted a gentleman across the aisle who was looking very distressed. My colleagues noticed the same thing and we had a brief exchange on how we might deal with a patient given the close quarters of the aisles and seats. As the plane taxied to take off position he because increasingly uncomfortable, short of breath and diaphoretic (sweaty). As the engines were spooling up I was at his side calling passengers to see if anyone had an sub-lingual Glyceryl Trinitrate (GTN aka Nitroglycerine). Since that incident I used to carry a spray with me on every aircraft ride until the liquid rules at which time it became impossible.</div><div style="font-size: 16px;">We administered borrowed GTN, aborted the take off roll and returned to the gate. By the time we got to the gate and the paramedics boarded the plane he had improved and his vitals had returned to normal. The US Paramedics were quite dismissive - to their view there was nothing wrong with him and we had wasted their time and the airline's. The gentleman asked our advice on what to do - should he proceed with the flight or get off and be checked out. Sadly in most of these cases we never find out what happens but I am pleased to say that he elected to leave and be checked out on the ground.</div><p /><div style="font-size: 16px;">Since that incident I always carry my stethoscope and used to carry other items - mainly because the airlines had little in the way of medical equipment or drugs. Since the banning of liquids and the overly aggressive nature of security much of this equipment has been either confiscated as as security risk or just not worth the hassle of security delays.</div><p /><div style="font-size: 16px;">Much has changed and in my most recent involvement I was pleasantly surprised to open a medical kit with both equipment (intubation, IV fluids and IV equipment, forceps) and also and a case full of useful drugs (useful in this instance include IV agents for heart, seizure and hypoglycemia) or sometime both:</div><div style="font-size: 16px;"><div style=""><div class='p_embed p_image_embed'> <img alt="Firstaidkit" height="300" src="http://posterous.com/getfile/files.posterous.com/drnic/K3FofeoCpl8omIGP3NTzaHzZvS9ByWqQX8YahfPi2Id6IozzvBz4Y7KaR5nt/FirstAidKit.jpg" width="288" /> </div> </div></div><p /><div style="font-size: 16px;">But as Dr Abramson points out:&nbsp;<i>“With some planes, it’s a hospital in a box, and they have everything you could ever want.&nbsp;But often they look like they’ve been picked over.”</i></div><p /><div style="font-size: 16px;">There are probably better controls these days especially since many of these kist contained controlled drugs and the regulations now require equipment to be available but I'm betting ymmv</div><p /><div style="font-size: 16px;">In many cases the in-flight kit includes and Automatic Emergency Cardiac Defibrillator (AECD) - often abbreviated to AED which attaches to patients and will assess rhythm and administer shocks semi automatically. I've had occasion to use one of these one time. This was the model on the aircraft I was on at the time:</div><div style="font-size: 16px;"><span style="font-size: 12px;"><div class='p_embed p_image_embed'> <img alt="Defibrillator-with-ecg-display" height="400" src="http://posterous.com/getfile/files.posterous.com/drnic/p4bRqNClKZNbXtI505zFoqk4wTKohFbUvYU1gkqaYBoB0NS8hHQXFAwXqS0Y/defibrillator-with-ecg-display.jpg" width="500" /> </div> </span></div><div style="font-size: 16px;"><span style="font-size: 12px;"></span>Attaching it to a patient who had no discernible blood pressure was unconscious and once connected in apparent asystole that spontaneously reverted to sinus rhythm before the shock was administered (much to the relief of the patient who woke up to find himself attached to the device as it issued an audible warning of rhythm problems)</div><p /><div style="font-size: 16px;">From my own personal recollection my experiences have included the following conditions</div><div style="font-size: 16px;">- kidney stone</div><div style="font-size: 16px;">- psychotic episode</div><div style="font-size: 16px;">- alcohol intoxication</div><div style="font-size: 16px;">- gastritis/food poisoning</div><div style="font-size: 16px;">- angina</div><div style="font-size: 16px;">- severe migraine</div><div style="font-size: 16px;">- hypotension of unknown etiology</div><p /><div style="font-size: 16px;">The general incidence of in flight emergencies has risen</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div><span style="font-size: 16px;">Since the earliest days of commercial aviation, airlines have coped with medical emergencies in flight by calling on physicians who</span><span style="font-size: 16px;">&nbsp;</span><span style="font-size: 16px;">happen to be passengers. And as more people travel by air, the number of emergencies has risen accordingly.&nbsp;</span><span style="font-size: 16px;">“Passenger health is becoming more and more of an issue, because of increased life expectancy and more people flying with pre-existing conditions,” said Dr. Paulo Alves, a vice president at MedAire, a company that provides crew members with medical advice&nbsp;from physicians on the ground.</span></div></blockquote><p /><div style="font-size: 16px;">My personal experience has been cyclical with a spate of incidences followed by none for months. But the experience is challenging at best:</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div><span style="font-size: 16px;">Airborne calls for medical assistance pose a singular challenge for physicians, who find themselves suddenly caring for a stranger&nbsp;whose history they don’t know, often with a problem well outside their specialty, in a setting with limited equipment but no shortage of&nbsp;onlookers scrutinizing their every move</span></div></blockquote><p /><div style="font-size: 16px;">What I found interesting was that despite being in a deep sleep (working as a junior doctor gives you all the skills necessary to sleep anywhere, anytime and any place) I have had several occasions where the announcement requesting medial assistance is like your own child's cry - it stands out and woke me up.</div><p /><div style="font-size: 16px;">As for thanks - I've received everything from snide remarks (Miami EMT's) to thanks, bottles of wine and my personal favorite the opportunity to sit in the jump seat for landing (fantastic view and a rare opportunity to watch the landing process first hand). Like my colleagues your desire to help is vested in the original intent that is&nbsp;<i>among the purest expressions of their Hippocratic oath.&nbsp;</i>It would always be nice to know how the patient did following intervention but I'm willing to bet that privacy regulations make this a challenging request to fulfill even if the patients who would likely be willing to share the outcomes</div><p /><div style="font-size: 16px;">There remain challenges in the system and with the improvement of medical equipment and drugs. But the identification of individuals available to help is still relatively poor. Like Dr Abramson:</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div><span style="font-size: 16px;">He also books his flights with “Dr.” in front of his name. “That’s so that if I’m asleep, they might wake me,” he said. And he doesn’t take</span><span style="font-size: 16px;">&nbsp;</span><span style="font-size: 16px;">sleeping pills or drink alcohol in flight. “The last thing you want to do is be woken up and not be with it,”&nbsp;</span></div></blockquote><p /><div><span style="font-size: 16px;">my flights are all booked with "Dr" in front of my name but since that moniker is used by a wide range of people (PhD's, dentists, vets, optometry, chiropractor, pharmacy, psychology, homeopathy, physical therapy, lawyers) and then there are the British Surgeons who go by Mr, Mrs or Miss.</span></div><p /><div style="font-size: 16px;">I have also had instance of being asked to provide&nbsp;proof of my medical degree. To a set of flight attendants on one flight my inability to show my medical degree relegated me to observer as the dermatologist and medical student attempted to deal with a falling blood pressure of unknown etiology. Lufthansa do have a program that allows you to fax your medical degree to their offices and they mark your frequent flyer record with an annotation that shows up whenever you fly to alert the flight crew that you are a doctor and willing to be called upon when you fly - that seems smart but is not replicated by any other airline to my knowledge.&nbsp;</div><p /><div style="font-size: 16px;">If I had a wish list it would include some means to validate my ability to help by providing my medical degree to the airlines, the opportunity to review the equipment and support ahead of time (in all instances where I have opened medical kits I have, with permission, dug into the box extensively to find out what is available for future reference) and some formal reporting mechanism and follow up.</div><p /><div style="font-size: 16px;">We all step up to the plate when asked - it would be nice if the airlines acknowledged that in some way as they lean on these resources on a daily basis and provided support and acknowledgement that was not as arbitrary as it is today.</div><p /><div style="font-size: 16px;">What has your experiences been - have you had in flight problems and how did you deal with them. Are there any air lines better than others at managing this request and in the support they provide?</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/in-flight-emergencies">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-712896734829141571?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-27641838341671831822011-05-22T14:25:00.000-04:002011-05-22T14:25:14.511-04:00Intuit is well known in finance and the commercial world and an interesting article by Austin Merritt on Software Advice "<a href="http://www.softwareadvice.com/articles/medical/intuit-health-1042511/">Intuit Health: A Sleeping Giant with Big Potential</a>" highlights the potential this company has in the healthcare space applying the principles so successfully used in their industry leading personal finance solutions (Quicken, Quickbooks, TurboTax etc). The strategy has been to offer highly competitive easy to use products that new businesses can use when starting out:<br /><blockquote>Intuit has muscled their way to significant market share in the retail, manufacturing, distribution, nonprofit, property management, and construction industries primarily through its QuickBooks product line. Companies in these industries adopt QuickBooks when they’re just starting out. As they grow, they ease into industry-specific packages from Intuit that replace, or integrate with, QuickBooks. The transition works nicely for Intuit and QuickBooks users. It creates headaches for their vertically-focused competitors.</blockquote>The strategy has proven effective in getting companies bought into the Intuit family and while not large revenue generators there were additional add on services (Intuit payment services, Bill Pay etc). The methodology is being repeated in healthcare with "Quicken Health Expense Tracker"<br /><blockquote>that allows insurance companies to provide patients with a clear breakdown of what they pay and what the patients owe. Patients naturally then pay through Bill Pay. Cha-ching for Intuit.</blockquote>But for this to be effective Intuit needs to pull in clinicians with integrated solution that would include an easy to use EMR. Intuit acquired MedFusion a good first step in delivering a practical solution to clinicians in desperate need an easy to use solution to help manage their office <strong>and</strong> their patients clinical information not just appointments, laboratory results and prescription refills.<br /><br />The short list presented:<br /><br /><ul><li>MediSoft / Lytec</li><li>Office Ally</li><li>HealthFusion / MediTouch</li><li>Practice Fusion</li><li>Kareo</li><li>AdvancedMD</li></ul><br />And while it is impossible to present all the possible options given the long list of EMR vendors for what is currently their sweet spot of small practices my list would include eClincalWorks, Greenway and Sage to mention a few. While not meeting the proposed list of small companies there are some interesting opportunities for a big splash and really placing Intuit definitively in the healthcare space<br /><br />I've passed comment on Intuit before as an interesting company to watch in the healthcare space. Their success will largely be determined by their ability to translate their simple easy to use concepts so successful in personal and company finance into the complex and challenging world of healthcare.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2764183834167183182?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-13993751666929881872011-05-06T09:22:00.000-04:002011-05-06T09:22:02.270-04:00and improve the quality of healthcare!<br />HealthImaging featured a report <a href="http://www.healthimaging.com/index.php?option=com_articles&amp;article=27321&amp;publication=21&amp;view=portals">Medical errors cost U.S. $17 billion in 2008</a> which estimated that<br /><blockquote>This figure amounted to 0.72 percent of the $2.39 trillion spent on healthcare that year in the U.S.</blockquote>The study identified the sources based on medical claims estimating:<br /><blockquote>564,000 inpatient injuries (1.5 percent of all inpatient admissions in the U.S.) and 1.8 million outpatient injuries (0.15 percent of the estimated outpatient encounters nationwide) </blockquote>Given the landmark publication "<a href="http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf">To Err is Human</a>" from the IOM from November 1999 that estimated at that time:<br /><blockquote>...total costs (in­cluding the expense of additional care necessitated by the errors, lost income and household productivity, and disability) of between $17 billion and $29 billion per year in hospitals nationwide.</blockquote>the progress remains frustratingly poor more than 10 years on. There is a top 10 list featured in the latest research that accounted for 69% of the costs<br /><br /><br /><ul><li>Postoperative infections were the most costly error, ($3.3 billion)</li><li>Pressure ulcers ($3.2 billion)</li><li>Mechanical complications of noncardiac device implant or graft ($1 billion)</li><li>Postlaminectomy syndrome ($995 million)</li><li>Hemorrhage complicating a procedure ($678 million)</li><li>Infection due to central venous catheter ($589 million)</li><li>Pneumothorax (collapsed lung) ($569 million)</li><li>Infection following infusion, injection, transfusion or vaccination ($566 million)</li><li>Other complications of internal prosthetic device, implant and graft ($398 million</li><li>Ventral (abdominal) hernia without mention of obstruction or gangrene ($342 million)</li></ul><br /><br />The list serves as a focal point for healthcare professionals and patients that offer significant opportunity for improvement in both costs and quality of care. With the <a href="http://www.hhs.gov/news/press/2011pres/03/20110331a.html">announcement of Accountable Care Act (ACO)</a> on March 31 by HHS will further focus the healthcare system on removing errors and delivering a more complete and holistic approach to care. There has been much written about the ACO concept with many commentators suggesting that organizations and healthcare facilities are not ready for these changes. I would suggest that we can neither afford as providers nor accept as patients any delay in a move towards fully accountable care that focuses on on putting the doctors and patients in better control of their care and linking reimbursement to outcomes<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-1399375166692988187?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-36017752808024123812011-04-25T11:27:00.001-04:002011-04-25T11:27:33.887-04:00<div class='posterous_autopost'>Robotic surgery is on the increase and for good reason. Its not just the ability to control movement more precisely but with the ability to create small instruments that are able to achieve the same function as larger more invasive instruments. As this interview with&nbsp;<a href="http://www.bmc.cardiologydomain.com/handler.cfm?event=practice,template&amp;cpid=19240">Dr Fernando</a>&nbsp;(a colleague and alum from the Royal Free Hospital) highlights a Thymectomy would typically require a large incision down the front of the chest (Sternotomy) but with the use of Robotic Surgery the same result was achieved with three small incisions the largest being 1cm (less than 1/2")<p /><div><object data="http://www.myfoxboston.com/video/videoplayer.swf?dppversion=8705" type="application/x-shockwave-flash" height="406" width="500"><param name="movie" value="http://www.myfoxboston.com/video/videoplayer.swf?dppversion=8705" /><param name="FlashVars" value="&skin=MP1ExternalAll-MFL.swf&embed=true&adSizeArray=300x240&adSrc=http%3A%2F%2Fad%2Edoubleclick%2Enet%2Fadx%2Ftsg%2Ewfxt%2Fwildcard%5F1%2Fdetail%3Bdcmt%3Dtext%2Fxml%3Bpos%3D%3Btile%3D2%3Bfname%3Drobot%2Dhelps%2Dperforms%2Dsurgery%2Din%2Dboston%2D20110421%3Bloc%3Dsite%3Bsz%3D320x240%3Bord%3D596070314757525900%3Frand%3D0%2E319889121154174&flv=http%3A%2F%2Fwww%2Emyfoxboston%2Ecom%2Ffeeds%2FoutboundFeed%3FobfType%3DVIDEO%5FPLAYER%5FSMIL%5FFEED%26componentId%3D134837788&img=http%3A%2F%2Fmedia2%2Emyfoxboston%2Ecom%2F%2Fphoto%2F2011%2F04%2F21%2Frobot%5Fsurgery%5F20110421%2EFXTimg%5Ftmb0000%5F20110421095327%5F640%5F480%2EJPG&story=http%3A%2F%2Fwww%2Emyfoxboston%2Ecom%2Fdpp%2Fmorning%2Frobot%2Dhelps%2Dperforms%2Dsurgery%2Din%2Dboston%2D20110421&category=&title=robot%5Fsurgery%5F20110421%2Emxf&oacct=foximfoximwfxt,foximglobal&ovns=foxinteractivemedia&headline=Robot%20helps%20performs%20surgery%20in%20Boston" /><param name="allowNetworking" value="all" /><param name="allowScriptAccess" value="always" /></object>&lt;p style="width:640px"&gt;<a href="http://www.myfoxboston.com/dpp/morning/robot-helps-performs-surgery-in-boston-20110421">Robot helps performs surgery in Boston: MyFoxBOSTON.com</a>&lt;/p&gt;</div><p /><div>You can get a sense from this marketing video for DaVinci Robotic systems</div><div><iframe title="YouTube video player" allowfullscreen="true" src="http://www.youtube.com/embed/0NZLpWrJGgk" frameborder="0" height="390" width="480"></iframe></div><div>As they point out - 7 degrees of freedom make procedures that would be impossible for a human to perform.</div><p /><div>This vide from the University of Maryland demonstrating Cardiac Surgery using Robots</div><div><iframe title="YouTube video player" allowfullscreen="true" src="http://www.youtube.com/embed/suJahF9VCe4" frameborder="0" height="390" width="480"></iframe></div><div>It is probably not lost on readers the similarity that these controls have with our current slew of game controllers and those skills are related. In fact with the advent of the&nbsp;<a href="http://www.xbox.com/en-US/kinect">X-Box Kinect</a>&nbsp;system that requires no controllers you have to wonder if we will see concepts that have more in common with the concepts many will remember from Minority Report</div><div><iframe title="YouTube video player" allowfullscreen="true" src="http://www.youtube.com/embed/NwVBzx0LMNQ" frameborder="0" height="390" width="640"></iframe></div><div>Technology enhancing our abilities not replacing them.</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/robotic-surgery-coming-to-s-hospital-near-you">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3601775280802412381?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-35423810666979710172011-04-15T18:40:00.001-04:002011-04-15T18:40:05.934-04:00<div class='posterous_autopost'>As promised my Slide presentation has been uploaded to Slideshare on LinkedIn: "Meaningful Use Day Of Reckoning Health Story". <br />Click on the link below to view the presentation. <br /><a href="http://slidesha.re/ejqTv7">http://slidesha.re/ejqTv7</a> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/meaningful-use-day-of-reckoning-slide-present">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3542381066697971017?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-5653618366633528002011-04-15T15:02:00.001-04:002011-04-15T15:02:03.577-04:00<div class='posterous_autopost'>Cloud computing is on a target to generate billions in revenue and is experiencing something of a revival. &nbsp;It's a revival when you consider that historically our access to computers used to be in the cloud...albeit the cloud was some data center and we were wired to that cloud with a hard wired terminal. Just look at this picture and the terminal behind me (circa 1980's when I was worked as a&nbsp;<a href="http://en.wikipedia.org/wiki/COBOL">COBOL</a>&nbsp;programmer and used machine language and&nbsp;<a href="http://en.wikipedia.org/wiki/Job_Control_Language">JCL</a>&nbsp;to submit these to the mainframe that was hundreds of miles away from my desk)!<div><div class='p_embed p_image_embed'> <img alt="Pastedgraphic-1" height="510" src="http://posterous.com/getfile/files.posterous.com/drnic/GDf8LWTpcvuHjA9GcBSnZDJNUwUCNSR1KDk9w8no9tlPJ8eAmZ9MRKPv8lWd/PastedGraphic-1.tiff.converted.jpg" width="481" /> </div> </div><div>This recent article in the NY Times (<a href="http://www.nytimes.com/2011/04/15/business/15cloud.html?_r=1&amp;nl=technology&amp;emc=techupdateema1&amp;pagewanted=all">The Business Market Plays Cloud Computing Catch-Up</a>) highlights the catch up on the part of&nbsp;the business market and predicting significant growth:</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div>I.B.M., a bellwether in the corporate technology market, forecasts that it will have $7 billion in cloud revenue by 2015. Of the total, $4&nbsp;billion will be customers shifting to cloud delivery from the company’s traditional software and services, and $3 billion is expected to be&nbsp;entirely new business.</div></blockquote><p /><div>and Dell is&nbsp;invest $1 billion over 2 years "<i>largely for cloud offerings</i>".&nbsp;Healthcare, while often a laggard in technology is also marching towards cloud based services realizing that complex software solutions can be delivered more cost effectively in a Cloud Based strategy. This 2009 paper on&nbsp;Cloud Computing and&nbsp;Healthcare;&nbsp;Bad Weather or Sunny Forecast? (<a href="http://www.soundoffcomputing.com/uploads/CloudComputingandHealthcare.pdf">pdf</a>)&nbsp;&nbsp;makes the point that this is an almost irreversible trend and entrants such as Microsoft and Google (<a href="http://www.healthvault.com/">HealthVault</a>&nbsp;and&nbsp;<a href="http://www.google.com/health/%20">Google Health</a>) suggest this will be an increasing trend.&nbsp;Offering more solutions, more processing power and more storage at lower prices will provide a slew of choices and accelerate technological innovation in healthcare IT and while there are challenges and concerns relative to security and reliability the overall trend will have a positive impact.</div><p /><div>In line with these trends is the announcement of the Nuance&nbsp;<a href="http://www.nuance.com/company/news-room/press-releases/NC_008146">Dragon Mobile SDK</a>&nbsp;and the Nuance Healthcare Development Program (NHDP)<a href="http://www.nuance.com/company/news-room/press-releases/NC_008507">bringing Speech to the Cloud</a>&nbsp;is significant offering a simple way for Independent Software Vendors (ISVs) and healthcare providers to&nbsp;integrate Nuance value added functionality directly into healthcare applications in the cloud. This brings streaming speech to the cloud allowing mobile devices and think clients to offer fast and accurate real time medical speech recognition. Integration is a snap and possible on multiple platforms&nbsp;including</div><p /><div><ul class="MailOutline"><li>Apple IOS,</li><li>Windows browsers : IE7 /&nbsp;IE8 / Chrome / Firefox,</li><li>MacOS browsers: Safari / Firefox,</li><li>Windows .NET</li></ul></div><p /><div>Calgary Scientific have already shown this integration off in the&nbsp;<a href="http://www.calgaryscientific.com/products/resolutionmd-mobile.html">ResolutionMD mobile</a>&nbsp;product and interest since the announcement has been great. Like many others we are</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div>“We’re moving to where the puck is going in this industry,”&nbsp;</div></blockquote><p /><div>Cloud computing will impact so many different areas in healthcare and technology in general and voice enabling these interactions will be key for some of these interfaces and given the level of interest will likely be offered soon.<p /><br /></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/cloud-computing-stepping-into-the-future">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-565361836663352800?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com1tag:blogger.com,1999:blog-8534714680637397259.post-68497206009742784712011-03-30T16:51:00.001-04:002011-03-30T16:51:57.173-04:00<div class='posterous_autopost'>In a fun piece by the&nbsp;<a href="http://www.theonion.com">Onion</a>&nbsp;titled:&nbsp;<a href="http://www.theonion.com/articles/quicklube-shop-masters-electronic-record-keeping-s,19736/">Quick-Lube Shop Masters Electronic Record Keeping Six Years Before Medical Industry</a>&nbsp;offers an alternative solution to the current challenges of implementing an EHR. Since car maintenance is well tracked and probably many of us have experienced the sophistication of he follow up by your local lubrication center sending you a reminder that your car is due the following check ups Karl's Lube &amp; Go is "6 years ahead of the medical industry"<div><div><p /><div><div>A comprehensive digital cataloging system that keeps track of its&nbsp;customers' car maintenance history, oil-change needs, and past&nbsp;fuel-filter replacements puts Karl's&nbsp;Lube &amp; Go's computerized&nbsp;record- keeping an estimated six years ahead of the medical industry's,&nbsp;sources confirmed Friday. "We figured that a basic database&nbsp;would help&nbsp;us with everything from scheduling regular appointments to predicting&nbsp;future lubrication requirements," said the proprietor of the local&nbsp;oil-change shop,&nbsp;Karl Lemke, who has no special logistical or&nbsp;programming skills, and who described his organizational methods, which&nbsp;are far more advanced than those of any&nbsp;hospital emergency room, as&nbsp;"basic, common-sense stuff." "We can even contact your insurance&nbsp;provider for you to see if you're covered and for how much, which&nbsp;means&nbsp;we can get to work on what's wrong without bothering you about it. The&nbsp;system not only saves me hundreds of thousands of dollars per year, but&nbsp;it saves my&nbsp;customers a bundle, too."&nbsp;</div></div></div></div><p /><div>Whilst tongue in cheek it has bothered me for many years to understand why I would unfailingly get reminders and even incentives from car maintenance but nothing from my local healthcare provider. But then maybe that has more to do with not having a primary care physician which as the USA article revealed:&nbsp;<a href="http://yourlife.usatoday.com/health/medical/menshealth/story/2011/03/Study-Half-of-men-dont-have-a-doctor/45453184/1">Half of men don't go to the doctor</a>&nbsp;that revealed</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div>45% don't even have a primary-care doctor</div></blockquote><p /><div>Yikes... and the survey goes further</div><p /><blockquote class="webkit-indent-blockquote" style="margin: 0 0 0 40px; border: none; padding: 0px;"><div>40% of men in their 40s have never had their cholesterol tested, and 70% have never had a prostate exam</div></blockquote><p /><div>I tis no wonder men have a shorter life expectancy than women. Time to do something about this - it is not too late for a New Years resolution. Go find a primary care physician and schedule a check up.....today!</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/car-maintenance-offer-solution-to-emr-challen">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6849720600974278471?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-69400224653458379322011-03-24T07:28:00.001-04:002011-03-24T07:28:06.888-04:00<div class='posterous_autopost'><div>In a recent study comparing acupuncture with simulated acupuncture:&nbsp;<br /><strong>Simulated acupuncture can treat nausea effectively in cancer patients undergoing radiotherapy</strong><br /><a href="http://www.news-medical.net/news/20110324/Simulated-acupuncture-can-treat-nausea-effectively-in-cancer-patients-undergoing-radiotherapy.aspx"></a><a href="http://www.news-medical.net/news/20110324/Simulated-acupuncture-can-treat-nausea-effectively-in-cancer-patients-undergoing-radiotherapy.aspx">http://www.news-medical.net/news/20110324/Simulated-acupuncture-can-treat-nausea-effectively-in-cancer-patients-undergoing-radiotherapy.aspx</a><p /></div><div>More compelling evidence of the power of the placebo effect and the power of our own thought and mind</div><div><br /><span style="">The study from Karoli ska Institutet and Linköping University &nbsp;in Sweden showed that patients, who received only standard care including medications for nausea, felt significantly more nau­sea than patients in both the real and simulated acupuncture groups.</span><br /></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/simulated-acupuncture-can-treat-nausea-effect">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6940022465345837932?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-14150586110876077102011-03-18T08:41:00.002-04:002011-03-18T08:52:07.217-04:00<a href="http://www.blogger.com/wwww.rossmartinmd.com">Ross Martin MD</a> (founder of the American College of Medical Informatimusicology as part of his self-proclamation as the world's leading singer/songwriter of health information technology standards development organization songs) has written a new song - a Rap this time on Meaningful Use. Driven by a desire to bring the "<a href="http://www.youtube.com/watch?v=tMwhl4IrPNc">Pants on the Ground</a>" by General Larry Platt tune to Meaningful Use:<br /><br /><iframe frameborder="0" height="225" src="http://player.vimeo.com/video/20923483" width="400"></iframe><br /><a href="http://vimeo.com/20923483">The Meaningful Yoose Rap</a> from <a href="http://vimeo.com/user6272566">Ross Martin</a> on <a href="http://vimeo.com/">Vimeo</a>.<br /><br /><blockquote>"Now you're probably thinking man something ain't right, this dude ain't got the moves and his rappin ain't tight"</blockquote><blockquote>"Got that one straight - I may not be too cool but this message is important so I'm willing to play the fool, tips your hats to the cats from the <a href="http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204"><span class="Apple-style-span" style="color: black;">ONC</span></a>"</blockquote><br />'nuff said!<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-1415058611087607710?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-73388087063768628692011-03-01T11:34:00.001-05:002011-03-01T11:34:28.722-05:00<div class='posterous_autopost'>Gorilla Glass (foundation of the iPhone display) - Imagine the possibilities in healthcare <br /><object height="300" width="500"><param name="movie" value="http://www.youtube.com/v/6Cf7IL_eZ38&hl=en&fs=1&hd=1" /></param><param name="wmode" value="window" /><param name="allowFullScreen" value="true" /></param><param name="allowscriptaccess" value="always" /></param><embed src="http://www.youtube.com/v/6Cf7IL_eZ38&hl=en&fs=1&hd=1" allowfullscreen="true" type="application/x-shockwave-flash" allowscriptaccess="always" wmode="opaque" height="300" width="500"></embed></object> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/glass-displays-a-view-into-the-future-of-disp">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-7338808706376862869?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-8668155099826811032011-03-01T09:58:00.000-05:002011-03-01T09:58:02.218-05:00Fresh from an exciting and busy week at <a href="http://www.himssconference.org/">HIMSS</a> in Orlando that was topped off with a personal highlight - witnessing the space shuttle launch from a Passenger Jet<br /><img align="left" alt="Shuttle Launch from UA 304.jpg" border="0" height="320" src="http://lh5.ggpht.com/_ppefu9Ztfx8/TWvlXQq89_I/AAAAAAAAAC0/kEf9flIsYIo/Shuttle%20Launch%20from%20UA%20304.jpg?imgmax=800" width="239" /><img align="right" alt="Launch 1.jpg" border="0" height="260" src="http://lh4.ggpht.com/_ppefu9Ztfx8/TWvleYerLxI/AAAAAAAAAC4/Bpg0ngrI4L0/Launch%201.jpg?imgmax=800" width="400" /> <br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br />and the video:<br /><iframe allowfullscreen="" frameborder="0" height="390" src="http://www.youtube.com/embed/vjbUZ0yTOrc" title="YouTube video player" width="640"></iframe><br /><br />There continues to be tremendous interest and excitement surrounding the potential for IBM's Jeopardy champion (Watson) to enhance medicine and ignite discussion on artificial intelligence in healthcare. This piece in the Boston Globe: <a href="http://www.boston.com/business/technology/articles/2011/02/26/ibm_scores_marketing_coup_with_watson_technology/?page=full">The plan behind Watson: winning hearts</a> captures the excitement and buzz we all felt at HIMSS last week that not only made Waston a household name it also garnered a huge audience with a big ratings swell. As Richard Mack put it:<br /><blockquote>“Watson has sparked the imaginations of those not just in the technology industry, but for an array of industries around the globe"</blockquote>Indeed this thought provoking piece from Diagnostic Imaging: <a href="http://www.diagnosticimaging.com/radblog/display/article/113619/1806004?GUID=8465EA69-16BD-499C-BF8E-1C099359BFD8&amp;rememberme=1&amp;source=NL">Will Watson Replace Radiologists?</a> The question being what will the impact be in healthcare and specifically in radiology where <em>radiologists review numerous images and base our findings on our experience and expertise, which are in turn based on reading articles and textbooks (our knowledge base)</em> and as the author asks:<br /><blockquote>If we program all of these knowledge bases into a computer, then wouldn’t the computer be as good or likely even better than we are?</blockquote>Interesting idea but I think this concept is more likely to follow form some of the automated image processing tools that are emerging, for example from <a href="http://www.mediantechnologies.com/">Median Technologies</a> and their <a href="http://www.mediantechnologies.com/lms_lung.htm">LMS-Lung application</a>:<br /><div class="separator" style="clear: both; text-align: center;"><a href="http://www.mediantechnologies.com/var/input/FileManager/LMS/Products/lung.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="230" src="http://www.mediantechnologies.com/var/input/FileManager/LMS/Products/lung.jpg" width="320" /></a></div><br />that automates the detection, evaluation and follow-up of lesions identified in CT images. (this technology interestingly came out of missile tracking systems). Perhaps given identification of lesions and findings in images this could then be coordinated with existing reports using some component of Watson to link image findings with clinical conditions and provide some level of machine intelligence to support radiologists<br /><br />But I think Dr Krishnaraj is right:<br /><blockquote>the personal relationship between a doctor and his patient can never be replaced. It is important, for example, to diagnose cancer, but how is that information communicated? I do not believe a computer will ever be able to demonstrate compassion or rest a hand of comforting support on the shoulder of a patient that is hurting</blockquote>Watson is exciting technology but it does not replace the clinicians or the clinician patient interaction. Techcrunch reported on some of the back lash and lack of understanding in this piece: <a href="http://seekingalpha.com/article/253476-the-next-stop-for-ibm-s-watson-healthcare">The Next Stop for IBM's Watson: Healthcare?</a>. Watson does not replace human intelligence. In fact the opposite is true it supplements human intelligence providing ready access to the large amount of information available today much as we access this information in our daily lives. For example, imagine you are shopping for fruit and come across Papaya in the supermarket, you have heard its good but have no idea how to select a good papaya so you turn to your smartphone and speak or enter "<a href="http://www.google.com/search?client=safari&amp;rls=en&amp;q=how+to+tell+a+ripe+papaya&amp;ie=UTF-8&amp;oe=UTF-8">How to tell a ripe papaya</a>" (which returns 17,400 results including pictures, videos and how tos). You apply that knowledge and select a good papaya based on new information and understanding. Watson extends this capability by helping understand the underlying meaning of the terms and linking the right information together to present a closer match to possible answers. In healthcare we are overwhelmed with new information presented in the form of randomized controlled trials, publications and research papers. A quick look at one resource (<a href="http://www.cochrane.org/">The Cochrane Collaboration</a>)<br /><div class="separator" style="clear: both; text-align: center;"><a href="http://www.cochrane.org/sites/default/files/uploads/images/cclogo70x82.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://www.cochrane.org/sites/default/files/uploads/images/cclogo70x82.gif" /></a></div><br />that is working to provide the best evidence for healthcare and the ~4,000 published Cochrane Reviews, &nbsp;<a href="http://www.thecochranelibrary.com/view/0/index.html">the Cochrane Library</a> and the updated list of <a href="http://www2.cochrane.org/reviews/en/index_newandupdated_reviews.html">treatment guidance and review of protocols</a>&nbsp;and you get a sense of the mass of data that clinicians need to read, digest, process and then apply in clinical practice. Dr Watson brings processing power to the clinical coal face to improve diagnostic accuracy, efficiency and patient safety but <b>not</b> to replace clinicians. Or as Dr Krishnaraj put it the<br /><blockquote>"personal relationship between a doctor and his patient can never be replaced"</blockquote><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-866815509982681103?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-44517577635637147582011-02-22T20:44:00.001-05:002011-02-22T20:44:40.445-05:00<div class='posterous_autopost'><img src="http://posterous.com/getfile/files.posterous.com/drnic/dQtFZJ9RDFpgI1CykBqwtdEWLlF3V2eRr7Cnr1co5kFsjPY0fRjrQ2v8xtvc/PastedGraphic-3.tiff.converted.jpg" width="479" height="640"/> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/fun-meeting-with-drjosephkim-freeehr-himss11">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4451757763563714758?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-71454214494792506792011-02-22T20:43:00.001-05:002011-02-22T20:43:39.615-05:00<div class='posterous_autopost'><img src="http://posterous.com/getfile/files.posterous.com/drnic/1tGADEkXRQoWJOeqdNKJD5r0liSf4IXrxU9v5n5g4yVbX1kYE9nJfCkNhi5Y/PastedGraphic-2.tiff.converted.jpg" width="479" height="640"/> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/another-interesting-discussion-with-techguy-j">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-7145421449479250679?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-47430187812316112992011-02-17T10:06:00.000-05:002011-02-17T10:06:49.602-05:00<div class="separator" style="clear: both; text-align: center;"><b><u>Watson Emerges Champion in Jeopardy</u></b></div><div class="separator" style="clear: both; text-align: center;"><a href="http://hitechanalogy.com/wp-content/uploads/2011/02/IBM-Watson-Jeopardy-500x285.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="182" src="http://hitechanalogy.com/wp-content/uploads/2011/02/IBM-Watson-Jeopardy-500x285.jpg" width="320" /></a></div><br />Watson emerged the Jeopardy Champion last night with a resounding $ 77,147, beating both competitors (Ken Jennings:$ 24,000&nbsp;and Brad Rutter:$21,600)&nbsp;by over 300% ($53,147/$55,547).<br /><img align="left" alt="2011-02-16WatsonWinningTotal.jpg" border="0" height="100" src="http://lh5.ggpht.com/_ppefu9Ztfx8/TV0qkOyLMgI/AAAAAAAAACk/JbYtz5uf8xg/2011-02-16WatsonWinningTotal.jpg?imgmax=800" width="125" /><br /><div style="text-align: center;">Hats off to Ken Jennings and Brad Rutter for taking on the challenge and doing such a great job<br /><img alt="2011-02-16WatsonThreeScores.jpg" border="0" height="150" src="http://lh5.ggpht.com/_ppefu9Ztfx8/TV0rvzBsxGI/AAAAAAAAACs/iGka4l94gdg/2011-02-16WatsonThreeScores.jpg?imgmax=800" width="200" /></div><br />This was followed today with the joint Nuance/IBM <a href="http://www.prnewswire.com/news-releases/ibm-to-collaborate-with-nuance-to-apply-ibms-watson-analytics-technology-to-healthcare-116395589.html">Press Release</a>: "IBM to Collaborate with Nuance to Apply IBM’s Watson&nbsp;Analytics Technology to Healthcare" (<a href="http://www-03.ibm.com/press/us/en/pressrelease/33726.wss">here on IBM</a> and <a href="http://www.nuance.com/company/news-room/press-releases/NC_008477">Nuance's site</a>) that recognizes the tremendous value that Watson can bring to healthcare. Watson showed last night the major advances that have been made by IBM's “Deep Question Answering” (QA) research team:<br /><blockquote>the ability of a computer to understand natural human speech inquiries that pertain to a limitless range of topics, and to make informed judgments about requests</blockquote>There was plenty of coverage as evidenced by the 15 Million hits in Google for the search (<a href="http://www.google.com/search?client=safari&amp;rls=en&amp;q=jeopardy+watson&amp;ie=UTF-8&amp;oe=UTF-8">Jeopardy/Watson</a>) with the vast majority <a href="http://mashable.com/2011/02/16/watson-jeopardy-day-2/">highlighting</a> Watson's superiority (<a href="http://www.time.com/time/business/article/0,8599,2049826,00.html">Time Magazine: Winner, Dr Watson I presume</a>, <a href="http://www.zdnet.com/blog/btl/ibm-watsons-next-adventure-healthcare-with-nuance/44973">ZDNet: Watson's Next Adventure - Healthcare with Nuance</a>, <a href="http://www.informationweek.com/news/healthcare/clinical-systems/showArticle.jhtml?articleID=229218809">Information Week: IBM Nuance Envision Watson Helping Doctors</a>, <a href="http://www.nytimes.com/2011/02/17/science/17jeopardy-watson.html">NY Times: Computer Wins on Jeopardy, Trivial It's Not</a> and<a href="http://online.wsj.com/article/BT-CO-20110216-719076.html">IBM Moving Watson Supercomputer Beyond 'Jeopardy' To Health-Care</a>. Stephen Wolfram of <a href="http://www.wolframalpha.com/">Wolfram Alpha</a> weighed in with this thoughtful post (<a href="http://blog.stephenwolfram.com/2011/01/jeopardy-ibm-and-wolframalpha/">Jeopardy IBM and Wolfram Alpha</a>) comparing Watson and Wolfram Alpha and this more light hearted post&nbsp;<a href="http://searchengineland.com/google-jeopardy-smartest-search-engine-but-no-ken-jennings-62577">If Google Played Jeopardy: Smartest Search Engine, But It’s No Ken Jennings</a> where he challenged search engines with the simplified task of entering the same Jeopardy Clues<br /><br />Google showed well <br /><div class="separator" style="clear: both; text-align: center;"><a href="http://searchengineland.com/figz/wp-content/seloads/2011/01/search-engines-jeopardy.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="340" src="http://searchengineland.com/figz/wp-content/seloads/2011/01/search-engines-jeopardy.gif" width="640" /></a></div>Leading them to suggest that<br /><blockquote>Either he’s (<i>Ken Jennings</i>) an immediate acquisition candidate in Mountain View and Redmond, or he should just start his own search engine and answer queries as they come in</blockquote>There were other dissenters including this post <a href="http://searchengineland.com/could-google-play-jeopardy-like-ibm-watson-65038">Could Google Play Jeopardy Like IBM's Watson</a>. Google has certainly cornered search and access of data but even if the data can be found with a google search and there are certainly some shared concepts in the search technologies I'm not sure that finding the data in a search page is the same as answering the question and really understanding the question. But the summary and analysis of Natural Langauge:<br /><blockquote>Natural Language Reality Check: The reality is that the technology that Watson demonstrates, while amazing in a game show, is overkill for what most people need. Those behind “natural language” search technologies have long trotted out sentences like the “Who’s in the pajamas” example above to demonstrate how “smart” their search tools are. And yet, most searches people do on search engines are only two or three words long.</blockquote>Missed the mark and the analogy is flawed on several counts. &nbsp;I would suggest that our interactions are deliberately simplified when we interact with Google - we work around the lack of understanding of the Google search engine. And while Watson may be overkill for "most people" the potential application in multiple areas dealing with ever increasing volumes of unstructured data it is healthcare that has been struggling with the challenge of overwhelming clinical knowledge and our inability to access and apply this at the time of care delivery. In this discussion on the possible healthcare applications of Wtason/DeepQA<br /><iframe allowfullscreen="" frameborder="0" height="390" src="http://www.youtube.com/embed/uWHG7DMLurE" title="YouTube video player" width="640"></iframe><br /><br />Dr Herbert Chase (Professor of Clinical of Medicine at Columbia University) says:<br /><blockquote>For at least 30 years it has been impossible for a physician to master all the material to practice medicine at the highest level. Biomedical literature has doubled in size every seven years but patients want those facts at the doctors finger tips when they see him (the doctor)</blockquote>It is this challenge of data that clinicians face every day as they attempt to deliver the best possible care to each and every patient at the time of the consultation and something their patients expect. Definitely not overkill for patients or doctors and given the Tsunami of medical knowledge and the challenge of sharing clinical data. DeepQA will add a new level of medical intelligence to support to clinicians is with the application of Natural Language Processing taken to a new level of understanding.<br /><br />Back in June I talked about this technology and the potential for application in healthcare (<a href="http://drvoice.blogspot.com/2010/06/nlp-in-healthcare.html">NLP in Healthcare</a>). In October Nuance announced our strategic partnership with IBM and I covered the news in this post: <a href="http://drvoice.blogspot.com/2010/10/clinical-documentation-challenges.html">Clinical Documentation Challenges</a> and then again building towards the Jeopardy challenge <a href="http://drvoice.blogspot.com/2010/12/nlp-in-healthcare-part-2.html">NLP in Healthcare Part 2</a> and most recently this week as part of the potential solution to the challenge of shareable clinical data and clinical data models (<a href="http://drvoice.blogspot.com/2011/02/pcast-opportunity-hl7-cda-uel-and-sage.html">The PCAST Opportunity, HL7 CDA, UEL and SAGE</a>)<br /><br />The announcement today builds on a deep research and technology partnership that already exists in multiple areas between the companies. As one person pointed out in a note to me yesterday<br /><blockquote>"I cannot understand that Watson cannot 'hear' an opponents wrong answer. They text in the question and then Watson parses the english, algorithms swirl, etc. However, when an opponent speaks it cannot hear. So when a bad answer is spoken it is bound to repeat it.. "</blockquote>That is part of the innovation and solutions that Nuance will contribute to the partnership which will also include the Clinical Language Understanding (<a href="http://www.nuance.com/for-healthcare/resources/nlp/index.htm">CLU</a>) Technology that will be used create new solutions that provide hospitals, physicians and caregivers access to critical and timely information expanding from recognizing what was said and parsing data to now understanding the intent and providing guidance. This will push us one step closer to intelligent medical analysis real time with the clinician to assist hospitals to utilize facts and knowledge as they migrate toward evidence-based and accountable care models:<br /><blockquote>Recognizing the tremendous value that Watson can bring to healthcare, Nuance and IBM have teamed to co-develop solutions that will transform vast amounts of clinical data into actionable information across the continuum of care. This endeavor is intended to unlock important medical knowledge and facts buried within huge volumes of data repositories, providing healthcare provider organizations, payers and individual physicians a new level of medical intelligence</blockquote>It has been yet another exciting day in the world of healthcare technology<br /><div><br /></div><br />If you want to see the Jeopardy games you can watch them below<br />Part 1:<br /><iframe allowfullscreen="" frameborder="0" height="390" src="http://www.youtube.com/embed/ZLdkJpAtt1I" title="YouTube video player" width="640"></iframe><br />Part 2:<br /><iframe allowfullscreen="" frameborder="0" height="390" src="http://www.youtube.com/embed/PHhDLUVAtqU" title="YouTube video player" width="640"></iframe><br />and Part 3:<br /><iframe allowfullscreen="" frameborder="0" height="390" src="http://www.youtube.com/embed/AQ76niVceQA" title="YouTube video player" width="640"></iframe><br /><br /><br />And it is not just healthcare:<br /><br /><iframe allowfullscreen="" frameborder="0" height="390" src="http://www.youtube.com/embed/dQmuETLeQcg" title="YouTube video player" width="640"></iframe><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4743018781231611299?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-60766044880438865602011-02-16T16:12:00.000-05:002011-02-16T16:12:50.183-05:00It was an exciting news day today with the announcement of a Strategic partnership between Nuance and 3M. Lots of coverage and keen interest from the press and healthcare industry as evidenced by the <a href="http://tinyurl.com/4exn933">290,000 search results in Google by 15:30 ET</a>. While many of the news links were picking up <a href="http://www.businesswire.com/portal/site/3m/index.jsp?ndmViewId=news_view&amp;ndmConfigId=1000940&amp;newsId=20110216005471&amp;newsLang=en&amp;vnsId=3M-Nuance-Team-Deliver-Computer-Assisted-Physician-Documentation">3M's Press Release</a> and <a href="http://www.nuance.com/company/news-room/press-releases/NC_008464">Nuance's Press Release</a> it was the <a href="http://histalk2.com/2011/02/15/histalk-interviews-janet-dillione-and-jon-lindekugel/">interview on HISTalk</a> that provided a detailed look into the tremendous synergies between the two companies and excitement surrounding the concept of Computer-Assisted Physician Documentation. As John Lindekugel said<br /><blockquote>In a nutshell, we’re taking 3M’s industry-leading Clinical Documentation Improvement approach, which a lot of hospitals rely on today in their HIM and documentation improvement departments, and applying all the technology that Nuance brings and its industry-leading technology to deliver that content to the point of care, to the physician.</blockquote>Replacing the manual time consuming and painful follow up process today with an automated tool that provides immediate feedback to the clinician at the point of care.....as one CMO put it "<em>that's huge!</em>".<br /><br />For clinicians CAPD's immediate feedback adds up to<br /><br /><ul><li>More accurate and specific documentation that is more effective in assessing and communicating the patient's condition</li><li>Reducing the burden of disruptive follow up questions and queries for Clinical Documentation Improvement (CDI) staff</li><li>Improving the overall quality and detail of the Clinical document without excessive change in behavior or effort</li><li>Achieving appropriate reimbursement with more accurate quality and detailed clinical reporting</li><li>Ease the burden of the ICD10 transition</li></ul><br />For any healthcare facility in the US CAPD means there are now automated tools to reduce the administrative burden on clinicians which will have a positive effect on clinician satisfaction and retention. More accurate information flowing through the clinical systems translates to accurate clinical risk and severity, reducing compliance risk and reducing administrative costs<br /><br />All this will be on show at <a href="http://www.himssconference.org/exhibition/default.aspx">HIMSS</a> next week in Orlando at <a href="http://onlinebuyersguide.himss.org/profile.asp?VendorId=28&amp;F_SearchCriteria=3M&amp;F_Country=&amp;F_State=&amp;F_CategoryId=&amp;F_City=&amp;F_Zip=">3M's Booth 3547</a> and <a href="http://onlinebuyersguide.himss.org/profile.asp?VendorId=9847&amp;F_SearchType=Key&amp;F_SearchCriteria=Nuance&amp;F_Country=&amp;F_State=&amp;F_CategoryId=&amp;F_City=&amp;F_Zip=">Nuance's Booth 2744</a>. If you will be at the show stop by and take a look. It will be a busy few days but there should be plenty of opportunities to talk to the folks involved in developing the solution and we are keen to get feedback from as wide arrange of stakeholders as possible.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6076604488043886560?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-38002765103278750272011-02-15T09:36:00.001-05:002011-02-15T09:36:00.560-05:00Certification remains one of the basic building blocks of the incentive program from the Government. CMS provides a <a href="http://onc-chpl.force.com/ehrcert">tool</a> for finding certified EHR technology for practices as part of the <a href="http://www.cms.gov/EHRIncentivePrograms/01_Overview.asp#TopOfPage">EHR incentive program</a>. As&nbsp;<a href="http://www.linkedin.com/in/houstonneal">Houston Neal</a>&nbsp;Director of Marketing at Software Advice points out "Certified" is the $44,000 buzzword. In this guest posting he drills down into the details of certification and provides a list of 5 key questions to ask to help avoid the pitfalls and make sure you will be eligible to receive the incentive payments:<br /><br /><br /><!--StartFragment--> <br /><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-size: 14.0pt; line-height: 115%;">Playing Games with ONC Certification<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-size: 10.0pt; line-height: 115%;">“Certified” is the $44,000 buzzword prefixing electronic health records (EHR) software. To qualify for Health Information Technology for Economic and Clincal Health (HITECH) Act incentive payments, you must use an EHR that is certified by the government. Additionally, you must use a system - or systems - that offer 100% of the functional and security capabilities required to meet “Meaningful Use” criteria.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-size: 10.0pt; line-height: 115%;">Many EHR vendors are promoting their products as “certified,” but the claim can be misleading. There are three ways they could lead you astray:<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><b><span style="font-size: 10.0pt; line-height: 115%;">Alternative Certifications<o:p></o:p></span></b></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-size: 10.0pt; line-height: 115%;">Before the HITECH Act, two organizations certified medical software:<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .25in left .5in; text-indent: -.25in;"><span style="font-size: 10.0pt; line-height: 115%;"><span style="mso-list: Ignore;">●<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><b><span style="font-size: 10.0pt; line-height: 115%;">Certification Commission for Health Information Technology (CCHIT) - </span></b><span style="font-size: 10.0pt; line-height: 115%;">CCHIT began certifying EHR software in 2006. Since then they have released </span><a href="http://www.google.com/url?q=http%3A%2F%2Fwww.cchit.org%2Fprevious_certs&amp;sa=D&amp;sntz=1&amp;usg=AFQjCNEPmh2-t26WmXQSfsYEz5JLya8GjQ">10 </a><a href="http://www.google.com/url?q=http%3A%2F%2Fwww.cchit.org%2Fprevious_certs&amp;sa=D&amp;sntz=1&amp;usg=AFQjCNEPmh2-t26WmXQSfsYEz5JLya8GjQ">certification</a><a href="http://www.google.com/url?q=http%3A%2F%2Fwww.cchit.org%2Fprevious_certs&amp;sa=D&amp;sntz=1&amp;usg=AFQjCNEPmh2-t26WmXQSfsYEz5JLya8GjQ"> </a><a href="http://www.google.com/url?q=http%3A%2F%2Fwww.cchit.org%2Fprevious_certs&amp;sa=D&amp;sntz=1&amp;usg=AFQjCNEPmh2-t26WmXQSfsYEz5JLya8GjQ">programs</a><span style="font-size: 10.0pt; line-height: 115%;"> for ambulatory and inpatient EHRs.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l0 level1 lfo1; tab-stops: list .25in left .5in; text-indent: -.25in;"><span style="font-size: 10.0pt; line-height: 115%;"><span style="mso-list: Ignore;">●<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><b><span style="font-size: 10.0pt; line-height: 115%;">KLAS - </span></b><span style="font-size: 10.0pt; line-height: 115%;">KLAS is a private organization that has gathered ratings on EHRs since 1997. Every year they rank EHR vendors and bestow a “Best in KLAS” award on the top 20.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-size: 10.0pt; line-height: 115%;">In an effort to stand out from the other 300+ EHR systems on the market, vendors widely promote their CCHIT or KLAS credentials. They may even tack the word “certified” onto their CCHIT or KLAS approved product. This muddies the water for providers. They have to distinguish between CCHIT, KLAS and certification from an ONC-Authorized Testing and Certification Body (ONC-ATCB). While CCHIT and KLAS are meaningful credentials, they’re not the certifications that qualify for incentive funds.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-size: 10.0pt; line-height: 115%;">This is especially confusing because CCHIT is <span style="background: white;">now one of six organizations</span> approved to certify EHRs for the HITECH Act. So, if an EHR vendor claims they have CCHIT certification, you’ll need to clarify which one. Is it ONC-ATCB certification, or one of CCHIT’s independent credentials?<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><b><span style="font-size: 10.0pt; line-height: 115%;">Complete EHR vs EHR Module<o:p></o:p></span></b></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-size: 10.0pt; line-height: 115%;">Software vendors can receive ONC-ATCB certification for a complete EHR <i>or</i> an EHR module. This means a product doesn’t need to meet all criteria for Meaningful Use - instead, it can be partially certified if one or more functions meet a subset of requirements. For example, a vendor could certify their e-prescribing application or their patient portal.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-size: 10.0pt; line-height: 115%;">This under-publicized detail could cost you thousands of dollars; by itself, a certified EHR module won’t make you eligible for incentive payments. You must use two or more modular EHRs that, combined, meet 100% of the ONC criteria. So while vendors can officially promote a module as having ONC-ATCB certification, it may fall short of making you eligible. <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><b><span style="background: white; font-size: 10.0pt; line-height: 115%;">Guaranteed Incentive Payments<o:p></o:p></span></b></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-size: 10.0pt; line-height: 115%;">Be mindful of guaranteed incentive payments. It is reasonable for a vendor to guarantee they’ll meet certification criteria. In fact, you might make it a requirement in your purchase decision.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-size: 10.0pt; line-height: 115%;">However, guaranteeing <i>incentive payments</i> is altogether different. Technology alone won’t make you eligible. EHRs are just a means to an end. Ultimately, you are responsible for achieving Meaningful Use status. So be wary of this type of guarantee. Read the fine print and find out how you are reimbursed if you don’t qualify for incentive payments. Does the vendor reimburse you the full amount of lost incentive payments? Or do you just get reimbursed for the cost of the software? You shouldn’t purchase a system based on this guarantee alone.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><b><span style="font-size: 10.0pt; line-height: 115%;">Five Key Questions to Ask Vendors<o:p></o:p></span></b></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-size: 10.0pt; line-height: 115%;">To help you avoid thse pitfalls, we put together a list of 5 questions to ask vendors. <span style="background: white;">Answering these will put you in a good position to become eligible for incentive payments.<o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo2; tab-stops: list .25in left .5in; text-indent: -.25in;"><span style="font-size: 10.0pt; line-height: 115%;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><i><span style="font-size: 10.0pt; line-height: 115%;">Which certification does the EHR have: CCHIT, KLAS or ONC-ATCB?</span></i><span style="font-size: 10.0pt; line-height: 115%;"> You must use an EHR that is ONC-ATCB certified in order to be eligible for incentive payments.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo2; tab-stops: list .25in left .5in; text-indent: -.25in;"><span style="font-size: 10.0pt; line-height: 115%;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><i><span style="font-size: 10.0pt; line-height: 115%;">Which product version has been certified?</span></i><span style="font-size: 10.0pt; line-height: 115%;"> Ask the vendor for complete details of their ONC-ATCB 2011/2012 certification, including: product name and version, date certified, unique product identification number, the criteria for which they are certified, and the clinical quality measures for which they were tested.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo2; tab-stops: list .25in left .5in; text-indent: -.25in;"><span style="font-size: 10.0pt; line-height: 115%;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><i><span style="font-size: 10.0pt; line-height: 115%;">Does the vendor have certification for a complete EHR or an EHR module?</span></i><span style="font-size: 10.0pt; line-height: 115%;"> If module, you will need to use more than one to be eligible for incentive payments. <span style="background: white;">The ONC has created </span></span><a href="http://www.google.com/url?q=http%3A%2F%2Fonc-chpl.force.com%2Fehrcert&amp;sa=D&amp;sntz=1&amp;usg=AFQjCNGcbzJWGR7n29QWL2tKteq_o9vsjw">a</a><a href="http://www.google.com/url?q=http%3A%2F%2Fonc-chpl.force.com%2Fehrcert&amp;sa=D&amp;sntz=1&amp;usg=AFQjCNGcbzJWGR7n29QWL2tKteq_o9vsjw"> </a><a href="http://www.google.com/url?q=http%3A%2F%2Fonc-chpl.force.com%2Fehrcert&amp;sa=D&amp;sntz=1&amp;usg=AFQjCNGcbzJWGR7n29QWL2tKteq_o9vsjw">handy</a><a href="http://www.google.com/url?q=http%3A%2F%2Fonc-chpl.force.com%2Fehrcert&amp;sa=D&amp;sntz=1&amp;usg=AFQjCNGcbzJWGR7n29QWL2tKteq_o9vsjw"> </a><a href="http://www.google.com/url?q=http%3A%2F%2Fonc-chpl.force.com%2Fehrcert&amp;sa=D&amp;sntz=1&amp;usg=AFQjCNGcbzJWGR7n29QWL2tKteq_o9vsjw">website</a><span style="background: white; font-size: 10.0pt; line-height: 115%;"> that allows you to build a list of EHR modules that meet 100% of ONC criteria.<i> <o:p></o:p></i></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo2; tab-stops: list .25in left .5in; text-indent: -.25in;"><span style="font-size: 10.0pt; line-height: 115%;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><i><span style="font-size: 10.0pt; line-height: 115%;">Will the vendor resubmit their EHR for final certification in 2012?</span></i><span style="font-size: 10.0pt; line-height: 115%;"> The current certification is temporary and only lasts through 2011. Make sure your vendor has plans to reapply in 2012, and find out if they will certify a complete EHR or just a module.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; mso-list: l1 level1 lfo2; tab-stops: list .25in left .5in; text-indent: -.25in;"><span style="font-size: 10.0pt; line-height: 115%;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><i><span style="font-size: 10.0pt; line-height: 115%;">Are you purchasing through a reseller or other business partner that renamed the product?</span></i><span style="font-size: 10.0pt; line-height: 115%;"> If so, make sure the renamed product has been approved by the ONC-ATCB. Even if it is the same version with identical features and functionality, it won’t make their Certified HIT Products List unless the original vendor reports it to an ONC-ATCB.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .5in; margin-right: 0in; margin-top: 0in; tab-stops: .5in; text-indent: -.25in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; tab-stops: .5in;"><i><span style="font-size: 10.0pt; line-height: 115%;">This article was written by Houston Neal of </span></i><a href="http://www.softwareadvice.com/medical/electronic-medical-record-software-comparison/">Software Advice</a><i><span style="font-size: 10.0pt; line-height: 115%;">. To view the original article, visit </span></i><a href="http://www.softwareadvice.com/articles/medical/playing-games-with-onc-certification-01020811/">Playing Games with ONC Certification</a><i><span style="font-size: 10.0pt; line-height: 115%;">.<o:p></o:p></span></i></div><!--EndFragment--><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3800276510327875027?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-22233605469036124352011-02-14T11:34:00.000-05:002011-02-14T11:34:57.250-05:00The recent publication of the PCAST Health Information Technology Report: <a href="http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.pdf">Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward</a>, &nbsp;published December 8, 2010 (<a href="http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-release.pdf">press release</a>&nbsp;and covered in this <a href="http://www.hhs.gov/news/imagelibrary/video/2010-12-08_press.html">webcast</a>) and became something of a Piñata for comments. Vince Kuratis did a great job of pulling these comments and responses together in his his blog <a href="http://thehealthcareblog.com/blog/2011/01/23/pcast-hit-report-becomes-a-political-pinata/">PCAST HIT Report Becomes a Political Piñata</a>.<br /><br />But Wes Rishell's post: "<a href="http://blogs.gartner.com/wes_rishel/2011/02/13/pcast-documents-vs-atomic-data-elements/">PCAST Opportunity: Documents vs. “Atomic Data Elements</a>”&nbsp;that reviews the PCAST recommendations and digs into the details of the development of standards and the basis for the exchange of information (documents vs snippets or Molecules/atoms), exchange formats and Universal ExchangeLanguage (UEL) vs HL7 CDA does an excellent job of dissecting out some of the controversies and homing in on exchange of data and the standards in question as well as highlighting the challenges associated with pre and post coordination of data (read less codes requirements and more code requirements). Interestingly Wes estimates<br /><blockquote>from 20,000 to 100,000 (data elements) but a number of physicians seem to agree that a very useful collection of molecules and radicals would contain many fewer than 20,000. Stan’s presentation describes several different parallel efforts to enumerate the molecules using siloed methodologies. The one he is working on as identified more than 4,000.</blockquote>He points to several related posts - this from John Halamka: <a href="http://geekdoctor.blogspot.com/2011/02/detailed-clinical-models.html">Detailed Clinical Models</a>&nbsp;that points to multiple other standards in development in other countries (Open EHR in Australia, ISO13972, Tolven's Open Source Clinical Data Definitions &nbsp;and the National Health Service Logical Record Architecture) which all adds up to a pressing need for a Universal Exchange Language...and in my mind translates to a significant challenge in developing and then keeping up to date.<br /><br />Both blogs point to an excellent detailed (almost 2 hours) presentation by Stan Huff (CMIO at Intermountain Healthcare): <a href="http://informatics.mayo.edu/recordings/CEM/ClinicalElementModel.swf">Practical Modeling issues: Representing Coded and Structured Patient Data in EHR Systems</a><br /><br /><embed height="100%" name="plugin" src="http://informatics.mayo.edu/recordings/CEM/ClinicalElementModel.swf" type="application/x-shockwave-flash" width="100%"></embed><yoono-share-selection-layer style="background-image: url(http://cache.yoono.com/static/sb/share/green-30.png) !important; border-bottom-color: rgb(47, 148, 47) !important; border-bottom-left-radius: 5px 5px !important; border-bottom-right-radius: 5px 5px !important; border-bottom-style: solid !important; border-bottom-width: 3px !important; border-left-color: rgb(47, 148, 47) !important; border-left-style: solid !important; border-left-width: 3px !important; border-right-color: rgb(47, 148, 47) !important; border-right-style: solid !important; border-right-width: 3px !important; border-top-color: rgb(47, 148, 47) !important; border-top-left-radius: 5px 5px !important; border-top-right-radius: 5px 5px !important; border-top-style: solid !important; border-top-width: 3px !important; cursor: pointer !important; display: none; position: absolute !important; z-index: 100000 !important;"></yoono-share-selection-layer><yoono-share-selection-btn style="-webkit-user-select: none !important; background-color: rgb(47, 148, 47) !important; color: white !important; cursor: pointer !important; display: none; font-family: arial, sans-serif !important; font-size: 11px !important; height: 17px !important; padding-right: 7px !important; padding-top: 3px !important; position: absolute !important; text-decoration: underline !important; z-index: 100000 !important;"><yoono-share-selection-btn-ico style="background-image: url(http://cache.yoono.com/static/sb/share/share-icons.png) !important; background-position: -1px -1px; float: left !important; height: 16px !important; margin-left: 8px !important; margin-right: 5px !important; width: 16px !important;"></yoono-share-selection-btn-ico>select</yoono-share-selection-btn><br /><br />And a link to some of the original work "Detailed Clinical Models for Shareable, Excutable Guidelines (<a href="http://cmbi.bjmu.cn/news/report/2004/medinfo2004/pdffiles/papers/5071Parker.pdf">pdf from MEDINFO 2004</a>) that detailed the NIST funded multi institutional SAGE research project<br /><blockquote>sharable, executable clinical guidelines. The project envisions a system that enables the authoring, localization and execution of significant clinical guidelines in a vendor independent manner</blockquote>One thing is for sure - this is a complex issue requiring much attention and focus since the coordination and sharing of data is a fundamental building block of effective, efficient and safe healthcare. Effective sharing of data appears to require standards and exchange languages. But today is the first of three part episodes of Jeopardy featuring Watson . I talked about this back in <a href="http://drvoice.blogspot.com/2010/06/nlp-in-healthcare.html">June</a> and again in <a href="http://drvoice.blogspot.com/2010/12/nlp-in-healthcare-part-2.html">December</a>. Tonight is the first night of the <a href="http://www-03.ibm.com/innovation/us/watson/">Waston</a> <a href="http://www.jeopardy.com/">Jeopardy</a> challenge.<br />In the countdown to Jeopardy<br /><iframe allowfullscreen="" frameborder="0" height="390" src="http://www.youtube.com/embed/dP4Jc5rGT1A" title="YouTube video player" width="640"></iframe><br /><br />It is clear IBM has pushed the limits of computing technology and "understand" the complex human language which Nuance has partnered to bring this same technology to Healthcare: <a href="http://drvoice.blogspot.com/2010/10/clinical-documentation-challenges.html">Clinical Documentation Challenges</a>&nbsp;that will apply a whole new way of looking at clinical documentation that reduces our dependance on codes, structure and defined clinical data models.<br /><br />If we consider the adeptness of the human mind and our ability to understand the fine nuance detailed of clinical reports without the data being tagged or encoded this suggests that the Watson applied to healthcare concept may hold a critical key to exchange and intelligent use of data. Based on the existing standard of "documents" we can innovate and use these documents that are currently a natural part of clinical care.<br /><br />So as Wes Rishell stated in his summary:<br /><blockquote>Documents will continue to be at the heart of information flow for patient care and one primary way of bundling clinical information about people</blockquote>In conjunction with some form of<br /><br /><ul><li>evolving universal exchange language (UEL),</li><li>encoding of data, and&nbsp;</li><li>reliable and simple ("but only as simple as possible, but not simpler") data representation</li></ul><br />In conjunction with machine based understanding that I think we will see tonight has been advanced to new and exciting levels we will have a foundation of sharing data efficiently and intelligently in our healthcare system<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2223360546903612435?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-86367227429778534812011-01-30T17:02:00.002-05:002011-01-31T18:08:34.975-05:00<div class="posterous_autopost">Headlines this week have provided much confusion in the march towards digitization of healthcare that were based on a Stanford study published in the Archives of Internal Medicine:&nbsp;<a href="http://archinte.ama-assn.org/cgi/content/full/archinternmed.2010.527">Electronic Health Records and Clinical Decision Support Systems</a>&nbsp;with a conclusion:<br /><div><blockquote type="cite">Our findings indicate no consistent association&nbsp;between EHRs and CDS and better quality. These results raise&nbsp;concerns about the ability of health information&nbsp;technology&nbsp;to fundamentally alter outpatient care quality.</blockquote><div><div>Needless to say a strong negative claim from a leading institution attracted a lot fo coverage (<a href="http://www.medscape.com/viewarticle/736195">Medscape</a>,&nbsp;<a href="http://www.reuters.com/article/2011/01/24/us-records-idUSTRE70N6IM20110124">Reuters</a>,&nbsp;<a href="http://www.healthdatamanagement.com/news/study-stanford-ehr-clinical-decision-support-quality-41781-1.html">Health Data Management</a>,&nbsp;<a href="http://www.ihealthbeat.org/articles/2011/1/25/health-it-tools-do-not-improve-care-quality-according-to-study.aspx">iHealthBeat</a>, &nbsp;<a href="http://www.dotmed.com/news/story/15218">DotMedNews</a>,&nbsp;<a href="http://www.bloomberg.com/news/2011-01-24/electronic-records-don-t-improve-outpatient-care-study-says.html">Bloomberg</a>.....and the list goes on). The power of the internet and the instantaneous nature of the news allows these stories to rapidly disseminate.</div><div><div><div>In fact some of this will add fuel to the&nbsp;<a href="http://thomas.loc.gov/cgi-bin/bdquery/D?d112:1:./temp/~bdPxOk:@@@L&amp;summ2=m&amp;%7C/home/LegislativeData.php?n=BSS;c=112%7C">HR408 Act</a>&nbsp;&nbsp;Spending Reduction Act of 2011 (the text of this can be found&nbsp;<a href="http://thomas.loc.gov/cgi-bin/query/z?c112:H.R.408:">here</a>). It is a far reaching bill attempting to reign in spending to the tune of 2.5 Trillion and includes several elements focusing on repeal of Healthcare IT stimulus spending S:302 which focuses on repealing the HITECH funding and investment - there was a good analysis in&nbsp;<a href="http://www.healthdatamanagement.com/news/legislation-house-gop-meaningful-use-hitech-41839-1.html?ET=healthdatamanagement:e1638:124535a:&amp;st=email&amp;utm_source=editorial&amp;utm_medium=email&amp;utm_campaign=HDM_Alert_012811_012811">Health Data Management&nbsp;GOP Bill Puts Meaningful Use, HITECH Act in Peril</a>&nbsp;that highlights the murky nature of the impact of this legislation.</div><div>But the power of the internet works both ways and there are several great articles that apply a sound analytical view on the study and highlight the limitations of the study. In this piece&nbsp;<a href="http://www.billhersh.info/">Dr WIlliam Hersh</a>;&nbsp;<a href="http://informaticsprofessor.blogspot.com/2011/01/electronic-health-records-do-not-impact.html">Electronic Health Records Do Not Impact the Quality of Healthcare</a>&nbsp;takes a long hard look at the study adn as he points out</div><blockquote type="cite"><div>Like almost all science that gets reported in the general media, there is more to this study than what is described in the headlines and news&nbsp;reports. The study was published in a prestigious medical journal by two Stanford researchers. The implementation of the research methods they&nbsp;used appears to be sound.</div></blockquote></div></div></div></div><div>But as he points out there are serious limitations to this type of study based on the type of study and the data resources, in particular the study "used a data source collected for other purposes and he highlighted the following limitations:</div><div><ol class="MailOutline"><li>A frequent challenge - the study looks at correlation, which does not mean causality</li><li>The quality measures used did not provide enough insight into actual quality improvement (process measures vs outcome measures)</li><li>No detail of the EHR's being used and if they had any decision support in place relative the the quality measures</li><li>THe care assessed was individual episodes of care and improvements in actual quality occur over multiple episodes of care (the longitudinal medical record)</li><li>Data analyzed was old (2005 - 2007) and in any field of technology including Healthcare Informatics this is old</li><li>No indication of the training and skill set of the clinicians being assessed and success and failure fo EHR's goes far beyond the technology and is closely tied to implementation and training</li></ol></div><div>And there was extensive discussion that pointed to other articles and studies highlighting the benefits and in particular emphasize how early we are in this process. I imagine that for several other key inventions there was a similar response:</div><div><ul class="MailOutline"><li>The Electric light bulb</li><li>Telephone</li></ul></div><blockquote class="webkit-indent-blockquote" style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote class="webkit-indent-blockquote" style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><i>This 'telephone' has too many shortcomings to be seriously&nbsp;considered as a means of communication. The device is inherently&nbsp;of no value to us.</i></div></blockquote></blockquote><blockquote class="webkit-indent-blockquote" style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote class="webkit-indent-blockquote" style="border: none; margin: 0 0 0 40px; padding: 0px;"><div><i><b>Western Union Internal Memo: 1876</b></i></div></blockquote></blockquote><div><ul class="MailOutline"><li>Automobile</li><li>Microprocessor</li><li>And even the internet and the world wide web</li></ul></div><div>THis follow up piece by Clem McDonald:&nbsp;<a href="http://archinte.ama-assn.org/cgi/content/full/archinternmed.2010.518">Clinical Decision Support and Rich Clinical Repositories: A Symbiotic Relationship</a>&nbsp;that highlighted a range of other positive studies and identifies significant breakdown in the meta analysis that was carried out.&nbsp;As he states succinctly:</div><blockquote type="cite"><div><ul class="MailOutline"><li>First, and most important, the&nbsp;current article tells&nbsp;us nothing about which CDS guidelines were implemented&nbsp;in the&nbsp;systems that they studied.&nbsp;Practices and EHRs vary considerably&nbsp;in the number and type of CDS rules that they implement, and&nbsp;we do not know whether the CDS rules&nbsp;implemented by the practicesthat participated in the surveys addressed any of the 20 quality&nbsp;indicators evaluated by Romano and Stafford.</li><li>Second, the current&nbsp;study and Garg and coauthors' review&nbsp;considered very different&nbsp;categories of guidelines. Most of the guidelines (60%) in&nbsp;Romano&nbsp;and Stafford's study concern medication use; none of them deals&nbsp;with immunizations or screening tests, which were the dominant&nbsp;subjects in the studies reviewed by Garg et al.3&nbsp;Furthermore,&nbsp;in our experience, care providers are less willing to accept&nbsp;and act on automated&nbsp;reminders about initiating long-term drug&nbsp;therapy than about ordering a single test or an immunization.</li><li>The&nbsp;third&nbsp;difference is that the&nbsp;current&nbsp;study examined the&nbsp;outcome of a single visit, while most of the trials reviewed&nbsp;by Garg and colleagues observed the cumulative effect of the&nbsp;CDS system on a patient over many visits.</li><li>Finally, the&nbsp;data&nbsp;available from NAMCS/NHAMCS may be limited&nbsp;compared with what&nbsp;is contained&nbsp;in most of the EHRs used for Garg and coauthors'&nbsp;trials. For example, the NAMCS/NHAMCS instruments have roomto record only 8&nbsp;medications, even though at least 17% of individuals&nbsp;older than 65 years take 10 or more medications.</li></ul></div></blockquote><div>The road to digitization of healthcare is long and filled with many ups and downs. This study adds the overall knowledge but should be taken in the context of what was studied and its contribution to guiding us down the correct path and not, as some would believe&gt; halting the journey and returning to the dark ages of pen and paper.</div><div style="font-size: 10px;"><a href="http://posterous.com/">Posted via email</a> from <a href="http://drnic.posterous.com/ehrs-and-their-impact-on-quality-of-care">drnic's posterous</a> </div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-8636722742977853481?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com1tag:blogger.com,1999:blog-8534714680637397259.post-4526465383355117512011-01-24T07:31:00.002-05:002011-01-31T18:09:18.711-05:00<div class="posterous_autopost"><div>Great post from Dr Halamka laying out the details of what is required to qualify for meaningful use incentives</div><div><b><br /></b><a href="http://mycourses.med.harvard.edu/ec_res/nt/36980CA6-E154-4820-A0ED-8B235138B79F/measures.pdf"></a><a href="http://mycourses.med.harvard.edu/ec_res/nt/36980CA6-E154-4820-A0ED-8B235138B79F/measures.pdf">http://mycourses.med.harvard.edu/ec_res/nt/36980CA6-E154-4820-A0ED-8B235138B79F/measures.pdf</a></div><div style="font-size: 10px;"><a href="http://posterous.com/">Posted via email</a> from <a href="http://drnic.posterous.com/excellent-meaningful-use-qualification-for-in">drnic's posterous</a> </div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-452646538335511751?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com2tag:blogger.com,1999:blog-8534714680637397259.post-45747170880918624352011-01-19T18:56:00.002-05:002011-01-31T18:09:40.686-05:00<div class="posterous_autopost">Nuance announced the launch of&nbsp;the Dragon Mobile SDK for iOS and Android via a new self-service website as part of the&nbsp;<a href="http://dragonmobile.nuancemobiledeveloper.com/">Nuance Mobile&nbsp;Developer Program</a>.<br /><div>&gt;&gt;&gt;&gt;Now mobile developers are able to quickly and easily leverage the powerful dictation and voice&nbsp;search capabilities at the core of the successful&nbsp;Dragon Dictationand&nbsp;Dragon Search&nbsp;apps, as well as Nuance’s&nbsp;trusted Vocalizer text-to-speech (TTS).&nbsp;</div><div>In line with the explosion of mobile applications and similar to the model for Apple's Developer Application (XCode) the SDK is available (for both Apple iPhone/iPad/iPod Touch iOS 4.0 and for Android v2.1 and higher. Supporting multiple languages the offering provides instant access to&nbsp;"easy-to-integrate prepackaged wrappers&nbsp;and widgets for rapid inclusion of voice recognition into their applications, all through a self-service website.&nbsp;Developers also have access to an on-line forum for additional support, a variety of code samples and full&nbsp;documentation."</div><div>And all for free! Leveling the developer playing field and fostering innovation of speech enabled apps so that as Michael Thompson, SVP and GM of Nuance Mobile Division put it:</div><div style="font-size: 14px; text-align: center;"><i>"If you can imagine it you can speech enable it"</i></div><div style="font-size: 10px;"><a href="http://posterous.com/">Posted via email</a> from <a href="http://drnic.posterous.com/nuance-self-service-mobile-developer-platform">drnic's posterous</a> </div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4574717088091862435?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-22512389025278431652011-01-14T12:08:00.000-05:002011-01-14T12:08:01.170-05:00<div xmlns="http://www.w3.org/1999/xhtml">So a recent survey from the CDC: NCHS Health E-Stat "<a href="http://www.cdc.gov/nchs/data/hestat/emr_ehr_09/emr_ehr_09.htm" target="_blank">Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates</a>" (pdf version <a href="http://www.cdc.gov/nchs/data/hestat/emr_ehr_09/emr_ehr_09.pdf" target="_blank">here</a>) and reported on the US Department of Health and Human Services website HHS.gov "<a href="http://www.hhs.gov/news/press/2011pres/01/20110113a.html" target="_blank">Surveys show significant proportions of hospitals and doctors already plan to adopt electronic health records and qualify for federal incentive payments</a>" suggests that<br /><ul><li>80% of hospitals , AND</li><li>41% of Office based physicians</li></ul>are intending to take advantage of the federal incentive payments for adoption and meaningful use of certified EHR's<br />And Dr David Blumenthal posted a video comment on the registration for EHR Incentive programs<br /><div class="youtube-video"><object height="385" width="640"><param value='http://www.youtube.com/v/GxemMXCl--I?fs=1&amp;hl=en_US' name='movie'></param><param value='true' name='allowFullScreen'></param><param value='always' name='allowscriptaccess'></param><embed width='640' height='385' allowfullscreen='true' allowscriptaccess='always' type='application/x-shockwave-flash' src='http://www.youtube.com/v/GxemMXCl--I?fs=1&amp;hl=en_US'> </embed> </object></div><br /><br />This is substantially higher than a recent set of stats that had the rates posted much lower. This is good news all round if the incentive program has stimulated that much interest and desire to move towards the digitization of the medical record which for Stage 7 has barely reached double digits according to the most recent HIMSS Analytics assessment of EHR implementations.<br /><br />For those wanting more information <br />Information about the incentive payments program is available on the <a href="http://www.cms.gov/ehrincentiveprograms." target="_blank">CMS website</a> and the Regional Extension Centers (RECs) technical assistance is available at the <a href="http://healthit.hhs.gov/REC" target="_blank">HealthIT web site</a>. So for those still pondering if this is worthwhile investment it seems that healthcare systems and your clinical peers see this as a valuable and positive move. Do you want to watch the train leave the station or be on it?<br /><br /><br /><div class="zemanta-pixie"><img alt="" class="zemanta-pixie-img" src="http://img.zemanta.com/pixy.gif?x-id=90f22cde-6a52-841e-8f8e-29546f324d49" /></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2251238902527843165?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-24469883146593475242011-01-11T17:45:00.002-05:002011-01-31T18:10:20.144-05:00<div class="posterous_autopost"><strong>Survey: Docs struggling financially, but new tech makes job easier</strong><br /><a href="http://www.healthcareitnews.com/news/survey-docs-struggling-financially-new-tech-makes-job-easier"></a><a href="http://www.healthcareitnews.com/news/survey-docs-struggling-financially-new-tech-makes-job-easier">http://www.healthcareitnews.com/news/survey-docs-struggling-financially-new-tech-makes-job-easier</a><br />Technology can actually make your life better...certainly according to doctors <br /><div style="font-size: 10px;"><a href="http://posterous.com/">Posted via email</a> from <a href="http://drnic.posterous.com/docs-struggling-financially-but-new-tech-make">drnic's posterous</a> </div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2446988314659347524?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-31239761416209026382011-01-06T12:36:00.001-05:002011-01-06T12:36:50.093-05:00<div class='posterous_autopost'><blockquote type="cite"><div><span style="">This needs to be fixed if telemedicine is ever to take off</span><br /></div></blockquote><blockquote type="cite"><div><div><strong>A national license to practice medicine</strong><br /><a href="http://www.kevinmd.com/blog/2011/01/national-license-practice-medicine.html"></a><a href="http://www.kevinmd.com/blog/2011/01/national-license-practice-medicine.html"></a><a href="http://www.kevinmd.com/blog/2011/01/national-license-practice-medicine.html">http://www.kevinmd.com/blog/2011/01/national-license-practice-medicine.html</a><p /><br /></div></div></blockquote> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/a-national-license-to-practice-medicine">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3123976141620902638?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-50558671148246866362011-01-06T12:19:00.001-05:002011-01-06T12:19:21.101-05:00<div class='posterous_autopost'>New innovation improves results in IVF&nbsp;<br /><strong>IVF breakthrough to hit the world market</strong><br /><a href="http://www.eurekalert.org/pub_releases/2011-01/uoa-ibt010511.php"></a><a href="http://www.eurekalert.org/pub_releases/2011-01/uoa-ibt010511.php">http://www.eurekalert.org/pub_releases/2011-01/uoa-ibt010511.php</a> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/ivf-breakthrough-to-hit-the-world-market">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-5055867114824686636?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-60100901106675922492011-01-06T12:16:00.001-05:002011-01-06T12:16:49.650-05:00<div class='posterous_autopost'>Eat more tomatoes.....<br /><strong>Tomatoes found to contain nutrient which prevents vascular diseases</strong><br /><a href="http://www.eurekalert.org/pub_releases/2011-01/w-tft010611.php"></a><a href="http://www.eurekalert.org/pub_releases/2011-01/w-tft010611.php">http://www.eurekalert.org/pub_releases/2011-01/w-tft010611.php</a> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/tomatoes-found-to-contain-nutrient-which-prev">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6010090110667592249?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-24349382474435250042010-12-21T09:30:00.001-05:002010-12-21T09:30:12.493-05:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <blockquote><div> <a name="TopOfPage"> </a> <p align="center"><b>Nuance’s eScription Platform Honored with Seventh Consecutive Best-in-KLAS Award</b></p> <p align="center"><b><i>Seven Consecutive Best in KLAS Awards, Market Growth and Continued Delivery of Innovation Reinforces eScription as Leading Solution for Hosted, Background Speech Recognition </i></b></p> <p><b>BURLINGTON, Mass., – December 20, 2010</b> – <a href="http://www.nuance.com/for-healthcare/by-solutions/mobile/dragon-medical-mobile-search/index.htm" target="_blank">Nuance Communications, Inc.</a> (NASDAQ: NUAN) today announced that its <a href="http://www.nuance.com/products/escription/index.htm" target="_blank">eScription</a> platform has received a <a href="http://www.klasresearch.com/Store/BrowseByTitle.aspx" target="_blank">Best in KLAS</a> award for the seventh consecutive year. With a score of 89.8, the eScription platform ranked the highest in the speech recognition category, surpassing its score from 2009 even as the platform’s usage has dramatically grown with both new and existing customers. Today, the number of active dictating clinicians who use eScription is up by 24 percent since one year ago.</p> <p>The Best in KLAS Award is driven solely from customer feedback, a testament to the demonstrated benefits of the eScription platform and the service and support provided to eScription customers. According to Nuance’s review of past Top 20 Best in KLAS Awards reports, Nuance is one of only four other healthcare IT vendors that have achieved a Best in KLAS product award for the past seven consecutive years. As noted in the KLAS report, 98 percent of customers surveyed indicated they would buy eScription again; this high level of customer satisfaction and confidence comes in 12 percentage points higher than the next highest ranked background speech solution.</p> <p>“Throughout our partnership with Nuance, the eScription platform has never disappointed and in fact, has met or exceeded all expectations,” said Jonathan Bowers, Vice President Information Services, Carolinas HealthCare System.&nbsp; “eScription’s ranking as the best speech recognition solution does not come as a surprise.&nbsp; In 2006, we leveraged KLAS’ ratings as part of our speech recognition vendor selection; our diligence and intuition to partner with Nuance was validated. Today, we’ve reduced report turnaround time by an average of 75 percent, realized significant cost savings and as we approach an annual run rate of 100 million lines through the platform, we are confident with eScription as our standard speech recognition solution across all Carolinas HealthCare System sites.”&nbsp;&nbsp;</p> <p>Nuance’s focus on customer satisfaction was echoed at the recent annual <a href="http://www.nuance.com/company/news-room/press-releases/NC_007689" target="_blank">Conversations Healthcare 2010</a> user meeting, where 39 healthcare organizations were recognized for saving one million dollars or more on medical transcription costs as a result of implementing eScription. Cumulatively, eScription Million Dollar Award recipients have reported savings of more than $140 million.</p> <p>“2010 marks the eScription platform’s seventh consecutive Best in KLAS award, a year of growth for the platform and a year of innovation across our portfolio,” said Janet Dillione, executive vice president, Nuance Healthcare. “Nuance is honored to be recognized by KLAS and by our customers. This distinction comes at an exciting time, one in which we are focused on delivering more value to our customer base and the healthcare industry at large.” </p> <p>Emphasizing Nuance’s commitment to innovation, earlier this month Nuance launched <a href="http://www.nuance.com/company/news-room/press-releases/NC_007930" target="_blank">Dragon Medical Mobile Recorder</a>, an iPhone app that offers clinicians a new level of clinical documentation flexibility by enabling mobile point-of-care dictation that is connected to Nuance’s speech-enabled transcription platforms, including <a href="http://www.nuance.com/products/escription/index.htm" target="_blank">eScription</a>. </p> <p>2010 Top 20 Best in KLAS Awards were determined based on 25 performance criteria in five categories: Sales and Contracting; Implementation and Training; Functionality and Upgrades; Service and Support; and General. KLAS, a market research firm, published its latest findings in the 2010 Top 20 Best in KLAS Awards: Software &amp; Professional Services report (December 2010). The product rankings are derived from product evaluations and confidential interviews with healthcare information technology (HIT) customers, incorporating performance data collected over the past 12 months (November 15, 2009 – November 15, 2010). </p> <p>eScription is Nuance Healthcare’s leading on-demand, enterprise-wide transcription platform.&nbsp; Whether a healthcare organization has an in-house staff of medical transcriptionists (MTs) or uses a fully outsourced approach, eScription is proven to help healthcare organizations reduce document turnaround time, improve consistency and quality, and save costs, without impacting clinician workflow.</p> <p><b>About KLAS</b></p> <p>KLAS is a research firm specializing in monitoring and reporting the performance of healthcare vendors. KLAS’ mission is to improve delivery, by independently measuring vendor performance for the benefit of our healthcare provider partners, consultants, investors, and vendors. Working together with executives from over 4500 hospitals and over 2500 clinics, KLAS delivers timely reports, trends, and statistics, which provide a solid overview of vendor performance in the industry. KLAS measures performance of software, professional services, and medical equipment vendors. For more information, go to <a href="http://www.klasresearch.com" target="_blank">www.KLASresearch.com</a>, email <a href="http://www.nuance.com/company/news-room/press-releases/NC_007959#" target="_blank"><a href="http://www.nuance.com/company/news-room/press-releases/NC_007959/mailto:marketing@KLASresearch.com">marketing@KLASresearch.com</a></a>, or call 1-800-920-4109 to speak with a KLAS representative. © 2008 KLAS Enterprises, LLC. All rights reserved.</p> <p><b>Nuance’s Healthcare Business</b></p> <p><a href="http://www.nuance.com/for-healthcare/index.htm" target="_blank">Nuance’s healthcare portfolio</a><a name="P38_5465"></a> of proven, speech-enabled clinical documentation and communication solutions enable healthcare provider organizations to improve financial performance, enhance patient care, and increase patient safety. With more than 10,000 healthcare provider organization customers and 450,000 clinician customers worldwide, Nuance has the experience and solutions that meet the individual needs of any size healthcare provider organization.</p> <p><b>Nuance Communications, Inc.</b></p> <p>Nuance is a leading provider of speech and imaging solutions for businesses and consumers around the world. Its technologies, applications and services make the user experience more compelling by transforming the way people interact with information and how they create, share and use documents. Every day, millions of users and thousands of businesses experience Nuance’s proven applications and professional services. For more information, please visit <a href="http://www.nuance.com/" target="_blank">www.nuance.com</a><a name="P40_6393"></a>.</p> <p><i>Nuance and the Nuance logo are trademarks or registered trademarks of Nuance Communications, Inc. or its affiliates in the United States and/or other countries. All other company names or product names may be the trademarks of their respective owners.</i></p> <p><i>The statements in this press release, relating to future plans or future events or services, are forward-looking statements which are subject to specific risks and uncertainties.&nbsp; There are a number of factors which could cause actual events or results to differ materially from those indicated in such forward looking statements, including fluctuations in demand for the Nuance products, the relationship with the customer or partner and the continued development of Nuance products.&nbsp; The reader is warned not to rely on these forward-looking statements without reservation, since these are simply reflections of the current situation.&nbsp; Nuance disclaims any obligation to update any forward-looking statements as a result of developments occurring after the date of this document.</i></p> </div></blockquote> <div class="posterous_quote_citation">via <a href="http://www.nuance.com/company/news-room/press-releases/NC_007959">nuance.com</a></div> <p>eScription racks up a 7th consecutive "Best in KLAS" concurrent with a big expansion in the user base up by 24% since last year. <br />This is a huge testament to the Nuance team who have worked tirelessly to maintain quality and customer service and contributed over $140 Million dollars in savings to multiple healthcare organizations <br />Thanks to the customers for their vote of confidence and congratulations to the Nuance team who continue to excel at delivering increasing value to the healthcare industry</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/nuance-escription-receives-7th-consecutive-be">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2434938247443525004?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-15114244124361573762010-12-17T13:00:00.001-05:002010-12-17T13:00:44.587-05:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <img src="http://posterous.com/getfile/files.posterous.com/drnic/mGyCtiHaqHscercbEBtgpladhAEjJwGfuFIcrFydsaoBnbznweajrnCtfChG/media_httpwwwmdnewsco_hqBBp.png.scaled500.png" width="250" height="163"/> <div class="posterous_quote_citation">via <a href="http://www.mdnews.com/news/2010_12/national_dec10_practice-management-at-its-best">mdnews.com</a></div> <p>The ability to access clinical information while make clinical rounds proved to be especially helpful to Jon Wahrenberger, M.D., a cardiologist at Dartmouth- Hitchcock Medical Center in Lebanon, NH where he was able to access information real time while at the patient's side and used as a collaborative tool with patients reviewing the information with the doctor</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/technology-helping-physicans-improve-their-pr">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-1511424412436157376?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-46929826100811555012010-12-15T10:32:00.000-05:002010-12-15T10:32:00.219-05:00Following up from my post back in June (<a href="http://drvoice.blogspot.com/2010/06/nlp-in-healthcare.html">NLP in Health care</a>) the Jeopardy challenge is on - coming to your TV February 14 - 16. There was lots of coverage of the announcement<br />This from the Washington Post - "'<a href="http://www.washingtonpost.com/wp-dyn/content/article/2010/12/14/AR2010121401008.html?wpisrc=nl_pmtech">Jeopardy!' to pit humans against IBM machine</a>" and the <a href="http://www-03.ibm.com/press/us/en/pressrelease/33233.wss">IBM release</a><br />Ken Jennings and Brad Rutter two of the leading Jeopardy winners will go up against Watson.&nbsp;Jennings had the game show's longest winning streak at 74 games in a row and Rutter has won the most money standing at $3.3 million.<br /><br /><b><i>What is Watson</i></b><br /><br /><object height="385" width="640"><param name="movie" value="http://www.youtube.com/v/3e22ufcqfTs?fs=1&amp;hl=en_US"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/3e22ufcqfTs?fs=1&amp;hl=en_US" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="640" height="385"></embed></object><br /><br />But what's important is the possible future applications:<br /><blockquote>IBM is hoping the technology it exhibits will have some practical uses eventually, for instance helping doctors diagnose illnesses or solving customer problems at technical support centers.</blockquote>Applying this in healthcare is part of the partnership announced back in October and featured in the posting &nbsp;"<a href="http://drvoice.blogspot.com/2010/10/clinical-documentation-challenges.html">Clinical Documentation Challenge</a>s". It will be exciting to see the performance of Watson in Jeopardy on live TV but its the application of this in healthcare that will present some revolutionary opportunities...watch this space<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4692982610081155501?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-44002042245701607512010-12-15T09:50:00.001-05:002010-12-15T09:50:14.735-05:00<div class='posterous_autopost'><div class="posterous_bookmarklet_entry"> <img src="http://posterous.com/getfile/files.posterous.com/drnic/ckxCklopkpCeqHfxgqefHlEsfpAoeCqkGczpmxuFenkfwaJBaCHsujksyyBo/media_httpwwwcmioneti_uhhkr.jpg.scaled500.jpg" width="200" height="200"/> <div class="posterous_quote_citation">via <a href="http://www.cmio.net/index.php?option=com_articles&amp;view=article&amp;id=25573">cmio.net</a></div> <p>iPad takes healthcare by storm - there are still some difficulties but form factor, battery life and ease of use win users over</p></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/ipad-in-practice-applying-the-apps">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4400204224570160751?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-62331694800929076642010-12-13T20:48:00.001-05:002010-12-13T20:48:44.405-05:00<div class='posterous_autopost'><div style="font-family: Georgia, serif; color: rgb(51, 51, 51); font-size: 13px; line-height: 20px;"><div><span style="color: rgb(0, 0, 0); font-family: arial, sans-serif; font-size: 12px; line-height: normal;">President's Council of Advisors on Science and Technology (PCAST) to Release Health Information Technology Report<p />SPEAKERS:<p />- Kathleen Sebelius, Secretary, HHS<br />- Lawrence Summers, Assistant to the President for Economic Policy and Director, National Economic Council<br />- David Blumenthal, National Coordinator for Health IT<br />- Eric Lander and Christine Cassel, President's Council of Advisors on Science and Technology<br />- Private-Sector Discussants<br /><span style="font-size: 13px; line-height: 20px;"><span style="font-size: 12px; line-height: normal;"><br /></span></span></span></div></div><object height="385" width="480"><param name="movie" value="http://www.youtube.com/v/NpZBF7FKk2M?fs=1&amp;hl=en_US" /><param name="allowFullScreen" value="true" /><param name="allowscriptaccess" value="always" /><embed allowfullscreen="true" src="http://www.youtube.com/v/NpZBF7FKk2M?fs=1&hl=en_US" allowscriptaccess="always" type="application/x-shockwave-flash" height="385" width="480"></embed></object><p /><p /><div><span style="font-family: Georgia, serif; color: rgb(51, 51, 51); font-size: 13px; line-height: 20px;"><span style="color: rgb(0, 0, 0); font-family: arial, sans-serif; line-height: normal; font-size: 12px;"><br />Read the report<br /><a href="http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.pdf" class="yt-uix-redirect-link" title="http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-report.pdf" rel="nofollow" target="_blank" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-color: initial; font-size: 12px; background-color: transparent; color: rgb(0, 51, 204); text-decoration: none;">http://www.whitehouse.gov/sites/defau...</a><p />Read the press release<br /><a href="http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-release.pdf" class="yt-uix-redirect-link" title="http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-release.pdf" rel="nofollow" target="_blank" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-color: initial; font-size: 12px; background-color: transparent; color: rgb(0, 51, 204); text-decoration: none;">http://www.whitehouse.gov/sites/defau...</a><br /></span></span></div><p /><div><div style="font-family: Georgia, serif; color: rgb(51, 51, 51); font-size: 13px; line-height: 20px;"><div><div style="color: rgb(0, 0, 0); font-family: arial, sans-serif; font-size: 12px; line-height: normal;">This video is also available at<br /><a href="http://www.hhs.gov/news/imagelibrary/video/2010-12-08_press.html" class="yt-uix-redirect-link" title="http://www.hhs.gov/news/imagelibrary/video/2010-12-08_press.html" rel="nofollow" target="_blank" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-color: initial; font-size: 12px; background-color: transparent; color: rgb(0, 51, 204); text-decoration: none;">http://www.hhs.gov/news/imagelibrary/...</a><p />We accept comments in the spirit of our comment policy:<br /><a href="http://newmedia.hhs.gov/standards/comment_policy.html" class="yt-uix-redirect-link" title="http://newmedia.hhs.gov/standards/comment_policy.html" rel="nofollow" target="_blank" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-color: initial; font-size: 12px; background-color: transparent; color: rgb(0, 51, 204); text-decoration: none;">http://newmedia.hhs.gov/standards/com...</a>&nbsp;<p />U.S. Department of Health &amp; Human Services (HHS)&nbsp;<br /><a href="http://www.hhs.gov" class="yt-uix-redirect-link" title="http://www.hhs.gov" rel="nofollow" target="_blank" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-color: initial; font-size: 12px; background-color: transparent; color: rgb(0, 51, 204); text-decoration: none;">http://www.hhs.gov</a></div></div><p /></div></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/presidents-council-of-advisors-on-science-and">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6233169480092907664?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-77309816098283181182010-12-08T09:45:00.001-05:002010-12-08T09:45:00.575-05:00A recent Dustin Comic like all good comics hit the proverbial nail on the head<br /><br /><img border="0" src="http://www.arcamax.com/newspics/13/1348/134870.gif" /><br /><br />Unfortunately the healthcare reform fails to address key aspects to the incentive problem in healthcare. The system remains centered on measuring what we do for patients rather than the end result.<br /><br />There are moves by employers and the insurance industry to incentives patients towards healthier behavior. This approach is not without problems as highlighted in this piece in the New England Journal of Medicine "<a href="http://healthpolicyandreform.nejm.org/?p=2630">Carrots, Sticks, and Health Care Reform — Problems with Wellness Incentives</a>" where the authors highlight the challenges for employers, employees and insurance in creating incentive and how this can introduce inequities that do more harm than good. As they point out<br /><blockquote>If people could lose weight, stop smoking, or reduce cholesterol simply by deciding to do so, the analogy might be appropriate. But in that case, few would have had weight, smoking, or cholesterol problems in the first place</blockquote>There is no doubt that patient incentives must be part of the solution but require thoughtful design and implementation to avoid the pitfalls<br /><blockquote>Incentives for healthy behavior may be part of an effective national response to risk factors for chronic disease. Wrongly implemented, however, they can introduce substantial inequity into the health insurance system. It is a problem if the people who are less likely to benefit from the programs are those who may need them more.</blockquote>But incentives aligned to the practice of evidence based medicine and in particular the financial challenges facing the ever increasing ordering of tests is where there seems to be significant progress. The announcement of a statewide adoption of <a href="http://www.nuance.com/products/radport/index.htm">Radport</a> by the Institute of Clinical Systems Improvement (ICSI), a nonprofit comprising 60 medical groups, 9,000 physicians, and six payers and health plans was covered extensively at <a href="http://rsna2010.rsna.org/">RSNA 2010</a> in Chicago this year and featured in this piece in Information Week "<a href="http://www.informationweek.com/news/healthcare/clinical-systems/showArticle.jhtml?articleID=228300177">System Helps Doctors Pick The Right Tests</a>" demonstrating a saving of $27 Million over the preceding year<br /><blockquote>During the yearlong pilot involving more than 2,300 ICSI-member physicians, ICSI saw no growth in the number of high-tech diagnostic imaging tests ordered. In previous years, the number of tests ordered grew about 8% annually...The lack of growth translates to a savings about $28 million for the year</blockquote>But any discussion on incentives needs to include the issue of malpractice - liability drives behavior in the same way as incentives do (in some respects its incentive in another from). Peter Orszag opinion in the NY Times <a href="http://www.nytimes.com/2010/10/21/opinion/21orszag.html?_r=2&amp;nl=opinion&amp;emc=tya1">Malpractice Methodology</a> makes the point that<br /><blockquote>The health care legislation that Congress enacted earlier this year, contrary to much of today’s overheated rhetoric, does many things right. But it does almost nothing to reform medical malpractice laws. Lawmakers missed an important opportunity to shield from malpractice liability any doctors who followed evidence-based guidelines in treating their patients.</blockquote>President Obama weighed in on this issue in June 2009 when he spoke to the American Medical Association when he highlighted the "<em>unnecessary tests and treatments (ordered by doctors) only because they believe it will protect them from a lawsuit</em>" and as he put it<br /><blockquote>We need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine and encourage broader use of evidence-based guidelines</blockquote>Medicine remains "more evidence-free" than should be the case:<br /><blockquote>One estimate suggests that it takes 17 years on average to incorporate new research findings into widespread practice</blockquote>Addressing the issue of liability can take the traditional approach of limiting punitive damages but as Peter Orszag said "provide safe harbor for doctors who follow evidence-based guidelines" is a much better idea and one that would sit well with patients and doctors alike (I'd be interested to hear from lawyers who agree or disagree on the merits of such an approach).<br /><br />There are some initial moves in this direction and a need to implement technology to help guide the treatment (as we see with ICSI) and all this would also lead to higher quality of care for <strong>everyone</strong> and possibly a new system that reimbursed based on the quality of care delivered versus the quantity of care.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-7730981609828318118?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-60333601271041388912010-12-06T07:08:00.001-05:002010-12-06T07:08:58.776-05:00<div class='posterous_autopost'><div>Despite a Randomized clinical trials (RCT) some eight years ago physicians continue to prescribe hormone replacement therapy (HRT) with regular dosage despite the risks associated with this therapy</div><div><br /><a href="http://www.medpagetoday.com/OBGYN/HRT/23734?utm_source=share&amp;utm_medium=mobile&amp;utm_campaign=medpage%2Biphone%20app">High-Dose HRT Still Prevalent (CME/CE)</a><p />More evidence for the requirement for clinical support tools and integration of evidence based medicine (EBM) into regular clinical practice. Capturing clinical data at the point of care to enable these tools to provide relevant clinical input and guidance is critical to increasing quality and safety in medicine. The journey begins with capturing clinically actionable data as part of the documentation process without burdening the physician with hunt and click data entry tasks.</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/8-years-on-hrt-still-prescribed-in-risky-high">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6033360127104138891?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-27033823615300572262010-11-25T09:19:00.001-05:002010-11-25T09:19:12.002-05:00Great Presentation on 100 day productivity system<br /><div style="width:425px" id="__ss_5827224"><strong style="display:block;margin:12px 0 4px"><a href="http://www.slideshare.net/stevenfeeney/100-day-system-where-creativity-and-productivity-collide" title="100 Day System: Where Creativity and Productivity Collide">100 Day System: Where Creativity and Productivity Collide</a></strong><object id="__sse5827224" width="425" height="355"><param name="movie" value="http://static.slidesharecdn.com/swf/ssplayer2.swf?doc=100daysystemsafepresentation-101118143645-phpapp01&stripped_title=100-day-system-where-creativity-and-productivity-collide&userName=stevenfeeney" /><param name="allowFullScreen" value="true"/><param name="allowScriptAccess" value="always"/><embed name="__sse5827224" src="http://static.slidesharecdn.com/swf/ssplayer2.swf?doc=100daysystemsafepresentation-101118143645-phpapp01&stripped_title=100-day-system-where-creativity-and-productivity-collide&userName=stevenfeeney" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="355"></embed></object><div style="padding:5px 0 12px">View more <a href="http://www.slideshare.net/">presentations</a> from <a href="http://www.slideshare.net/stevenfeeney">Steven Feeney</a>.</div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2703382361530057226?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-44365460806197932932010-11-24T19:03:00.001-05:002010-11-24T19:03:27.143-05:00<div class='posterous_autopost'><strong>5 Innovative Technologies Changing Health Care [VIDEOS]</strong><br /><a href="http://mashable.com/2010/11/24/health-care-tech/"></a><a href="http://mashable.com/2010/11/24/health-care-tech/">http://mashable.com/2010/11/24/health-care-tech/</a> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/5-innovative-technologies-changing-health-car">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4436546080619793293?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-42154741204386956012010-11-24T18:27:00.001-05:002010-11-24T18:27:07.683-05:00<div class='posterous_autopost'><strong>Healthcare Illuminated</strong><br /><a href="http://healthcareilluminated.publisha.com/articles/16346"></a><a href="http://healthcareilluminated.publisha.com/articles/16346">http://healthcareilluminated.publisha.com/articles/16346</a> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/pollutant-playing-role-in-multiple-sclerosis">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4215474120438695601?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-72458238978544915032010-11-24T18:05:00.001-05:002010-11-24T18:05:55.587-05:00<div class='posterous_autopost'><strong>The Doctor will Sync You Now</strong><br /><a href="http://www.thehealthcareblog.com/the_health_care_blog/2010/11/the-doctor-will-sync-you-now-.html"></a><a href="http://www.thehealthcareblog.com/the_health_care_blog/2010/11/the-doctor-will-sync-you-now-.html">http://www.thehealthcareblog.com/the_health_care_blog/2010/11/the-doctor-will-sync-you-now-.html</a> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/the-doctor-will-sync-you-now">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-7245823897854491503?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-81720815450272776992010-11-11T13:06:00.001-05:002010-11-11T13:06:00.770-05:00As is often the cases conflicting information in the media on the benefits of screen, x-rays and healthcare.<br />This piece in the NY Times: <a href="http://www.nytimes.com/2010/11/05/health/research/05cancer.html?_r=1&amp;nl=&amp;emc=a1">CT Scans Cut Lung Cancer Deaths, Study Finds</a> suggests that annual CT Scans of current and former smokers reduces the risk of death form lung cancer:<br /><blockquote>Annual CT scans of current and former heavy smokers reduced their risk of death from lung cancer by 20 percent, a huge government-financed study has found. Even more surprising, the scans seem to reduce the risks of death from other causes as well, suggesting that the scans could be catching other illnesses.</blockquote>And while there does seem to be some benefit as Dr Patz (professor of radiology at Duke who helped devise the study) put it:<br /><blockquote>he was far from convinced that a thorough analysis would show that widespread CT screening would prove beneficial in preventing most lung cancer deaths. Dr. Patz said that the biology of lung cancer has long suggested that the size of cancerous lung tumors tells little about the stage of the disease.&nbsp;“If we look at this study carefully, we may suggest that there is some benefit in high-risk individuals, but I’m not there yet,” Dr. Patz said.</blockquote>And before you run out the door to get your CT scan its worth taking note of Dr Ben Goldacre's insightful blog <a href="http://www.badscience.net/">Bad Science</a> that takes a hard look at the science behind claims and does a great job debunking the myths and taking a hard look at <a href="http://www.badscience.net/category/statistics/">statistics</a>. But as we have seen over the last few months there is an increasing focus on excessive use of imaging technologies. Earlier this year the Imaging e-Ordering Coalition (Co Chaired by our very own Scott Cowsill) <a href="http://www.imagingeconomics.com/issues/articles/2010-08_07.asp">Successfully made a case to congress</a> to include computer-based physician order entry (CPOE) solutions as a potential method for imaging utilization management in recently passed health care legislation:<br /><blockquote>the Coalition is making several recommendations to policy makers in Congress and CMS...One of the recommendations is that imaging CPOE tools should be based on consensus medical guidelines and literature, such as the ACR's appropriateness criteria. Another recommendation is that CPOE and decision support tools should be compatible with any CMS-approved electronic medical record (EMR) systems and be able to track results.</blockquote>In recent news the <a href="http://www.rt-image.com/content=59B826BF-BE62-E0E3-0DD9648823291C2D">Healthcare alliance aims to improve the imaging process, Changing the Game</a> the coalition continues to push for<br /><blockquote>E-Ordering, also referred to as clinical decision support (CDS) (to) provide(s) physicians with real-time, electronic access to pre-exam, case-by-case decisions linked to evidence-based clinical guidelines and tailored to a patient’s specific circumstances</blockquote>and cites a 7-year study at MGH (pub 2009) that showed a dramatic decrease in the growth rates of several imaging exams<br /><ul><li>CT exams down from 12% growth to 1%</li><li>MR exams down from 12% dropped to 7%</li><li>Ultrasound down from 9% to 4%</li></ul>So with that in mind the concurrent news that Minnesota’s Institute for Clinical Systems Improvement (ICSI) is spearheading the First Statewide Effort to Help Ensure Patients Receive Appropriate High-Tech Diagnostic Imaging Tests that is targeted to save Minnesota healthcare community more than $28 million annually (this was the savings estimated from the year long pilot with 2,300 physicians from five Minnesota medical groups, five health plans taking part. You can read more about it <a href="http://www.nuance.com/company/news-room/press-releases/NC_007674">here</a>, and <a href="http://www.startribune.com/lifestyle/health/107009898.html?page=3&amp;c=y">here</a> in the Star Tribune in Minneapolis St Paul and <a href="http://www.zdnet.com/blog/btl/nuances-radport-unit-wins-big-hospital-deal-healthcare-momentum-accelerates/41444">here</a> on ZDNet<br /><br />The process and challenges are outlined in this video:<br /><br /><object height="295" style="background-image: url(http://i1.ytimg.com/vi/01tq_KNicyE/hqdefault.jpg);" width="480"><param name="movie" value="http://www.youtube.com/v/01tq_KNicyE?fs=1&amp;hl=en_US"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/01tq_KNicyE?fs=1&amp;hl=en_US" width="480" height="295" allowscriptaccess="never" allowfullscreen="true" wmode="transparent" type="application/x-shockwave-flash"></embed></object><br /><br />Showing how you can help the busy clinician by providing them with a simple, intelligent and above all standardized appropriateness criteria to guide the clinician in ordering the most appropriate study for the patient at the time of consultation. This improved <u>patient satisfaction</u>, clinic efficiencies and reduced administrative costs. While there will be those who distrust technology over seeing clinical decision making the solution does not force or prevent clinicians from ordering the test they deem the most appropriate. What it does do is provide <b>evidence based guidance</b> on the suitability or clinical appropriateness of the test.<br /><br />How do you feel as a patient or as a clinician on technology guiding care choices? Like it or not expect to see more as we continue to cope with a veritable Tsunami of clinical data, studies and discoveries that by some estimates <b>require a doctor to read for <u>70 hours per week</u></b> just to keep up in their one speciality.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-8172081545027277699?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com1tag:blogger.com,1999:blog-8534714680637397259.post-5571270978382919562010-11-05T12:28:00.001-04:002010-11-05T12:28:06.348-04:00<div class='posterous_autopost'>A colleague and friend wrote this great piece for Health Management Technology :&nbsp;<a href="http://www.healthmgttech.com/index.php/solutions/electronic-medical-records/the-problem-with-problem-lists.html">The Problem with Problem Lists</a>&nbsp;in which he reviews the history of the problem list (now over 40 years old!) and while<p /><div><blockquote type="cite"><span style="font-family: Helvetica, Arial, sans-serif; font-size: 12px; line-height: 16px;">While their value in patient care has been demonstrated in countless studies, physicians have historically adopted them with much less enthusiasm than one would expect.</span></blockquote><div><br /><div>They are not as prevalent or pervasive as you might expect. IN fact this was subject to an extensive discussion on a list serv and I made the point here that managing these&nbsp;expanding list of problems can be a significant challenge for any system.&nbsp;It tends to be easy to add&nbsp;problems but as Davide points out&nbsp;</div><p /><div><blockquote type="cite"><span style="font-family: Helvetica, Arial, sans-serif; font-size: 12px; line-height: 16px;">While patients’ diseases, symptoms and risk factors evolve and change, the corresponding items on the electronic problem list tend to age rapidly and may soon become irrelevant or even inaccurate. For example, a certain symptom may have disappeared, or an initial diagnosis may have been further defined, making the initial description too generic to guide actual care. Additionally, as multiple specialists engage with a patient, they focus on problems that are both different and overlapping. While each provider contributes to the problem lists (from different perspectives), patient data rapidly becomes repetitive or redundant, rendering the electronic problem list less useful</span></blockquote></div><p /><div>As one of the commentators pointed out clearly defining what should be captured and documented int he problem list is a god place to start and supplementing that by cleaning up old information (archiving old details, problems and information that perhaps was relevant but has now either been over taken by events (OBE) or was relevant for a specific episode of care but is now not.</div><p /><div>But capturing the latest information from the range of inputs remains a challenge and facilitating narrative based documentation&nbsp;</div><p /><div><blockquote type="cite"><div style="font-family: Helvetica, Arial, sans-serif; font-size: 12px; line-height: 16px;"><p style="margin-top: 10px; margin-bottom: 15px;">to preserve detailed and expressive descriptions of patients and their stories and are commonly accepted as the best way to capture and arrange the informational background on which effective diagnostic reasoning is based.</p></div></blockquote></div><div>Is preferred by many but unfortunately&nbsp;</div><div><blockquote type="cite"><div style="font-family: Helvetica, Arial, sans-serif; font-size: 12px; line-height: 16px;"><p style="margin-top: 10px; margin-bottom: 15px;">The final output of such systems is a textual clinical note.</p></div></blockquote></div><div>Technology is now starting to address this problem by providing tools that analyze the content of the narrative, understanding the underlying clinical description and intent of the physician.</div><p /><div><blockquote type="cite"><span style="font-family: Helvetica, Arial, sans-serif; font-size: 12px; line-height: 16px;">Consider this sentence: “The otitis media for which the patient was seen last month appears to be fully resolved.” CLU automatically and reliably assesses that the “otitis media” is “resolved” and thus should be removed from the list of current problems. Today, this action would require manual editing of the data. However, with CLU this happens automatically, with the physician confirming the deletion.</span></blockquote></div><p /><div>Thereby bridging the clinical divide between the physicians desire and need to document the full clinical condition in narrative form capturing all nuanced detail of the patient's history and the need to automatically extract clinical data and facilitate the integration of structured semantically interoperable data directly into the EMR.</div><p /><div>Timely innovation given the major push towards electronic medical records as part of the governments incentives in ARRA and HITECH and relevant in any clinical setting where narrative remains the key data captured.</div><p /><p /><p /><p /><p /><p /><p /></div></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/the-problem-with-problem-lists">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-557127097838291956?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-34641800090172201472010-10-18T12:22:00.000-04:002010-10-18T12:22:19.036-04:00We are facing significant changes to the world of clinical documentation with the big push encompassed in the Meaningful Use requirements that push provides and healthcare facilities inexorably towards an electronic medical record (EMR) but there remain significant concerns over the potential impact these solutions can and will have on our clinical documentation.<br /><br />In this piece in the Archives of Internal Medicine (Subscription required):<a href="http://archinte.ama-assn.org/cgi/content/full/170/14/1276">Time Spent on Clinical Documentation: Is Technology a Help or a Hindrance?</a> (<a href="http://archinte.ama-assn.org/cgi/content/abstract/170/4/377?ijkey=ec594250189a6a115729255af1c1b7e48c0faa22&amp;keytype2=tf_ipsecsha">abstract</a>) the review of the excessive burden of clerical work was cited as a detractor to the learning process for residents buried in a quagmire of administrative burdens. While the authors acknowledge the value that EHRs bring including <cite>more efficient and safer order entry, easily accessible clinical information, and the ability to facilitate documentation through decision support or documentation templates</cite>. While these positive effects can streamline and potentially diminish the low value tasks their experience at the University of Chicago demonstrated that<br /><blockquote>residents often research a new patient extensively on the EHR prior to the history taking and physical examination, preferring to obtain information via clerical work rather than direct patient assessment. In addition, the well-described habits of "cutting and pasting" notes or copying forward previous notes with minor daily updates are work-arounds that may save time but provide little opportunity for education and reflection about a patient's course</blockquote><br />This was further emphasized a recent interview in Healthcare Informatics <a href="http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=349DF6BB879446A1886B65F332AC487F&amp;nm=&amp;type=Blog&amp;mod=View+Topic&amp;mid=67D6564029914AD3B204AD35D8F5F780&amp;tier=7&amp;id=A046065EA53A46898A6070EB2044C040">Medical Documentation and Meaningful Use</a> focusing on the challenges of meaningful use and the loss of the narrative:<br /><blockquote>Policymakers have been too caught up in discrete data fields, putting the narrative element of the medical transcription process in jeopardy (and) meaningful use rules do not go far enough in guaranteeing that information is robust enough to provide a basis for complex clinical decisions and coordinate patient care. “Granularity and specificity have been overlooked,”</blockquote><br />As he point out<br /><blockquote>It would be unfortunate to sacrifice the nuanced reporting by an overemphasis on discrete data. Structured reporting does not necessarily mean sacrificing the whole, nuanced record</blockquote><br />But if you remain unconvinced this excellent paper "<a href="http://perspectives.ahima.org/index.php?option=com_content&amp;view=article&amp;id=136:communication-of-clinically-relevant-information-in-electronic-health-records-a-comparison-between-structured-data-and-unrestricted-physician-language&amp;catid=58:conference-paper&amp;">Communication of Clinically Relevant Information in Electronic Health Records: A Comparison between Structured Data and Unrestricted Physician Language</a>" in the AHIMA Journal Perspectives carried a study to determine <cite>what information is lost when free dictation of data is replaced with structured entry of information</cite>?:<br /><blockquote>If physicians restrict themselves primarily to structured data entry, what happens to the “nuances of patient variability” </blockquote><br />According to the authors nobody has yet attempted to answer this particular question which leaves a major gap in our understanding of the long term impact of the EMR on our clinical knowledge in the context of data, information, knowledge, wisdom (DIKW). And while there are some advantages to the capture of structured data and integration of information from different sources and disparate systems (an important goal in the meaningful use framework) the disadvantages of this limited selection of choices include the increased time to document (= less time with patients or for patients) but more importantly "<cite>discrete data may not catch the nuances of patient variability</cite>".<br /><br />The study while limited in size attacks the problem systematically and in sufficient details to arrive at what can only be described as very troubling conclusions. Naturally dictated cardiology notes were manually highlighted with information that would be captured in a a structured data entry system. These annotated notes were then reviewed by two independent physician experts who were asked to review the highlighting of the notes and <cite>imagine himself as a physician assuming responsibility for the patient, and to imagine that the highlighting had been added by the previous physician, indicating what he or she believed to be clinically relevant and necessary to include in the communication</cite>. In an inspirational piece of design there was no mention of the EMR/EHR and structured note taking so the content was reviewed in pure clinical terms - brilliant! The experts scored missing content that was marked up rating the missing content (if any) in terms of the severity of the omission:<br />1 - Minimal Severity through to<br />5 - failing to mark up the language was extremely severe, in terms of having serious consequences for the care of the patient if that clinically relevant information had not been communicated to you<br /><br />The results, even in the most conservative analysis:<br /><blockquote>(they) find that 50 percent of the notes include at least one omission rated 3 or higher on a 5-point scale, and 25 percent contain omissions rated 4 or higher</blockquote><br />So fully 25% of notes contain omissions that rated 4 or 5 on the severity of the clinical impact of that omission! With less conservative analysis at least one expert showed 100% of notes as containing at least one omission rated with severity of 3 or higher, with 5.25 such omissions on average and omissions with “serious consequences for the care of the patient” (severity rating equal to 5) in fully 55 percent of the notes!<br />That's worth restating:<br /><blockquote><b>All notes contained clinically significant omissions (Grade 3 or higher) and on average contained 5.25 such omissions and over half contained severe omissions!</b></blockquote><br />The content that was missed in some cases could be added to flexible systems but there were distinct pieces of <cite>nuanced or detailed elaborations of information</cite> and temporal/logical content and the clinician thought process for example:<br /><blockquote>- after identifying reporting severe pain in one patient’s neck and back, the dictating physician adds that she was “almost brought to tears just in getting her up on the examination table.” Both experts found it relevant that a patient was “able to walk on flat levels and walk at a moderate pace for one hour without abnormal shortness of breath or chest pain.”<br />- a patient’s nonsustained ventricular tachycardia (fast heart rate) occurred “during post myocardial infarction care…far removed from the time of his infarction.” The cardiologist found it highly relevant, for another patient, that the dictating physician was “hesitant to recommend his FAA certification renewal” without a repeat of a previous catheterization. <br />- the physician recommends continuing Toprol because it “seems to be controlling [the patient’s] palpitations well.” In another, the dictating physician considers discomfort to be “suggestive of angina.” In a third, the dictating physician expresses a belief that results of stress testing “would rule out significant major coronary artery disease, despite it being a somewhat incomplete study.”</blockquote><br />While the study size is small and there are some potential acknowledge bias the design and conservative analysis suggests the problems is very significant and adds further weight when considering the methods for capturing and recoding clinical data. And while it is possible that adding this missing content is possible with the free text fields replete in EMR systems I have heard clinicians say they have modified their patient diagnostic review process to avoid the "other" field specifically to limit the time necessary to type this content into the "other" box. Adding speech recognition technology can decrease the time to populate these boxes but providing a more elegant and integrated solution that allows for capture of the full patient story and clinical history. As the authors conclude:<br /><blockquote>Even under quite conservative assumptions, we have found that important clinical information, detail, and nuance would fail to be captured by an EHR standard’s discrete fields, with potentially serious consequences for the patient. Such omissions could potentially influence not only clinical care, but the progression from data to information to knowledge discovery in clinical research. Clearly the question merits further attention and study.</blockquote><br />In the inimitable words from Master Po in the iconic 70s TV Series <a href="http://en.wikipedia.org/wiki/Kung_Fu_%28TV_series%29">Kung Fu</a>:<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://upload.wikimedia.org/wikipedia/en/7/7b/Caine_and_Master_Po.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="185" src="http://upload.wikimedia.org/wikipedia/en/7/7b/Caine_and_Master_Po.jpg" width="320" /></a></div><div style="text-align: center;">Tread lightly grasshopper</div><br />The narrative must be integrated and preserved and will remain a fundamental foundation of clinical knowledge now and into the future of healthcare information systems. How are you preserving the information in your EMR or have you seen the record dumbed down?<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3464180009017220147?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com1tag:blogger.com,1999:blog-8534714680637397259.post-16614134790430739872010-10-17T06:18:00.001-04:002010-10-17T06:18:40.071-04:00<div class='posterous_autopost'><div>While the idea of law suits against vaccine manufactures is appealing. Opening these doors to a multitude of frivolous cases will have a chilling effect on vaccine development and vaccine use<p /><a href="http://www.medpagetoday.com/Pediatrics/Vaccines/22707?utm_source=share&amp;utm_medium=mobile&amp;utm_campaign=medpage%2Biphone%20app">Supreme Court Considers Vaccine Injury Case</a><p /></div><div>On the list of snake oil challenges is the vaccine causes autism bunkum. Unsupported in any scientific study but perpetuated by a wide range of people who may have good intentions but are using their influence to damage years of hard work building vaccination programs and relegating serious and life threatening diseases to the&nbsp;<span style="">&nbsp;history books</span></div><p /><div><span style="">Let's hope the Supreme court can take account of these effects as they consider this case. If not we could be in for a rash of diseases.</span></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/vaccination-suits">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-1661413479043073987?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-26341262567874427872010-10-17T06:08:00.001-04:002010-10-17T06:08:29.840-04:00<div class='posterous_autopost'>Don't think immunization is just for kids its not. Adults need those boosters too<p /><a href="http://www.medpagetoday.com/InfectiousDisease/Vaccines/22773?utm_source=share&amp;utm_medium=mobile&amp;utm_campaign=medpage%2Biphone%20app">Adults Not Getting Tdap Boosters (CME/CE)</a><p />Have you had yours? <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/adults-need-tetanus-diptheria-boosters-too">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2634126256787442787?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-21912392284214738472010-10-14T11:06:00.001-04:002010-10-14T11:06:25.644-04:00<div class='posterous_autopost'><span style=""><span>In a timely piece from the NY Times featuring Dr Verghese who continues to demo strategy and teach medical students that the physical examination is an essential part of the clinician patient interaction.&nbsp;</span><br /><span></span><br /><blockquote type="cite"><blockquote type="cite"><blockquote type="cite"><blockquote type="cite"><blockquote type="cite"><blockquote type="cite"><blockquote type="cite"><blockquote type="cite"><blockquote type="cite"><blockquote type="cite"><span></span><br /></blockquote></blockquote></blockquote></blockquote></blockquote></blockquote></blockquote></blockquote></blockquote></blockquote><span>At Stanford, Dr. Abraham Verghese on a mission to bring back something he considers a lost art: the physical exam.</span><br /><span>&lt;&lt;&lt;&lt;&lt;&lt;&lt;</span><br /><span><a href="http://nyti.ms/9pqWHC"></a><a href="http://nyti.ms/9pqWHC">http://nyti.ms/9pqWHC</a></span><br /><span></span><br /><span>In what seems much like the House brilliance of observation combined with a ready wit and and extensive knowledge of medicine Dr. Abraham Verghese vividly demonstrates the value and contribution of the physical examination and worries that the skill is being lost in American medicine and is not being taught to medical students in the US.&nbsp;</span><br /><span></span><br /><span>The physical exam should not be relegated to history books and while time pressures make spending time on this intimate interaction difficult the rewards are not just found in more clinical information but also closer links to patients.&nbsp;</span><br /></span> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/physical-examination-a-dying-art-that-needs-t">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2191239228421473847?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-32183352781897874372010-10-06T16:17:00.000-04:002010-10-06T16:17:24.621-04:00We are on a path to roll out a large swathe of Electronic Health Records (EHR) but a recent report published on the AISHealth.com <a href="http://www.aishealth.com/Bnow/hbd100410.html">Audits of Electronic Health Records Cloning Reveal Documentation Problems That Put Compliance at Risk</a> will give many folks reasons to pause and consider their strategy in rolling out electronic medical records and reconsider how they capture information in these systems.<br /><br />Interestingly the article suggests that EHR's "<cite>can reduce the time it takes physicians to document patient encounters</cite>" but there is a fair amount of research suggesting that EHR can increase the burden and time taken to document. A study in the Healthcare Ledger in March 2009 showed an increase of ~ 4x when documenting using the EHR and there is increasing concern that the current burden of clerical work being required of medical residents is limiting the educational opportunities and failing to teach our future doctors the process of reflection and distillation of a patient history that is an essential part of the diagnostic process (Doll and Arora 2010). Add to that that many EHR systems limit the potential for capturing the complete clinical story of the patient as outlined in a recent study “Communication of Clinically Relevant Information in Electronic Health Records: A Comparison between Structured Data and Unrestricted Physician Language” (Resnik, Niv et al 2010) in a systematic comparison between free natural language dictations and information codified by structured categories in an EHR demonstrated a failure to capture clinically significant information. Even in the most conservative estimate the study demonstrated 25% clinical omissions that rated 4-5 on a 1–5 scale of seriousness (1 being minimal severity and 5 meaning severe).<br /><br />However the access to real time information and improved legibility deliver significant benefits and advances into our healthcare system. But as Nina Youngstrom points out:<br /><blockquote>CMS and Medicare contractors are wary of classic EHR physician documentation shortcuts — cloning (cut and paste), macros and templates — and audits are bearing out their concerns</blockquote>As the audit demonstrated "<i>Each note should contain individualized data that supports the medical necessity of the visit or procedure</i>.” and problems stem from EHR documentation shortcuts:<br /><ul><li>Cloning (cutting and pasting): Physicians copy information from previous patient encounters (e.g., demographic, history of present illness, exam, medical decision making) and paste it in the current encounter.</li><li>Templates: Physicians fill out templates for patient encounters that cover a lot of ground with a few key strokes. The review of systems is pre-filled with the term “negative” for each organ system. For positive answers, physicians must change “negative” to reflect the positive response given by the patient.</li><li>Macros: Macros are a type of EHR shortcut that allows the entry of generous customized data quickly. Though initially CMS resisted the use of macros, the agency gave its approval for their use by teaching physicians (see Medicare Transmittal 811). With macros, teaching physicians, for instance, type in “.liv” to convey “liver exam,” which triggers a drop-down menu of choices for the next step.</li></ul><br />So avoiding these pitfalls and capturing the essence of the clinical consultation in the "Medical decision making" which is the cognitive process and is hard to document with templates and macros is key to both good quality documentation as well as avoiding potential CMS audits and challenges in the future.<br /><br />There is no one size fits all to these challenges and in different clinical circumstances different solutions will be beneficial but providing tools to document the complete narrative and extract key data elements will help drive clinically actionable data into the EHR while maintaining the decision making process that includes taking and documenting a full history without burdening the physician with mundane data entry tasks. Clinical Language Understanding offers to bridge this divide capturing the voice with proven voice recognition Technology (<a href="http://www.nuance.com/for-healthcare/by-solutions/speech-recognition/dragon-medical/index.htm">Dragon Medical</a>) and the exciting addition of <a href="http://www.nuance.com/for-healthcare/resources/nlp/index.htm">Clinical Language Understanding</a>: The video demonstrates the CLU in action offering an alternative path for clinicians weary from screen based data entry:<br /><br /><object height="385" width="640"><param name="movie" value="http://www.youtube.com/v/uBS1ONx4t2I?fs=1&amp;hl=en_US"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/uBS1ONx4t2I?fs=1&amp;hl=en_US" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="640" height="385"></embed></object><br /><br />Or you can see the video <a href="http://www.nuance.com/videoplayer/videoplayer.asp?p=/healthcare/NLP/&amp;n=Nuance-CLU&amp;w=662&amp;h=411">here</a>, and can see Paul Ricci on CNBC "Street Signs” hosted by Erin Burnett "<a href="http://www.cnbc.com/id/15840232/?video=1608825145&amp;play=1">Nuance Partners with IBM</a>":<br /><br /><object classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=9,0,0,0" height="380" id="cnbcplayer" width="400"> <param name="type" value="application/x-shockwave-flash"/><param name="allowfullscreen" value="true"/><param name="allowscriptaccess" value="always"/><param name="quality" value="best"/><param name="scale" value="noscale" /><param name="wmode" value="transparent"/><param name="bgcolor" value="#000000"/><param name="salign" value="lt"/><param name="movie" value="http://plus.cnbc.com/rssvideosearch/action/player/id/1608825145/code/cnbcplayershare"/><embed name="cnbcplayer" PLUGINSPAGE="http://www.macromedia.com/go/getflashplayer" allowfullscreen="true" allowscriptaccess="always" bgcolor="#000000" height="380" width="400" quality="best" wmode="transparent" scale="noscale" salign="lt" src="http://plus.cnbc.com/rssvideosearch/action/player/id/1608825145/code/cnbcplayershare" type="application/x-shockwave-flash"/></embed></object><br /><br /><br />and read about the collaboration with IBM <a href="http://www.nuance.com/company/news-room/press-releases/NC_007399">here</a>. What would you rather be doing? Manual data entry or dictating. This announcement and the work underway offers a solution that bridges the divide between the need for clinically actionable data and physicians desire to capture the complete clinical story for the patient.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3218335278189787437?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com1tag:blogger.com,1999:blog-8534714680637397259.post-47245976546949768332010-09-23T09:23:00.001-04:002010-09-23T09:23:00.332-04:00Mike Elgan said so......: <a href="http://www.computerworld.com/s/article/print/9186560/Say_it_with_me_Voice_is_ready_for_prime_time?taxonomyName=Mobile+and+Wireless&amp;taxonomyId=15">Say it with me: Voice is ready for prime time, It's time for the victory of voice to shout down the tyranny of text</a> in this enlightening piece that had many comments all in the positive relative the to advance of technology<br /><blockquote>Talking is the best user interface...Language is natural to people and universal to all cultures. Language is a spoken medium. Written language is merely the symbolic representation of spoken language. It's an abstraction, but a necessary one.</blockquote><br />And he asked <i>But is the technology there yet?</i>. You bet!<br /><blockquote>In the future, we'll talk to our computers and they'll talk back. We know this is true because talking is the most natural way for human beings to communicate. The evolution of the human-machine interface always moves the workload of interaction from the person to the computer. The perfect UI would be a natural conversation, just like you have with other people.</blockquote><br />Could not have said it better myself! This is especially true in the healthcare setting where clinicians are overwhelmed with paper work and documentation requirements. As Mike points out there are hurdles, no insurmountable<br /><ul><li>Technology: creation of software (supported by powerful hardware) that can understand spoken language</li><li>Technology: content must be searchable. Text can be indexed, and we've grown addicted to the ability to search for and find the things we've written, and</li><li>Cultural: the barrier to voice-based computer interaction is one of habit. We've grown used to typing on keyboards. Although speaking is natural, speaking to a computer feels a little weird at first. And people generally don't like learning a new way to do things.</li></ul><br />In the piece he features three products that address these issues and go much farther <a href="http://www.voicebase.com/">VoiceBase</a> for indexing and searching, <a href="http://www.dial2do.com/">DialtoDo</a> to convert spoken utterances into action, and as he puts it the Mother of All Voice Applications, <a href="http://nuance.com/dragon/index.htm">Dragon NaturallySpeaking 11</a> from Nuance.<br /><blockquote>Dragon NaturallySpeaking takes dictation so accurately that it begins to approach Steve Jobs' favorite word: "Magical." For the first week of use, I was actually shocked when it correctly recognized obscure names, extremely technical terms, brand names with correct capitalization (for example, iPhone) and performed other unlikely feats. Since I started using it, I've written the first drafts of all of my columns and blog posts, including this column, using Dragon NaturallySpeaking.</blockquote><br />But as Mike points out the downside to this innovations, speed and accuracy that is especially relevant to healthcare is the lack of time to think. Many of us use typing time as thinking time....if you lose the typing time you lose the thinking time and generating content becomes a little more challenging at first:<br /><blockquote>The accuracy has an unexpected and very welcome side effect: It makes it easier to write. I assumed that typing was automatic, requiring little brain power. But using Dragon has demonstrated that mental energy was diverted from the task of typing to the task of thinking, which is what makes writing so much easier. I can also write faster using Dragon.</blockquote><br />This requires a change in behavior and an adaptation to the lost thinking time that can make clinicians feel less productive as they have to pause during dictations. But for those that already adapted to dictation and that process is easy (think existing dictating clinicians who use a telephone or hand held recorder device to dictate and generate clinical notes using traditional dictation and transcription) then a move to dictating directly to your PC is one step closer.<br /><br />But be warned as he identified "<i>It's not feasible yet for most people to completely abandon keyboards, mice and text and interact entirely via the spoken word.</i>" - so don't try to make that happen or expect it to happen. Again think of the telephone and texting - in some respects Texting could be considered a retrograde step but for many (read millions) texting is preferable to actually using the phone to speak to someone.<br /><br />Embrace the tools that make sense in your work and home life and importantly as I said in this piece at <a href="http://www.healthcareguy.com/">HealthCareIt Guy Blog</a>: <a href="http://www.healthcareguy.com/2010/08/28/guest-article-top-10-tips-for-successfully-using-speech-recognition-in-ehrs-and-healthcare-apps/">Top 10 tips for successfully using speech recognition in EHRs and healthcare apps</a> spend the money on a good microphone<br /><br />I'll leave you with Mike's closing comments:<br /><blockquote>And what can I say about Dragon NaturallySpeaking 11? It's the biggest user interface advance since the iPhone. The bottom line is that voice is finally ready for prime time. I've decided to continue my experiment indefinitely and to keep pushing the voice envelope as far as it will go. Voice makes using a computer faster, easier and a lot more fun.</blockquote><br />How about you - have you made the jump? Can it work for you in your environment and if not what is is the barrier to using voice in your world?<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4724597654694976833?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-32257253645723098112010-09-22T07:14:00.001-04:002010-09-22T07:14:36.026-04:00<div class='posterous_autopost'><div>No doubt the recently presented abstract on fish oil will drive even more alternative medicine claims. The study currently preliminary:</div><div><br /><a href="http://www.medpagetoday.com/MeetingCoverage/HFSA/22272?utm_source=share&amp;utm_medium=mobile&amp;utm_campaign=medpage%2Biphone%20app">HFSA: Fish Oil Benefits Early Heart Failure (CME/CE)</a><p />As always the data requires careful analysis and while superficially linking taking fish oil to reducing cardiac diseases but there are problems with this approach</div><p /><div>- the study was arrows out on patients with Cardiomyopathy</div><div>- study is preliminary and yet to be reviewed and published in a peer review journal</div><p /><div>While taking fish oil may not cause harm (apart from your wallet) linking this abstract for the purpose of selling more fish oil is a major part of the misleading activities that take place to confuse the general public and persuade them to buy unnecessary alternative therapies.&nbsp;</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/fish-oil-studies">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3225725364572309811?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-9953826799173103132010-09-22T07:02:00.001-04:002010-09-22T07:02:25.820-04:00<div class='posterous_autopost'>In yet another noteAble challenge faced in the healthcare system over the coming years is the massive increase in Dementia over the next 20 years. Expect to see an additional 85% more in the next 20 years<p /><a href="http://www.medpagetoday.com/Geriatrics/AlzheimersDisease/22315?utm_source=share&amp;utm_medium=mobile&amp;utm_campaign=medpage%2Biphone%20app">Report Predicts Massive Dementia Burden</a><p />This is another symptom of the baby boomers getting older tied to the inevitable health decline we all suffer with age.&nbsp; <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/dementia-to-increase-by-85-over-next-20-years">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-995382679917310313?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-5279946355451886032010-09-22T06:55:00.001-04:002010-09-22T06:55:27.403-04:00<div class='posterous_autopost'>In a move away from "pay and chase" to fraud prevention Medicare will start to ask for fingerprint and background checks on some beneficiaries in an attempt to decrease fraud<p /><a href="http://www.medpagetoday.com/PublicHealthPolicy/Medicare/22299?utm_source=share&amp;utm_medium=mobile&amp;utm_campaign=medpage%2Biphone%20app">Medicare Proposes New Anti-Fraud Measures</a><p />Challenging problem with big money at stake but seems this strategy may fall foul of individual rights based on innocent until proven guilty? <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/medicare-moves-to-fingerprinting">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-527994635545188603?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-75584581093175036192010-09-22T06:48:00.001-04:002010-09-22T06:48:14.124-04:00<div class='posterous_autopost'><a href="http://www.medpagetoday.com/Cardiology/Prevention/22306?utm_source=share&amp;utm_medium=mobile&amp;utm_campaign=medpage%2Biphone%20app">For Compression Hose, Length Matters (CME/CE)</a><p />Using above knee bs cAlf length compression TED stockings improves prevention of DVTs in at risk patients <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/length-of-compression-stocking-matters-in-dvt">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-7558458109317503619?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-14480049276524911142010-09-16T12:31:00.000-04:002010-09-16T12:31:30.185-04:00The topic of hours and fatigue in medicine continues to rumble on with no real resolution in site. A couple of recent articles and news items highlighted the continuing challenges.<br /><br />The Daily Mail reported the Coroners' comments and verdict in this piece (<a href="http://www.dailymail.co.uk/news/article-1310988/Coroner-hits-doctors-hours-patients-dies.html">Coroner hits out at doctors' hours after patient dies</a>) and Doctors.Net also featured the report: <a href="http://www.doctors.net.uk/news/Article.aspx?newsid=11199&amp;areaid=5">Junior Hours Blamed at Inquest (membership required)</a><br /><blockquote>An elderly man died in hospital after waiting five hours to see a doctor. After being told how Roland Holbrow died without seeing a doctor, a coroner yesterday criticized European rules that restricting junior medics' working hours.<br />Michael Rose described the European Working Time Directive....'Hospitals are running into problems,' he said. 'I can see the clear warning signs, although I am not going to refer this to Mr Lansley as I think he will already be aware of it.</blockquote>There's no shortage of views from both sides of this discussion:<br /><br /><u>Those in favor of restricting hours</u><br /><blockquote>..I don't agree that anyone should work that amount of hours, its not safe, and it courses problems in the future.<br />..criticise the PCT for not employing enough Doctors.<br />..Hospitals at fault here for NOT recruiting sufficient staff to provide proper shift cover... instead, they've been reducing manning levels instead so as not to exceed the WTD hours limit<br />..At the end of the day though do we really want to be treated by a doctor who has been on duty for over 12 hours. Pilots and the like are restricted on hours worked for safety reasons so should we really be seeing a doctor who is dead on his/her feet and then expect them to make the correct diagnosis first time every time. I doubt if many hospital administrators have a clue what happens overnite in their hospital and how bad things are they will have left by 5 30 in any case</blockquote><br /><u>And those that think we need to return to longer hours so junior doctors get "more experience"</u><br /><blockquote>..Good to see such a courageous coroner and Clinical Director, both willing to speak unpopular truths. We must unshackle Juniors from the restrictions of the "New Deal", and EWTD, whilst maintaining a sensible work / not work life balance. Also we need a 24/7 365 days a year fully active acute sector i.e. more flexible working all round, and likely more doctors<br />..can some one explain to me why FY1's were taken off doing night shifts and regular weekends? It seems ridiculous that we have a national shortage of doctors yet a massively under used resource of Dr's needing exposure so as to mature into decision making<br />..A few facts about EWTD. 1. It was never intended for the professions. I know of no professional (or other successful person in other walks of life) who has worked ONLY 48hrs pw when 'on the way up' (or indeed having 'arrived'!)</blockquote><br />Even some senior surgeons weighed in in a letter to the Telegraph suggesting <a href="http://www.telegraph.co.uk/health/healthnews/7992314/Cuts-to-junior-doctors-hours-may-impact-on-patient-care-warn-surgeons.html">limiting hours will have a significant adverse impact on patient care</a>. In fact they have been arguing that junior doctors need to work more hours<br /><blockquote>The College and others have consistently argued that junior doctors need to work more than the 48 hours per week permitted by the European Working Time Directive in order to amass enough experience and learning to become safe and competent surgeons. </blockquote><br />Interesting a study just out in the Journal of Amarican Medical Association: "<a href="http://jama.ama-assn.org/cgi/content/extract/304/11/1166-a">Presenteeism Among Resident Physicians</a>" and was featured in the NPR Shots Blog <a href="http://www.npr.org/blogs/health/2010/09/15/129886578/doctors-in-training-sharing-more-than-medical-care">Doctors-In-Training May Give More Than Medical Care</a>:<br /><blockquote>nearly 60 percent of respondents said they had worked while sick at least once and nearly a third reported having worked while sick more than once. At one "outlier" hospital not named in the study, 100 percent of the respondents reported having reported to work while sick.<br />A related problem, the survey found, is that busy medical residents (who are already known to not get enough sleep in the early years of post-medical school training, despite rules attempting to ensure they do) also reported not having enough time to see a doctor for their own medical care.</blockquote><br />One thing is for sure - tired people are not giving their best. As one junior doctor put it<br /><blockquote>In the last 2 weeks I have worked 105 hours without a day off. This is my rota and includes no overtime. I would say my patient care was compromised at the end as was my love for the job. ....I have maximum 2 hours of teaching every other week as the wards are too busy to leave the rest of the time</blockquote><br />Managing the hours and providing a good working environment is going to be essential. Technology will play a role in helping reduce work burdens and creating efficiencies but updating our training system must be included in the update to our health systems<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-1448004927652491114?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-63298273067125847922010-09-14T17:46:00.001-04:002010-09-14T17:46:44.572-04:00<div class='posterous_autopost'><a href="http://graphics8.nytimes.com/images/2010/09/14/science/14kelsey-2/jpKELS-articleInline.jpg">Dr Frances Oldham Kelsey</a>&nbsp;was ahead of her time and is to be honored tomorrow for her contribution in preventing a a much larger Kevadon (better known as Thalidomide) disaster that occurred in Europe:<div><p /><div><a href="http://www.nytimes.com/2010/09/14/health/14kelsey.html?nl=health&amp;emc=healthupdateema2">The Public’s Quiet Savior From Harmful Medicines</a><br /><p /></div><div>50 years on much of her insistence on scientific rigor and data remain the main stay of drug review and our process for managing new drugs and procedures. INteresting for someone who got the job because her name sounded like a man's</div><p /><div><blockquote type="cite">She was hired sight unseen by Dr. Eugene Geiling, a renowned pharmacology professor at theUniversity of Chicago, because&nbsp;he read her name as Francis. When she got the acceptance letter, in 1936, she realized his mistake and asked a professor at&nbsp;McGill University&nbsp;whether she could accept the job.</blockquote></div><p /><div>Not sure things have changed as much as we might like given the intense focus currently on&nbsp;<a href="http://www.huffingtonpost.com/kristin-rowefinkbeiner/dont-pop-the-bubby-yet-fo_b_696042.html">Women's Equality Day</a>&nbsp;on inequality on women's opportunities and pay</div><p /><p /><blockquote type="cite"><div>Dr. Kelsey demanded better tests for thalidomide. She also distrusted Merrell, a company that had a history of confrontations&nbsp;with the F.D.A. She soon discovered that Kevadon had been linked in Europe with reports of nerve damage — reports the&nbsp;company had failed to provide her.</div><div>“I had the feeling throughout the day,” she wrote after a meeting with company executives, “that they were at no time being&nbsp;wholly frank with me and that this attitude has obtained in all our conferences, etc., regarding this drug.”</div></blockquote><p /></div><div>Again - not sure things have changed much and we must continue to demand science and data to support treatments</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/shout-out-to-dr-frances-oldham-kelsey-iconic">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-6329827306712584792?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-76716313650407789552010-09-14T15:28:00.001-04:002010-09-14T15:28:06.267-04:00<div class='posterous_autopost'>New developments in technology to allow for the creation of components in real time in three dimensions <br />>>><a href="http://www.nytimes.com/2010/09/14/technology/14print.html?_r=1&nl=technology&emc=techupdateema1">http://www.nytimes.com/2010/09/14/technology/14print.html?_r=1&nl=technology&...</a> <p /> imagine the possibilities for grafts, artificial organs and joints built customized to the individual. We are starting to see customized drugs - it won't be long before we see customized implants and even artificial organs. <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/3-d-printing-will-impact-joint-replacements-s">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-7671631365040778955?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-38888112714715279252010-09-07T12:13:00.001-04:002010-09-07T12:13:42.599-04:00<div class='posterous_autopost'>I'm what is probably no big surprise we find detailed studies showing billions wasted with unnecessary vista to the doctor and the ED: <br />Health Care Wastefulness Is Detailed in Studies <p /> A heavy reliance on emergency rooms care is seen as a sign of weaknesses in the primary health care system. <br /><a href="http://nyti.ms/cFqcED">http://nyti.ms/cFqcED</a> <p /> If there's a lesson here it's the fixing of the healthcare system involves everyone of us. Making good choices, intelligent use of resources and an acceptance that things are going to change in the way we decide on care, who receives what and when <br />Are you playing your part <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/health-care-wastefulness-is-detailed-in-studi">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3888811271471527925?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-21279809671858856832010-09-03T14:15:00.002-04:002010-09-03T17:01:09.596-04:00The latest in a an annual competition looking for unusual and innovative users of Dragon the winner of the 2010 <a href="http://community.nuance.com/groups/i-speak-dragon/forum/default.aspx">I speak Dragon</a> contest EvanUp posted a story <a href="http://community.nuance.com/groups/i-speak-dragon/forum/t/1565.aspx">Dragon NaturallySpeaking: a matchmaker</a> - a truly heart warming story of adversity that was overcome by chance introduction linked to Dragon and culminated in marriage......EvanUp the author was diagnosed with MS<br /><br /><blockquote>After a few strange experiences with blurred vision and numbness, I was diagnosed with multiple sclerosis and was absolutely terrified by what it might do to me. </blockquote><br /><br />His local administrator suggested he try Dragon and pointed him to another user who told him <i>without any hesitation or reservation matter-of-factly</i>:<br /><br /><blockquote>“I have MS. It started affecting my hands so I got Dragon. It saved my career. Why do you ask?"</blockquote><br /><br />Sharing a common bond and enemy the two formed a friendship that culminated in marriage and as EvanUp puts it:<br /><br /><blockquote>Dragon NaturallySpeaking and multiple sclerosis served as our extremely unlikely matchmakers, and the luckiest break I've ever had</blockquote><br /><br />In what is important in life this ranks up at the top on my list and aside from congratulating EvanUp for winning the competition I want to thank him for sharing his quite personal but truly positive outlook on life in the shadow of adversity.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-2127980967185885683?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-36738815886215784742010-09-01T09:23:00.004-04:002010-09-03T17:02:45.885-04:00In a recent online discussion the question was posed "what makes up the skills and requirements of a CMIO". There was much discussion on the nature of the job, the skills needed and where new recruits needed to go to get those skills. But one reply stood out linking the skill set to everything we learn and do as clincinas. So with the permission of of a W Joseph Ketcherside MD, CEO of the Ketcherside Group and a Clinical informaticist who also practices of clinical medicine I post his response in it's entirety<br /><br /><blockquote>Our patient (a health care system) comes to us with a Chief Complaint (I want to install an EMR).</blockquote><blockquote>We gather a little more specific information by taking a History of Present Illness (Why do you want to install an EMR? Improved safety? Decrease cost? Improve quality? Integrate inpatient and outpatient care? And so on.)</blockquote><blockquote>We take some Past Medical History (What systems have you worked with before? Any successful implementations? Failed ones?)</blockquote><blockquote>We do the ROS (How do you sit in the market? Market share? Referral areas and types? What are the financials? What is the culture overall?</blockquote><blockquote>What academic relationships do you have? What is your system's relationship to the community? And so on.)</blockquote><blockquote>Then, we do the Physical Exam (Current state analysis and documentation. Palpate the database. Auscultate the medical staff.)</blockquote><blockquote>We develop a Differential Diagnosis (Major processes that could be impacted and possible solutions.)</blockquote><blockquote>We work with the patient (health system) to determine what a good health outcome would be for them (Future state model).</blockquote><blockquote>We come to agreement on a treatment plan (Implementation roadmap and project plans) that will reach that future state.</blockquote><blockquote>Then we operate (implement) and, hopefully, are lucky enough to provide ongoing care (continued improvements).</blockquote><blockquote>So, I still practice medicine. When I was a neurosurgeon I cared for multi-system organisms (people).</blockquote><blockquote>As a clinical informaticist, my patients are multi-organism systems. But, they are still my patients.</blockquote><blockquote>And, sitting in the ED on a Saturday night of a CPOE go-live, I would observe that CPOE implementation is exactly like clipping an aneurysm - hours and hours of boredom randomly interspersed with moments of stark terror.</blockquote><blockquote>So that's my two cents on the practice of Applied Clinical Informatics.</blockquote><br />This resonates with me and is close to the points I made in a guest posting over at Healthcare <br />IT Today "<a href="http://healthcareittoday.com/2010/08/10/chief-medical-information-officer-nuance-communications/">A Day in the Life of a CMIO</a>. WHat's your experience - what makes a good healthcare informaticist?<br />"<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3673881588621578474?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-71203251796768561842010-08-24T10:27:00.002-04:002010-08-24T10:27:00.370-04:00In the Spirit of helping those that face the digital tidal wave of technology in healthcare with trepidation I offer the following top ten reasons why this will be a good thing and include some thoughts on easing the transition from current methods to a digitized clinical office<br /><br /><b><u>1) Ready Access for Everyone</u></b><br />Paper medical records cause harm and in multiple studies have been shown to fail to deliver the necessary information to all the clinicians involved in care. In a study I quoted some years ago done by then Arthur Anderson they found that in less than half of patients cases the relevant clinical notes were neither available or could be found at the time the patient was seen. Digital records are available to everyone involved in the care of the team who has access. Instant availability provides referring physicians and specialists as well as the patients with a copy of medical record quickly and conveniently.<br /><br /><b><u>2) Digital Record are More Easily Kept Up To Date</u></b><br />New innovations and digitization allows for the capture of information by the patient prior to a visit. Almost every clinical facility asks patients to fill in forms as they sit in a waiting room – the information contained in these forms is marginal at best and locked away on a piece of paper. From a patient perspective the information has likely been provided to multiple other offices and clinical providers. Digital records are on the pathway to effective and meaningful sharing of clinical data that will remove the need to render or re capture the same information. Focusing on capturing it once and allowing the patient to review it for correctness and completeness at the time of the visit is likely to lead to a much higher quality more accurate medical record. It may seem foreign to many clinicians but the patient probably has the biggest vested interest in an accurate and complete medical record more so than anyone else involved in the clinical care process. In some cases the digital record can be shared with the patient ahead of time online in a secure environment and they can check, update and complete this before arriving for their appointment.<br /><br /><br /><b><u>3) Filtering and presentation</u></b><br /><div class="separator" style="clear: both; text-align: center;"></div>Clinical information captured as data throughout the continuum of care can be presented in innovative and more useful ways ("Can Electronic Clinical Documentation Help Prevent Diagnostic Errors";&nbsp;N Engl J Med 362;12 March 25, 2010 <a href="http://content.nejm.org/cgi/reprint/362/12/1066.pdf">pdf</a>).<br /><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/_ppefu9Ztfx8/TGG7513BGEI/AAAAAAAAABw/lH5Jo_shS5o/s1600/UpwardTrend.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="208" src="http://4.bp.blogspot.com/_ppefu9Ztfx8/TGG7513BGEI/AAAAAAAAABw/lH5Jo_shS5o/s320/UpwardTrend.jpg" width="320" /></a></div>Seeing a single blood pressure reading adds little to the clinical decision-making process. Seeing the blood pressure plotted over time with a clear upward trend is far more useful in identifying hypertension that requires treatment.<br /><br /><br /><b><u>4) No Need to Loose the Narrative</u></b><br />Capturing the whole story remains an essential component of any clinical record with the history contributing anywhere up to 80% of the final diagnosis. As part of any move to the digital medical record the inclusion of this narrative and the ability to record it without interfering with the normal workflow is a must. EHR’s have a wide range of tools and techniques for capturing and recording the patient record and there is wide variation in their use. Different specialties have different needs – in ophthalmology there are many data points routinely collected and form filling on a computer or digital tablet is likely to be efficient. General medicine on the other hand is dependant on the narrative and the detail behind the symptom. In this case it is important to provide tools to capture the data efficiently without adding to the time required for documentation. Historically these notes were hand written which probably induced an element of brevity. Hand written notes were replaced by dictation and transcription which while efficient for the clinicians introduced delays in the availability of information to the referring physician and other clinicians and proved costly. Recent moves introduced templates and forms along with tools to create these notes and while they work in some cases there are disadvantages of losing the patient story, and the inability to convey the meaning (“The transition from paper to electronic inpatient physician notes”;&nbsp;J Am Med Infom Assoc 2010; 17:108-111 <a href="http://jamia.bmj.com/content/17/1/108.abstract">abstract</a>).&nbsp;Speech remains the most common means of communication and providing tools to capture the clinical story and convert that into a digital record have been successful in many settings (<a href="http://www.nuance.com/news/pressreleases/2010/20100216_fallon.asp">Fallon clinic Study</a>).&nbsp;The key to success is offering a progressive blend of tools and methods to accommodate individual preferences and situational constraints. No one method suits all circumstances and all individuals and providing choice is the key to success. Present a choice and allow regular dictation and transcription while offering a pathway to more structured data entry, either through computer based forms entry or using speech recognition dictating directly into the EMR. (<a href="http://www.healthcaretechnologyonline.com/article.mvc/Save-The-Clinical-Narrative-0001?VNETCOOKIE=NO">Save the clinical narrative</a>)<br /><br /><b><u>5) Creating Structure and Data</u></b><br />If the narrative forms is an essential part of any clinical record so is structured data but generating both elements remains a challenging prospect for the busy clinician. New technologies on the horizon will automatically process the narrative and extract data elements to be placed directly into fields within an EMR. Using clinical language understanding (CLU) in conjunction with speech recognition technologies allows the clinician to document a succinct evaluation and description while automatically producing a discrete and codified problem list among other key clinical values. Codification renders this data useful to the EMR making it semantically interoperable. This forms the basis of the decision support, evidence based medicine and the error catching for ePrescribing solutions that have built in databases of contra indications based on specific clinical conditions (an allergy for instance) or careful monitoring and adjustment of doses based on renal function test (Gentamicin for example needs careful monitoring of renal function to prevent hearing damage)<br /><br /><b><u>6) Practical Clinical Support Tools</u></b><br />Human memory alone cannot guarantee the right questions and clinical information is gathered and applied to arrive at the most likely differential diagnosis. The landscape of clinical knowledge is rapidly changing and becoming more complex. Doctors need approximately 2 million pieces of information to practice medicine and subscribe to an average of 7 journals representing approximately 2,500 articles per year that they must read, process and then apply in order to stay current – an all but impossible task that is only getting harder (<i>Sackett DL: Surveys of self-reported reading times of consultants in Oxford, Birmingham, Milton-Keynes, Bristol, Leicester, and Glasgow, 1995. In Rosenberg WMC, Richardson WS, Haynes RB, Sackett DL. Evidence-Based Medicine. London: Churchill -Livingstone</i>).&nbsp;Digital records are the basis for applying knowledge and providing decision support to busy clinicians. While these alerts and tools are still in their nascent form, many are far to intrusive and can be triggered too easily. Refinement of these tools will bring about better quality of care helping prevent errors and facilitating informed decision making for patients and clinicians.<br /><br /><br /><b><u>7) ePrescribing – The Key to Safer More Efficient Prescribing</u></b><br />Electronic prescribing appears to reduce the rate of medication errors and should be an integral part of any clinical system. While the process of entering a prescription can seem arduous initially efficiency is rapidly achieved through frequent use and user customized and system stored favorites and pre populated prescriptions can ease this pain. Add to that the value of legible prescriptions that are almost instantly available to pharmacies and help the patient and the pharmacist and clinicians deliver the right drug with the right dose to the right patient at the right time. And built in to the prescribing system are contra indications, allergies and drug-drug interactions that can be caught as part of the prescribing activity, reducing medication errors and improving the quality of care.<br /><br /><b><u>8) Timely and Failsafe Communications</u></b><br />Computers are good at repetitive tasks and once programmed never forget. Tracking results, tests and clinical findings and ensuring that urgent communications reach the intended recipient every time is easier using a digital record. Much of our personal lives are now organized using mobile hand held devices that include calendars, automatic alerts and alarms, so could be our digital medical record. I receive notification from my bank when an unusual transaction exceeding a specific amount is authorized from my credit card. A digital record can identify unusual or abnormal results and highlight the information to the clinical team including communicating the information to the patient. Even with the best intentions paper based communication can and do break down. There are many examples a condition being identified correctly but a breakdown in communication to the patient or the correct caregiver may have led to an unfortunate, but potentially avoidable consequences.<br /><br /><b><u>9) Security</u></b><br />While much has been made of security issues associated with digital medical records the reality is that medical records than the old paper records. Furthermore access is easily tracked and audited. Ensuring the right level of security is essential. There has been many stories of paper records that frequently “walked” out of hospitals, clinics and into the back of cars, offices and even dumpsters.<br /><br /><b><u>10) Mobility and Portability</u></b><br />We live in a rapidly changing world and recent natural disasters have demonstrated the need for mobility and portability. Hurricane Katrina demonstrated the need to create medical records that are available in more than one location and are effectively backed up. There were few patients affected by Hurricane Katrina that were able to leave the area and attend another facilities and receive care without significant interruption. For example Veterans who fled the area almost instantly had their medical records available in other VA hospitals. While this might be an extreme example of crisis mobility and extraordinary circumstances our population and society is far more mobile than ever before. People no longer live their entire life in the same location. In addition to facilitating mobility, digital records deliver built in redundancies and create backups and copies to ensure survivability of information. But mobility is not just about the record but the ability of the clinician to access the record from any location and at any time. Seeing patients out of hours has always been difficult with the lack of available information – digital records that are accessible from any location and even on portable devices can provide instant access to key data to help clinicians manage patients efficiently. Reviewing a medical record on a mobile phone may not be ideal but having access to information even on a small screen is preferable to having no information as the basis of clinical decisions on patient care.<br /><br />Digitizing medical records is not so much a destination but a journey and one that we must all take. There are challenges but the benefits are clear. The question you must ask yourself as a physician is can you afford not to go digital and more importantly can your patients.<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-7120325179676856184?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com3tag:blogger.com,1999:blog-8534714680637397259.post-41739547592970829922010-08-24T06:39:00.001-04:002010-08-24T06:39:29.131-04:00<div class='posterous_autopost'><div>Average wait time for "emergency" treatment is in excess of 4 hours. As the article puts it:&nbsp;<a href="http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/21346?utm_source=share&amp;utm_medium=mobile&amp;utm_campaign=medpage%2Biphone%20app">Fast Treatment Rare in Emergency Departments</a><br />&gt;&gt;enough time to watch 4 episodes of the TV series ER!</div><div>Actually mo<span style="">re like 6 if you removed the adverts</span></div><div><span style="">A sorry state of affairs that reflects the strain on the service and a high degree of inappropriate use driven by financial pressures, uncertainty and ignorance</span></div><div><span style="">There must be big savings to be had in focusing on this problem, creating better low cost (or free) alternatives, and including some push to stop unnecessary usage.&nbsp;</span></div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/average-wait-time-in-ed-4-hours">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-4173954759297082992?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-31504460493302360502010-08-24T06:25:00.001-04:002010-08-24T06:25:45.648-04:00<div class='posterous_autopost'><div>It is probably no great surprise that sledding injuries occur in children but the severity especially in children under 4 years of age tends to be more severe and more likely to be a head injury. The commonest injury across all groups was fractures followed by contusions and abrasions&nbsp;<p /><a href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/21814?utm_source=share&amp;utm_medium=mobile&amp;utm_campaign=medpage%2Biphone%20app">Sledding Injuries Common in Kids, Can Be Severe (CME/CE)</a><p /></div><div>It may seem a long way off as we sit in the heat of the summer but it will be sledding season soon</div> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/sledding-injuries-can-be-severe">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-3150446049330236050?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0tag:blogger.com,1999:blog-8534714680637397259.post-85137958780131760292010-08-24T06:16:00.001-04:002010-08-24T06:16:37.242-04:00<div class='posterous_autopost'>Previous spill clean ups show increased health problems in the workers including respiratory problems and even some chromosomal changes<br /><a href="http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/21830?utm_source=share&amp;utm_medium=mobile&amp;utm_campaign=medpage%2Biphone%20app">Oil Spill Clean-Up Tied to Adverse Health Effects (CME/CE)</a> <p style="font-size: 10px;"> <a href="http://posterous.com">Posted via email</a> from <a href="http://drnic.posterous.com/oil-spill-clean-up-workers-likely-to-experien">drnic's posterous</a> </p> </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/8534714680637397259-8513795878013176029?l=drvoice.blogspot.com' alt='' /></div>Nick van Terheyden, MDhttp://www.blogger.com/profile/06931616951635617636noreply@blogger.com0