Thursday, August 30, 2012

Medical students still burdened by high debt loads

This problem needs to be fixed - if the debt load for a student emerging from medical school training is that high their income needs will be very high just to make loan payments.

Average debt of $162,000 - $205,000: Imagine starting out your early life with that kind of debt load!

Posted via email from drnic's posterous

Tuesday, August 7, 2012

Voice of the Doctor - August 10

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

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

 

There are three ways to tune in:

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

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

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

Voice of the Doctor - August 10

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

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

 

There are three ways to tune in:

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

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

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

Posted via email from drnic's posterous

Monday, August 6, 2012

Larry Weed's Grand Rounds at Emory University in 1971

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

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

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

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

Posted via email from drnic's posterous

Larry Weed's Grand Rounds at Emory University in 1971

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

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

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

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

Friday, August 3, 2012

Healthcare's Often Missing Element - The Human Element

About 6 years ago Dow Chemical sponsored what became a series of iconic TV commercials – simply called The Human Element. They still crop up occasionally - and I still think they are CLIO worthy – but no wins to date. A summary of the soothing, violin accompanied voice-over went like this:

For each of us there is a moment of discovery. In the flash of a synapse we learn that life is elemental. This knowledge changes everything. We see all things connected. The element not listed on the chart – is the missing element – the human element. And when we add it to the equation – the chemistry changes. Every reaction is different. The human element is the element of change. Nothing is more fundamental. Nothing more elemental.

In the course of those same 6 years we’ve raced breathlessly – sometimes frantically – to bring the promise of new technology to healthcare. E-Health, M-Health, D-Health – all with varying degrees of success but all with the same triple aim – improved care, health and cost.

Xerox has new evidence to suggest that there are still some sizable gaps in at least one critical element of our healthcare transformation – and it’s that human element. A recent survey of 2,147 U.S. adults, conducted for Xerox by Harris Interactive found that only 26% want electronic health records (EHR’s). Even beyond that surprise, only 40% of respondents believe that EHR’s will deliver better, more efficient care – and that’s down 2% from last year’s survey. About 85% also said they have privacy concerns about EHR systems generally. Those concerns aren’t unfounded. Today’s headline over at ModernHealthcare reports that over the last 3 years there were over 470 healthcare data breaches that involved the medical records of over 20 million people.

Much of that human element relates to a variety of customer experiences around all the different dialog’s in healthcare (physician to hospital, hospital to payer, patient to doctor etc…). In this context, consumers are really all of us – regardless of any healthcare  affiliation. Fundamentally changing these experiences isn’t as simple as slathering on a glitzy web design – or racing full throttle to the cloud and mobile. Recent headlines certainly aren’t conclusive – but they do suggest ample room for innovation and improvement – especially around that human element:

Even with the big Enterprise IT decisions – headlines here often reflect areas of both significant risk and doubt:

In an effort to help providers to maximize the value of an EHR, Xerox turned to researchers at the venerable Palo Alto Research Center (PARC – a company that Xerox spun-off about 10 years ago) as a way to explore the landscape of innovation around EHR’s.

A big part of PARC’s healthcare work for Xerox is using ethnography and other social science methods to observe and analyze actual work practices – not just what people say they do – said Steve Hoover, CEO, PARC. If there’s one thing that this survey tells us, coupled with our own experiences, it’s that you should never develop or deploy technology outside of the human context.

PARC’s rich history in engineering innovation is legendary – spanning more than 40 years – and includes such key developments as laser printing, Ethernet, the modern personal computer, graphical user interface (GUI), object-oriented programming, ubiquitous computing, amorphous silicon (a-Si) applications, and advancing very-large-scale-integration (VLSI) for semiconductors.

Relative to healthcare, Xerox acquired ACS almost 3 years ago – which in turn acquired The Breakaway Group last fall (in part for their PromisePoint® technology – a kind of flight-simulator for large-scale EHR deployments). Last year, ACS signed a $500 million, 10-year agreement with Allscripts for hosted IT Services using Allscripts’ Sunrise Enterprise Suite to support EHR’s. These large scale connections (Xerox, ACS, Allscripts) combined with the innovation engines of companies like PARC and The Breakaway Group represent an exciting development. It’s where innovation – including the human element – meets scale – in healthcare. PARC’s influence is still relatively early – and most clearly represents the opportunity around that human element. Steve Hoover summarized it best:

PARC helped to usher in the era of ubiquitous computing – but in the evolution to truly personalized computing we recognized the critical importance of contextual computing. Bringing that deep understanding to large industries like healthcare is both a rich heritage – and an exciting opportunity. It’s also one we’re extremely passionate about.

Love this piece by @DanMunro on the missing "element" (love the graphic with an Atomic number of 8 - same as Oxygen and an Atomic weight of 7E-09)

As Dan points out this si the key ingredient that is missing in so much of the dicussion and includes everything from the dialog with the physician/hospital/payer) to the interaction with the EMR and the engagement with the Xerox Spin off PARC that has been exploring the EHR interaction for ten years.

Interesting concept to have a flight simulator version of EMR's which was exactly the process we went through about 20 years ago when we designed our paperless hospital in Glasgow. We built mock up rooms and tested them in earnest with real physicians, nurses and other ancillary staff to work out the workflow kinks in the room's ergonomics.

We need more of this and perhaps even an independent testing environment that takes the CCHIT testing and certification methodology a stage further.

Posted via email from drnic's posterous

Thursday, August 2, 2012

Voice of the Doctor DIscussion Aug 3 with Chuck Webster, MD (@EHRWorkflow)

I had the pleasure of talking with Chuck Webster, MD (@EHRWorkflow) over the last few days and weeks and he just posted this interview at his website
We found much in common (not justin healthcare but in books, space and science fiction) and he has kindly agreed to join me tomorrow for the #VoiceoftheDr radio show at 2:30 ET
We will be continuing the theme from this interview and discussing EMR usability, how interface design is so important and how it can be improved with the addition of intelligent speech interfaces and the importance of enabling clinicians to use narrative documentation as the source of truth in our march towards digitization of medicine and the medical record
Posted via email from drnic's posterous

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Natural language processing (NLP) applied to medical speech and text, also know as Clinical Language Understanding (CLU), is a hot topic. It promises to improve EHR user experience and extract valuable clinical knowledge from free text about patients. In keeping with this blog’s theme, NLP/CLU can improve EHR workflow and sometimes uses sophisticated workflow technology to span between users and systems.

drnick-skype

10. Most of my previous questions are pretty “geeky.” So, to compensate, from the point of view of a current or potential EHR user, what’s the most important advice you can give them?

To me, the core issue is usability and interface design. The interface and technology has struggled to take off in part because the technology has been complex, hard to master and in many instances has required extensive and repeated training to use. The combination of SR [speech recognition] and CLU technology offers the opportunity to bridge the complexity chasm, removing the major barriers to adoption by making the technology intuitive and “friendly”. We can achieve this with intelligent design that capitalizes on the power of speech as a tool to remove the need to remember gateway commands and menu trees and doesn’t just convert what you say to text but actually understands the intent and applies the context of the EMR to the interaction. We have seen the early stages of this with the Siri tool that offers a new way of interacting with our mobile phone, using the context of your calendar, the day and date, location and other information to create a more human-like technology interface that is intuitive and less intimidating.
You can see the full interview at Video Interview and 10 Questions for Nuance’s Dr. Nick on Clinical Language Understanding via chuckwebster.com