Crucial breakthroughs in the treatment of many common diseases such as diabetes and Parkinson's could be achieved by harnessing a powerful scientific approach called systems biology, according to leading scientists from across Europe. Systems biology is a rapidly advancing field that combines empirical, mathematical and computational techniques to gain understanding of complex biological and physiological phenomena. (via Key to future medical breakthroughs is systems biology)
If anyone needed further proof that Healthcare 2.0, ehealth or whatever you want to call it is coming, one need only look at the major push that the good folks at Google are making on this front:
What they've built is an innovative 3D environment to help people experience how healthcare is being revolutionized by enabling health information to be deeply networked and easily exchanged.
To visit the island in Second Life, simply search on "IBM Healthcare." The island was also developed with an innovative HUD, or heads-up display, to help visitors navigate their experience.
Electronic healthcare is also about evolving toward a system more focused on patients, not technology. To that end the IBM Virtual Healthcare user experience begins with the patient in the home, where a visitor can create a facsimile of their Personal Health Record (FYI: More than 150,000 IBMers in the U.S already have access to an electronic version of their healthcare data.)
Visitors can then see how their personal, electronic health records can securely interact with the other major parts of a connected, interoperable ehealthcare system: doctors' offices, hospitals, pharmacies, laboratories, etc.
The island is debuting as part of the HIMSS 2008 conference, one of the world's largest healthcare events.
Here's a bit more on how the island will serve as an interactive simulation of eHealth:
Visitors can then walk, fly or use "transporters" to visit the various island stations:
-- The Patient's Home: In the secure environment of a private home,
patient avatars can initiate a PHR and populate it with their personal
health characteristics and clinical history, accessed and downloaded from
physician EMR data. They can also establish privacy and security
preferences as well as health directives. The ground floor demonstrates
secure messaging with health systems and activates the initial PHR. Using
a transporter to move upstairs, patients use home health devices to take
weight, blood pressure and blood sugar readings in the privacy of a
bedroom, further incorporating this information into the PHR, which is
shown on presentation screens.
-- The Laboratory: This stop offers laboratory and radiology suites to
help avatars extend their understanding of the benefits of HIE. Here,
patients can check in at a Patient Kiosk and have blood work and radiology
tests performed. The use of EHRs -- revealing only appropriate portions of
the PHRs -- shows how consumers can also benefit through cost and time
-- The Clinic: Patient avatars transport or walk from the Lab to the
Clinic, where a welcome from their primary-care physician awaits. A
combination of scripting and information screens supports simulation of a
patient exam, after which an electronic prescription is generated, and the
continued development of the EHR is explained on nearby screens.
-- The Pharmacy: Here, avatars can check in at a Patient Kiosk that
simulates the verifying of drug information. They then receive their
prescriptions and update their PHRs/EHRs with new medication data. The HIE
architecture demonstrates how use of PHR/EHR technology can prevent
consumers from purchasing medications that are contra-indicated given the
medicines they presently require, as well as alerting them about potential
drug-to-drug interactions. The PHR/EHR is again updated.
-- The Hospital: In this futuristic, three story structure, avatars
arrive for a scheduled visit with a specialist. Physicians' offices,
patient rooms and exam rooms are all simulated here.
-- The Emergency Room: Avatars can chose to experience a virtual
emergency by "touching" a specially scripted control. This engages a
medical episode and a ride on a fast gurney directly into the private and
secure emergency treatment area, where a special screen is programmed to
reveal the full incorporation of the PHR to ensure proper treatment.
As part of some research on IBM's efforts in collaborative innovation, I was checking out the new beta site for alphaWorks, IBM's public program for early adopters of new technologies and trends, and came across this very interesting new offering related to open-standards based exchange for healthcare data. Technologists can actually go in and try this system out. A bit out of my technical skill level (not sure what an "affinity domain" is), but would be interested to hear feedback on those who do try it out. As always, please spread the word:
What is Public Health Information Affinity Domain (PHIAD)?
PHIAD creates the first on-demand system in the public health industry by enabling the integration and sharing of data generated at clinical and public health institutions across proprietary systems and political boundaries.
The system is built upon international coding systems, as well as the coordination between open-source technologies and the 'Integrating the Healthcare Enterprise' (IHE) initiative in the use of standards to allow multi-national public health reporting and surveillance.
PHIAD supports hierarchical data flow across different domains. Each regional PHIAD collects data from local sources, such as doctors and veterinarians. The regional PHIAD then forwards appropriate information to a national PHIAD, which is administered by a disease control organization such as the Centers for Disease Control (CDC). PHIAD can extend this hierarchy of data sharing to international partnerships. At each level, different data-sharing policies concerning person identification, location identification, authorship, and results can be implemented.
The following idea was proposed in IBM's InnovationJam, one of our goundbreaking global brainstorming events. The InnovationJam is currently happening, over a period of 72 hours, on IBM's intranet. InnovationJam is the first time we've extended this collaborative experience beyond employees to their family members, some of our business partners and other external participants including universities. InnovationJam features forum discussion on "Going Places," "Staying Healthy," "Finance and Commerce," and "A Better Planet." As you can imagine, some great conversations on the personalization of medicine, electronic health records, pandemic preparation, and managing healthcare costs are underway. We want to spotlight one of the most innovative ideas to come out of the discussion thus far: Independent Health Record Banks.
Amnon Shabo (Shvo), Healthcare and Life Sciences, IBM Research Lab in Haifa
In a nutshell, the model of Independent Health Banks suggests that medical records will not be kept
anymore by healthcare providers; rather they will be sustained for the
entire lifetime of an individual by new players in the healthcare
industry- "Independent Health Records Banks" which will be (1)
independent of healthcare providers / insurers / government-agencies
and (2) regulated by new legislation.
The fundamental principle of the new legislation is that the copy of a medical record stored in such an EHR bank is the only medico-legal copy. The record is sustained objectively by an EHR bank and all authorized parties can have access to it. Such a bank acts as a custodian/trustee. Multiple competing banks will be established by private enterprises (once the appropriate legislation will be in place), much like financial banks.
Healthcare providers could reduce their costs of medical records archiving as this function will be carried out by the EHR banks. Insurers will support it as it will improve the quality of care their customers get. Privacy will be better protected as no global patient identifiers will be needed since a bank account number will be the only access key that the individual needs.
And most importantly, true longitudinal EHRs will finally come out of the raw attested medical records by advanced information technologies employed by the EHR banks.
A more detailed description of this vision is available in the follwoing papers:
* Shabo, A., Vortman V. and Robson B. (2001). Who’s Afraid of Lifetime Electronic Medical Records? In proceedings of TEHRE – Towards Electronic Health Records Conference, London, UK, November 2001. Available online at http://www.haifa.ibm.com/projects/softwa...
* Shabo, A. (2006). A Global Socio-Economic-Medico-Legal Model for the Sustainability of Longitudinal Electronic Health Records. Methods of Information in Medicine 3/2006: 240-245.
Ivan Oprencak, Extreme Blue, IBM Almaden Research
The medical profession, like early forms of paper, originated in Ancient Egypt. Perhaps this explains why doctors are so fond of the material. According to a 2003 National Ambulatory Medical Care Survey, 83% of office-based physicians in the US continued to use paper based medical records. A more realistic explanation for the low adoption rate of electronic medical records (EMRs) lies in another ancient invention - money. Physicians bare the full cost of an EMR application; however, most of the EMR’s benefits, such as reduction in duplicate procedures, go to the insurance companies. No wonder doctors are reluctant to give up paper. While no technology can realign the mismatched incentives that exist in the American healthcare system, lowering the cost of EMR applications would give physicians a better return on their investment.
Open source is emerging as the higher return option for getting doctors to go electronic. A recent report by the California HealthCare Foundation made a compelling case for open source software in healthcare. I believe in this vision. Open source is low cost, easily customizable, and highly collaborative. EMR applications, such as OpenEMR, MirrorMed, and ClearHealth, are gaining acceptance in physician’s offices.
Turning paper records into their digital equivalent makes healthcare information management more efficient. However, to harness the true power of software as a catalyst of change, EMR applications need to connect and interoperate. Allowing physicians to access patient’s data at anytime in any place will fuel a new wave of healthcare innovations. Electronic drug prescriptions, remote health monitoring devices, and disease outbreak alerting systems are possible only if we have the ability to share medical information.
Interoperability between EMR applications depends on common protocols and data formats. However, healthcare standards for electronic interchange of data, like HL7, are complex and costly to implement. It would be unrealistic to expect all EMR products (EMR Consultant site lists over 300 of them) to conform to these standards. Again, this is where open source can make a difference. The Eclipse Open Healthcare Framework (OHF) is an open source implementation of the major healthcare industry standards. Existing applications can take advantage of web services based OHF Bridge that provides a simple interface for interconnecting diverse EMR products.
While I cannot predict the ultimate impact of open source on healthcare, I am confident that by lowering costs, open source EMR applications and open source interoperability tools are giving doctors a new reason to finally stop using paper.
Paul Grundy, MD, MPH, IBM Well-Being Director for IBM Global Well Being Services and Health Benefits (And covering doctor on Tristan da Cunha, 1985)
More good news on the telemedicine connection with Tristan da Cunha (for background see my previous post)! We have established partners, who are going to help us in the various stages of this project. UPMC is going to develop the connection via the Internet with Tristan da Cunha. MedWeb, which already links to Djibouti and some other very remote locations, is also assisting IBM in developing the tools, technology, and equipment necessary for the connection.
When this connection is established Dr. Joerg Jaschinski of Tristan will be able to send digital X-ray, EKG, and the like over the Internet and get real time specialist consultation. Besides establishing the link, we plan to set up two servers for the system in case one crashes so that images can be transmitted and UPMC contacted at any time.
Northstar Global, an international banking firm, is joining the project as well by donating the money, with help from their partners, necessary to give the island the necessary technology.
IBM and Dr. Jaschinski thank all the partners involved in this project. Dr. Jaschinshi wants to “…thank all the people involved warmly from the Tristan community…”
Paul Grundy, MD, MPH, IBM Well-Being Director for IBM Global Well Being Services and Health Benefits (And covering doctor on Tristan da Cunha, 1985)
The response to my last post on Tristan da Cunha has been encouraging. We have heard from an employee at UPMC and most notably from Dr. Joerg Jaschinski, the current doctor on the island. We hope to get some more viral interest behind this project so we can make it happen. Let us know what you are thinking about this project, but in Dr. Jaschinski's own words:
"If you could provide better technical equipment/ support, the island and I would be very thankful. Working in such an isolated place can be very difficult at times like recently when I had to treat a sailor who fell 10 meters into a ships hold and sustained fractures to the femur, mandible and maxilla as well as internal injuries (he is doing well, following advise via Swinfen telemed). Look forward to hearing from you."
Marion Ball, Fellow
in IBM's Center for Healthcare Management (And co-editor of this new book on EHRs)
Aspects of Electronic Health Record Systems, Second Edition, provides healthcare decision makers the crucial information and tools they need to implement an EHR system. The contributors to this book are involved in all aspects of the national and international EHR movement: academics, CIOs, consultants, vendors, end users, clinicians, radiologists, technologists, applied informatics researchers, and basic scientists all weigh in on the topic as well as provide real life examples from a wide range of sources.
This book covers historical EHR systems through current, cutting-edge systems employed by academia, the Department of Defense, and international health care institutions in Canada, the United Kingdom, and Australia. Comprehensive discussion of fundamental issues lays the groundwork in this book for in depth information on specialized topics like decision support, medical imaging, and automated text processing.
Clinical Research Needs ▪ Patients' Needs ▪ The EHR-S in Population Health ▪ Scope and Sites of Electronic Health Record Systems ▪ Patient Safety, Quality of Care, and CPOE ▪ Public Policy Issues for CPRs, EHR-Ss, and the NHIN ▪ The Department of Defense EHR ▪ The Global Perspective ▪ Databases in Healthcare ▪ Standards, Standards, Standards ▪ Privacy and Security ▪ Computer-Based Documentation ▪ Health Text Analysis ▪ Digital Imaging ▪ Clinical Adoption ▪ Evaluation of Electronic Health Record Systems ▪ Grand Challenges of IT in Medicine ▪ Grand Challenges of Medicine and Health for IT
Communications and strategy expert specializing in smarter planet, virtual worlds & 3D Internet, social software and networking, Web 2.0 and collaborative innovation, healthcare information technologies,corporate strategy and communications, nanotechnology commercialization