Friday, January 28, 2011

Health Information Technology (HIT)

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A preliminary review of the literature on electronic medical records, EMRs and health information technology (HIT) initiatives raise a couple of doubts.

One is the apparent lack of accommodation for new bio-medical and genomic advances. The lack of a current medical diagnostic database with criteria, frustrates the accommodation for new science. Such a comprehensive medical information database needs to be infinitely scalable, dynamic and freely accessable at least by the providers.

Although stage II envisions decision support, -- such is already the case in the best of the EMRs deployed so far -- stage II does not include differential diagnosis. There again the lack of a current medical information terminology / database frustrates any attempt to correlate patient data with outcome or the genome with medical illness.

Also, the plan underestimates the resistance and distrust that both patients and providers might have in relinquishing their proprietary right to the inherent value of the medical record. The hospitals, insurance companies, drug companies and HMOs will vie for control or at least access to this information. I doubt that the federal government instills more trust. The States with their medical schools and public health departments may be neutral ground, but the level of federal access remains unclear.

Obviously we need to do this. We rank behind most of the Western World in health despite having the best medical schools and high level institutions.

The office of the national coordinator (ONC) clearly defines the issue of trust. However the suggestion that the rewards of stage II will yield to penalties in stage III seems contra-productive. On the contrary studies in human behavior suggest that education and access to information motivate far better than punishment. One might say especially with highly educated and motivated professionals.

Sadly, current medical information is harder and more expensive to come by than classified government information. Journals, books and medical seminars are extraordinarily expensive and archaic compared to the Internet, yet firewalls copyright and exorbitant access fees block that information as well.

It seems illogical to view the medical record database as public information (with privacy safe guards) whilst current medical information remains proprietary.

http://motorcycleguy.blogspot.com/2010/12/language-of-healthit.html
http://ahier.blogspot.com/search/label/Office%20of%20the%20National%20Coordinator

Thursday, January 6, 2011

Room-temperature sub-diffraction-limited plasmon laser by total internal reflection

Ren-Min Ma, Rupert F. Oulton, Volker J. Sorger, Guy Bartal & Xiang Zhang
Nature Materials (2010) published online 19 December 2010

“Plasmon lasers are a new class of coherent optical amplifiers that generate and sustain light well below its diffraction limit. Their intense, coherent and confined optical fields can enhance significantly light–matter interactions and bring fundamentally new capabilities to bio-sensing, data storage, photolithography and optical communications.” http://www.nature.com/nmat/journal/vaop/ncurrent/abs/nmat2919.html

The desk top microscope just keeps getting better and better, contributing to the rapid advancements of mediocal knowledge. For every click down into the infintisimal, the scale of information expands exponentionally.

For those who think we just about know it all, one might buy a new microscope. Bio-medicine intersects with physics more and more. There lies an entirely new reality as medical science probes the molecular level and beyond --- below the light defraction limit --- into a world of atoms, particles and quantum mechanics.

Tuesday, January 4, 2011

Electronic Medical Record (EMR)

Quick Pitch
We build electronic medical records (EMR) s in many ways, but until we post patient data including genomic material into databases as discrete data points, it will not be possible to analyze the data in a meaningful way.
Patient records repeat the same words and phrases many times. The chart could be three inches thick, but if one were to reduce it to only the repeated words and phrases and index them in a database, the record might cover only a couple of pages. In a sense, this is compression, but the compressed elements are now accessible and correlated with other information in a relational database.
The same strategy applies to current medical information and terminology. As data points on a modern relational database, specific terms defining diagnosis, criteria or treatment become available for programmed analysis, statistical use, machine logic, artificial intelligence (AI), research and data mining. New biomedical information floods the system beyond the pace of human processing. New medical information is highly perishable difficult to access, expensive and time consuming.  A credible EMR must include a continuously updating database of current medical knowledge.
EMRs strive for many things. One of them involves computer decision support systems (CDSS). A successful decision support offers the clinician diagnostic possibilities, suggestions for further testing, statistical probabilities and treatment options derived from patient data and current medical information not otherwise accessible to the clinician – specifically differential diagnosis. In design, we place far too much emphasis on reimbursement, and treatment and pay not enough attention to patient care and diagnosis.
One clinician in a year will likely produce over a thousand records. The total grows year to year, so after thirty or so years the total will exceed say thirty thousand records. Such a database affords opportunity to correlate data both in real time and retrospectively.  Combine one clinician’s records with others in the region and you have a database exceeding the size of most major studies. The bigger the database, the greater grows the value. Uploading the data anonymously to a related institution, for instance the medical school makes it available for educational focus, CME and ongoing research, even an opportunity to correlate genetic data with real world pathology. Critically, medical information, current diagnostic terms and criteria must flow back down into the clinical computers.
With the government grants for deploying and substantially using EMRs, we have the opportunity to build not just an EMR but also a relational database of medical information (MIDB) that corrects itself based on actual outcome and statistical analysis.
We must keep all of these programs out from between the patient and the clinician, maintaining a sense of humanity and the art of medicine.