A Window into the Incoming Gush of Data: Healthcare in Pittsburgh

I really enjoyed this piece, by Barb Darrow, about the development of healthcare-related data management at the University Pittsburgh Medical Center (UPMC) for a number of reasons.  First of all, as the article explains, UPMC is a leader in the area and is doing some really interesting things!  Secondly, I always enjoy a good story about the economy of Pittsburgh, since it represents one of the best cases (the best case?) of transforming a US rust belt city into a 21st century City (Health care and robotics are among the key fields relevant to that success.).  Finally, and most significantly, the issues raised in the article demonstrate that mastering new levels of data management do not lead to ease and simplicity but rather, to even greater opportunities and challenges.

In the case, of UPMC, getting a head start on developing Electronic Medical Records has led, first of all, to the challenge of coordinating  independent systems across specialties.  Being able to manage enormous amounts of granular data, and to understand how to deploy that data, is one of the frontiers beyond the systems coordination step:

Doctors now try to take a more holistic view of their patients, and that requires the ability to pull together data from different sources. Imaging data is separate from surgery notes, which is separate from pharmacy data.

“If we look at big data, the idea is how to interconnect multiple points of data across the broad, biological continuum,” Shrestha said. “If the patient is diabetic, you don’t just see an endocrinologist looking at the liver in terms of liver function tests or any scans but across the biological spectrum of organs and then down to a cellular level. We look at pathology slides, reports on molecular imaging and down to the genomic levels.”

Darrow explains that data can be broken down into three buckets: imaging data, which accounts for close to 50% of UPMC’s digital information; databases, which account for about 10%; and unstructured information, such as “postoperative notes, radiology reports, discharge summaries,” which accounts for the remaining 40%.  The piece goes on to describe some of the specific technologies that are being used to address these various categories and concludes by pointing to another, even further frontier: the integrated management of pathology reports.

Big data, as the article in which I found the above reference would argue, is here to stay.  The more we know, the more we that will become knowable.  Personally, I find the challenge daunting

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EHR’s and Cloud Computing

From February, but still worth noting:

ONC [The Deparment of Health and Human Services’ Office of the National Coordinator for Health Information Technology] is creating a network of Regional Extension Centers (REC) that will provide regionalized support to medical providers for the selection and implementation of an EHR . . . To track, manage and report on this critical effort, Acumen Solutions will implement a cloud computing CRM and Project Management solution from Salesforce.com that will be used nationally across all Regional Extension Centers. This solution will provide the REC’s with the ability to manage all interactions with medical providers related to their selection and implementation of an EHR solution. [from the website of vendor Acumen Solutions.]

Gvt Rules in EHR Implementation

From the EMR and HIPAA Blog, a concise example of how stimulus money for EHR’s can lead to inefficiencies in electronic investment:

. . . the stage 1 meaningful use criteria really focuses on EMR’s having the ability to share patient information, but doesn’t actually require them to share information. In stage 2 and stage 3, my understanding is that the requirements to start sharing this clinical information will be a major part of the criteria.

. . .  let’s imagine a clinical office spends more than they should on a certified EHR and show stage 1 meaningful use. No doubt they spent a fair amount of time dealing with the reporting requirements of stage 1 meaningful use. As with any EMR implementation they made a lot of changes in their office and for the most part their [sic] satisfied with getting the EMR stimulus money the first year.

Well, stage 2 meaningful use rolls in and now they’re required to start sending their patient data to some state designated HIE [Health Information Exchange] (or other similar entity). What’s going to happen if their state doesn’t have an HIE where they can send the data? Or what if you’re from a small state like Delaware or Montana (small in people) and your EMR vendor decides that they’re not going to build the features required for you to interact with your state EMR?

The example is not surprising but it’s always a good idea to keep track of how the massive funds that can kick-start an industry will inevitably lead to distortions.

The Electronic Infrastructure: When Information Systems Outpace the Hardware and Humanware They Run On

A fascinating article at the Huffington Post relates upsetting stories about the dangers of a too-rapid EMR implementation.

An excerpt:

Altogether, the [Huffington Post] Investigative Fund identified 237 reports of “adverse events” associated with health information technology reported to the FDA over the past two years. Most problems involved computerized medical ordering software or systems that supply the software with vital information, such as recommended doses of medicine or test results. Most of the adverse events recorded in FDA files were blamed on software malfunctions, user error or the system’s lack of user friendliness.

What Problems Can Open Source “Solutions” Actually Solve?

A reader request at Alexandria (another blog at which I post) got me digging into the open source side of Electronic Health/Medical Records.  I was fascinated by a discussion of how a person can ascertain the stability of open source software as it shed light on both (a) the viability of open source software for the future of health record systems and (b) the ways in which we determine the reliability of a product, in general.

John, of the EMR and HIPAA blog, proffers that

The most important point to consider with an open source EMR is the health of the community surrounding the open source EMR. If the community is strong, then you’ll see some amazing things happen. If the community is weak, then the open source EMR will still be around in a few years, but no improvements to the software will be made. The way technology progresses means that your software must improve or it will be outdated in a couple years time. Continue reading

From Apple to Apps: An Early Innovator’s Perspective on the Future of Personal Health Records

Few people fall in love with health information systems because of someone bombing battleships, but Peter Groen is an exception.  In 1981, while working as a computer systems analyst at a hospital in Atlanta, he was part of a team that helped a paralyzed patient to communicate by carefully attaching an electrical lead to the man’s eyelid by which he was thence able to instruct the computer to “bomb” targets in an early Apple video game. “We knew that a thinking man was trapped inside that body when he was able to follow instructions and successfully play the game.  We were then able to write a simple program that let the patient ‘write’ a simple message using a similar method of controlling the computer.”  Groen was hooked: “I couldn’t see working in finance, marketing or sales after that.  I wanted to use my knowledge to help people and working in health care was the right place to do that.” Continue reading

A Quick Case Study from the Field: Tasting the Challenges of International Collaboration on Electronic Health Records

A conversation I had yesterday with a senior executive at a health management firm shed some light on the challenges of working internationally in the field.  Our conversation centered on China; three details stood out:

1)    American medical coding systems are completely foreign to many Chinese health officials; they employ a coding system that is, in some ways, influenced by traditional Chinese medical practices.

2)    Chinese records are sorted by numbers only, and not according to the alphabetical system (naturally, this flows from the fact that Chinese words are composed of ideograms and not letters; still it presents challenges to international collaboration in this area).

3)    Chinese patients are expected to bring to their doctors a file including their basic medical information/background.  If they do not bring the file with them, doctors tend to proceed with a reevaluation of the patient’s baseline health; the very idea of electronic records is quite remote from this paradigm.

The challenges of working internationally in any field are, of course, great.  Human services, with its sensitive records and involvement in intimate issues make addressing challenges such as those above all the more daunting.

Even so, future posts will attempt to explore promising pathways for such endeavors.