healthcare technology

Current controversy surrounding health domains is rooted in the Internet’s growing importance as a health information source. In 2013, the International Telecommunication Union estimated that 38.8% (2.7 billion) of the world’s population used the Internet. Many of these users are seeking important health information online. In the United States, surveys report 72% of online adults accessed the Internet to find health information primarily on the subjects of diseases and treatments . Other regions, including the European Union and emerging markets, have also shown marked increases in online health information seeking and self-diagnosing behavior.

The importance of establishing an inclusive yet reliable presence for health information online is critical to future global health outcomes given the growing importance of the health Internet. However, .health and many other health-related gTLDs are now on sale to private sector entities that largely permit open and unrestricted use. Yet, the globalized nature of the Internet, the public health need for privacy, security, and quality health information, and the rapid expansion of online health technologies demonstrate a critical need to ensure proper governance of future health domains. Focusing on the public good can be a first and crucial step to ensure an accurate, reliable, and evidence-based online presence for health for this generation and the next.

Each of our bodies is utterly unique, which is a lovely thought until it comes to treating an illness -- when every body reacts differently, often unpredictably, to standard treatment. Tissue engineer Nina Tandon talks about a possible solution: Using pluripotent stem cells to make personalized models of organs on which to test new drugs and treatments, and storing them on computer chips. (Call it extremely personalized medicine.)

Patient engagement, defined as the process of placing patients at the center and in control of their own healthcare, is becoming a chief healthcare priority

Concurrently, a number of national information infrastructure initiatives are targeting increased patient engagement and the design of health information systems that improve the availability of health information and integrate it in meaningful ways for patients.  So far, these technology goals have been advanced primarily through the design of personal health records (PHRs), patient portals, electronic health records (EHRs), and health information exchanges (HIEs).  However, we remain far from achieving the goal of truly engaging patients in their care.

Generation and exchange of health data with patients is a requirement for Stage 3 EHR meaningful use incentives. Patients are entitled to an electronically generated copy of the record of their encounters with providers. 

Sharing provider-generated data with patients is expected to promote patient engagement and accountability, but our own experiences suggest that the data that are being shared are currently a mixed blessing.  For example, one encounter report took the form of a 6-page document in which the vast majority of information was copied and pasted from previous encounters and in which there were several factual errors. The errors will be discussed with the provider during the next visit.

Certainly the report got our attention; whether empowerment will result remains an open question.  On another occasion, although the visit itself had included making decisions about future treatment, the plan was not mentioned in the document, leaving the patient to rely on her own memory and notes.

You walk in to the doctor’s office – nervous – thinking of the last time you received the injection of your monthly medication, remembering how painful and aggravating it was when the nurse couldn’t find your vein and poked you five different times to insert the IV.

This time, however, something is different. When the nurse shows up he is wearing a special pair of glasses, something you wouldn’t expect to see during such a standard procedure. The device uses advanced technology and shows the nurse a perfect highlighted image of your veins so he can insert the IV in one painless attempt.

Sounds like science fiction right? Wrong. This is a real device and is just one early example of how Augmented Reality (AR) technology is changing the healthcare landscape.

Research shows that up to 40 percent of IV sessions require multiple attempts to locate and access the vein. Augmented reality comes to the rescue in a standard procedure that still causes so much discomfort and dissatisfaction.

Typically, when people think of AR, they imagine glasses and screens that present new layers of content on top of real world images. This traditional model will still play a significant role in the future. However, there’s another aspect to AR that will be important, specifically in the healthcare industry and that is the ability to instantly display relevant information to people who need it most.

Imagine a doctor who is able to view a patient’s medical history displayed over the latest medical scan, and even over the patient himself. We are already beginning to see wearable medical devices that provide critical health information during relevant points of the day.

In the near future, the next time you want to bite into your hamburger, you might get a friendly reminder that your cholesterol level won’t like it.

We are still facing significant barriers before we will be able to see AR’s full potential in action. Some of these barriers are practical, such as problems with Wi-Fi connectivity and battery life. Several of the barriers are conceptual, but we do see a huge shift in people’s mindsets.

Wearables will play a major role in this. For example, there have been several crowd-sourced campaigns to develop wearables that could sense your heart rate and blood oxygen levels and send you real-time notifications. In another case, there was an abdominal surgery that took place on one side of a city, and in parallel was live-streamed via glasses to a medical school class.

Medicine is one of the industries that provides tangible real-world benefits to help people live better lives, and AR can help immensely. When you’re dealing with life and death decisions, immediate access to necessary and relevant information is of the utmost importance.

This is where AR has the most potential to disrupt the industry – putting the information doctors and healthcare providers need in front of their eyes, when they need it. Beyond that, this same experience can be tailored for the needs of patients and everyday users unlocking the potential for a real revolution in health and in the way people think about maintaining their health.

A fundamental question about any (Clinical Decision Support System) CDS is just how good is it, i.e. does it get the right answer for generic and specific patients? If it doesn’t this may be the result of one or more issues such as flawed information having been used to build the system, flawed programming, or the patient being outside of an often undefined or ill defined population when for another population the CDS does actually provide the right answer

A common CDS disclaimer is that it is always up to the practitioner to second guess the CDS as necessary, or in other words, the CDS is not actually supposed to be relied upon. Depending on the complexity of the underlying theory and data, the practitioner may or may not in reality have the ability to do this, or they may not have a more rational basis for doing so than “I don’t think that is right”. Such a conclusion would put the practitioner outside of what might be considered a practice guideline. On the other hand if a CDS is easy to second guess, then it might not be very valuable in the first place.

In this context comes the recent controversy over the new cholesterol and statin on line “risk calculator”. As first reported in the New York Times, it was determined that an online risk calculator overestimated patient specific risk by an average of 100% (100 here is not a typo). If action were based on this erroneous calculator, statin therapy would be substantially over-prescribed. In this regard the Times cites a statement from the organizations that published the guidelines that will continue to be a CDS classic: patients and doctors should discuss treatment options rather than blindly follow a calculator. Or, in other words, it is not to be relied on.

Apparently the problem with the risk calculator is at least in part that the risk data on which it was based was decades old and therefore did not apply to the current US population which in at least some ways has actually gotten healthier. In addition the mathematical model used was one of linearly increasing risk which has not been demonstrated to be correct. Thus the flaws in the calculator were a result of the inappropriateness and lack of justification of the knowledge bases used to build it. Despite these fundamental issues, no plans to remove or revise the calculator were identified.

This risk calculator was not imbedded within an EHR, and it requires manual input of multiple patient parameters. And of course there are additional potentially relevant patient parameters that are not part of the calculation. However something like this certainly could be part of an EHR either by direct integration, or by pointing the EHR user to it and perhaps automatically using relevant patient information that might already be in the EHR. 

more at http://www.hitechanswers.net/lesson-clinical-decision-support/