Newer posts are loading.
You are at the newest post.
Click here to check if anything new just came in.

February 24 2012

Top stories: February 20-24, 2012

Here's a look at the top stories published across O'Reilly sites this week.

Data for the public good
The explosion of big data, open data and social data offers new opportunities to address humanity's biggest challenges. The open question is no longer if data can be used for the public good, but how.

Building the health information infrastructure for the modern epatient
The National Coordinator for Health IT, Dr. Farzad Mostashari, discusses patient empowerment, data access and ownership, and other important trends in healthcare.

Big data in the cloud
Big data and cloud technology go hand-in-hand, but it's comparatively early days. Strata conference chair Edd Dumbill explains the cloud landscape and compares the offerings of Amazon, Google and Microsoft.

Everyone has a big data problem
MetaLayer's Jonathan Gosier talks about the need to democratize data tools because everyone has a big data problem.

Three reasons why direct billing is ready for its close-up
David Sims looks at the state of direct billing and explains why it's poised to catch on beyond online games and media.


Strata 2012, Feb. 28-March 1 in Santa Clara, Calif., will offer three full days of hands-on data training and information-rich sessions. Strata brings together the people, tools, and technologies you need to make data work. Save 20% on Strata registration with the code RADAR20.

Cloud photo: Big cloud by jojo nicdao, on Flickr

February 21 2012

HIMSS asks: Who is Biz Stone and what is Twitter?


Today, one of the founders of Twitter, Biz Stone, gave the opening keynote at HIMSS.

This is probably going to be the best keynote at HIMSS, followed by a speech from Dr. Farzad Mostashari, which will also be excellent. It goes downhill after that: there will be a talk about politics and another talk from an "explorer." I am sure those will be great talks, but when I go to HIMSS, I want to hear about health information technology. Want to know what @biz actually said? As usual, Twitter itself provides an instant summary.

HIMSS stands for Healthcare Information and Management Systems Society. The annual HIMSS conference is the largest Health IT gathering on the planet. Almost 40,000 people will show up to discuss healthcare information systems. Many of them will be individuals sent by their hospitals to try and find out what solutions they will need to purchase in order to meet meaningful use requirements. But many of the attendees are old school health IT experts, many of whom have spent entire careers trying to bring technology into a healthcare system that has resisted computerization tooth and nail. This year will likely break all kind of attendance records for HIMSS. Rightly so: The value of connecting thousands of health IT experts with tens of thousands who are seeking health IT experts has never been higher.

It is ironic that Biz Stone is keynoting this year's talk, because Twitter has changed the health IT game so substantially. I say Twitter specifically, and not "social media" generally. I do not think Facebook or Google+ or your social media of choice has had nearly the impact that Twitter has had on healthcare communications.

HIMSS, and in many cases traditional health IT along with it, is experiencing something of a whirlwind. One force adding wind has been the fact that President Obama has funded EHR systems with meaningful use, and made it clear that the future of healthcare funding will take place at Accountable Care Organizations (ACO) that are paid to keep people healthy rather than to cover procedures when they are sick. It is hard to understate the importance of this. Meaningful Use and ACOs will do more to computerize medicine in five years than the previous 50 years without these incentive changes.

But in the same breath, we must admit that the healthcare system as a whole is strained and unable to meet the needs of millions of its patients. The new force in healthcare is peer to peer medicine. There are really only a few things that doctors provide to patients. They either provide treatment, or they provide facts, or perhaps, they provide context for those facts. More and more, patients are seeking facts and context for that information, from the Internet generally and other patients specifically. This can be dangerous, but when done correctly it can be revolutionary .

It's not rocket science really; our culture has changed. Baby boomers still wonder if it is OK to discuss sexual issues in polite company. Their kids blog about their vasectomies. It's not just that we blog about vasectomies. We read blogs about vasectomies and consider it normal.

Someday, I will decide whether or not I should get a vasectomy. (I would like to have kids first). When I make that decision, I might just give @johnbiggs a shout and ask him how its going. He might not have time to answer me. But some vasectomy patient somewhere will have the time to tell me what it is like. Some epatient will be willing to spend an hour talking to me about what it meant to them to have this procedure. I can talk with patients who had a good experience, I can talk to patients who had a bad experience. I will have access to insights that my urologist does not have, and most importantly does not have time to discuss with me in any case.

For whatever reason, the epatient community centers around Twitter. More than likely this is because of the fundamentally open nature of this network. Although it is possible to "protect" tweets, most account holders tend to tweet to the whole world. If you are interested in a particular health-related issue, you can use Twitter to find the group of people who are discussing that issue. Twitter is a natural way for people who are connected by a common thought or issue to organize. Facebook, on the other hand, is about connecting with people you already know. The famous quote applies: "Facebook is about people you used to know; Twitter is about people you'd like to know better." You could change that quote to read "Twitter is about people you'd like to know who have had vasectomies."

There are people on Twitter right now discussing very personal health issues. All you need to experience this is to do a little research to understand what hashtag a community is using to connect with each other. For instance:

I intentionally chose diseases that are not easy to discuss in person. Discussion on these delicate issues between people dealing with these problems happens all the time on Twitter. Very often Twitter is the place to find and meet people who are dealing with the same healthcare issues that you are, and then discover another place on the web where patients with similar conditions are gathering and helping each other. For better or worse, Twitter has become a kind of peer-to-peer healthcare marketplace. I think this is about a billion times more interesting than surgeons who update families via Twitter, although that is cool, too.

At Health 2.0 or the OSCON healthcare track, these kinds of insights are regarded as somewhat obvious. It is obvious that patients are seeking each other out using social media technologies and that this must somehow eventually be reconciled with the process that doctors are just undertaking to computerize medicine. But at HIMSS this is a revolutionary idea. HIMSS is full of old-school EHR vendors who are applying technology that was cutting edge in 1995 to 2012 problems. HIMSS is full of hospital administrators who recognize that their biggest barrier to meaningful use dollars is not an EHR, but the fact that 50% of their nurses do not know how to type.

I can promise you that the following conversation will be happening thousands of times in the main hall at HIMSS before Biz Stone speaks:

Attendee 1: Who is this speaking?

Attendee 2: Biz Stone.

Attendee 1: Who is that?

Attendee 2: One of the founders of Twitter.

Attendee 1: What is Twitter?

For this audience, Biz Stone talking about how Twitter revolutionizes healthcare will be electric. I wish I could be there.

Meaningful Use and Beyond: A Guide for IT Staff in Health Care — Meaningful Use underlies a major federal incentives program for medical offices and hospitals that pays doctors and clinicians to move to electronic health records (EHR). This book is a rosetta stone for the IT implementer who wants to help organizations harness EHR systems.

Related:

Sponsored post
soup-sponsored

Soup.io will be discontinued :(

Dear soup.io fans and users,
 
today, we have to share very sad news. Soup.io will stop working in less than 10 days. :(
 
It's breaking our heart and we honestly tried whatever we could to keep the platform up and running. But the high costs and low revenue streams made it impossible to continue with it. We invested a lot of personal time and money to operate the platform, but when it's over, it's over.
 
We are really sorry. Soup.io is part of the internet history and online for one and a half decades.
 
Here are the hard facts:
- In 10 days the platform will stop working.
- Backup your data in this time
- We will not keep backups nor can we recover your data
 
July, 20th, 2020 is the due date.
 
Please, share your thoughts and feelings here.
 
Your Soup.io TEAM
Reposted bydotmariuszMagoryannerdanelmangoerainbowzombieskilledmyunicorn

Building the health information infrastructure for the modern epatient

To learn more about what levers the government is pulling to catalyze innovation in the healthcare system, I turned to Dr. Farzad Mostashari (@Farzad_ONC). As the National Coordinator for Health IT, Mostashari is one of the most important public officials entrusted with improving the nation's healthcare system through smarter use of technology.

Dr. Farzad MostashariMostashari, a public-health informatics specialist, was named ONC chief in April 2011, replacing Dr. David Blumenthal. Mostashari's full biography, available at HHS.gov, notes that he "was one of the lead investigators in the outbreaks of West Nile Virus and anthrax in New York City, and was among the first developers of real-time electronic disease surveillance systems nationwide."

I talked to Mostashari on the same day that he published a look back over 2011, which he hailed as a year of momentous progress in health information technology. Our interview follows.

What excites you about your work? What trends matter here?

Farzad Mostashari‏: Well, it's a really fun job. It feels like this is the ideal time for this health IT revolution to tie into other massive megatrends that are happening around consumer and patient empowerment, payment and delivery reform, as I talked about in my TED Med Talk with Aneesh Chopra.

These three streams [how patients are cared for, how care is paid for, and how people take care of their own health] coming together feels great. And it really feels like we're making amazing progress.

How does what's happening today grow out of the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) Act in 2009?

Farzad Mostashari‏: HITECH was a key part of ARRA, the American Recovery and Reinvestment Act. This is the reinvestment part. People think of roadways and runways and railways. This is the information infrastructure for healthcare.

In the past two years, we made as much progress on adoption as we had made in the past 20 years before that. We doubled the adoption of electronic health records in physician offices between the time the stimulus passed and now. What that says is that a large number of barriers have been addressed, including the financial barriers that are addressed by the health IT incentive payments.

It also, I think, points to the innovation that's happening in the health IT marketplace, with more products that people want to buy and want to use, and an explosion in the number of options people have.

The programs we put in place, like the Regional Health IT Extension Centers modeled after the Agriculture Extension program, give a helping hand. There are local nonprofits throughout the country that are working with one-third of all primary care providers in this country to help them adopt electronic health records, particularly smaller practices and maybe health centers, critical access hospitals and so forth.

This is obviously a big lift and a big change for medicine. It moves at what Jay Walker called "med speed," not tech speed. The pace of transformation in medicine that's happening right now may be unparalleled. It's a good thing.

Healthcare providers have a number of options as they adopt electronic health records. How do you think about the choice between open source versus proprietary options?

Farzad Mostashari‏: We're pretty agnostic in terms of the technology and the business model. What matters are the outcomes. We've really left the decisions about what technology to use to the people who have to live with it, like the doctors and hospitals who make the purchases.

There are definitely some very successful models, not only on the EHR side, but also on the health information exchange side.

(Note: For more on this subject, read Brian Ahier's Radar post on the Health Internet.)

What role do open standards play in the future of healthcare?

Farzad Mostashari‏: We are passionate believers in open standards. We think that everybody should be using them. We've gotten really great participation by vendors of open source and proprietary software, in terms of participating in an open standards development process.

I think what we've enabled, through things like modular certification, is a lot more innovation. Different pieces of the entire ecosystem could be done through reducing the barrier to entry, enabling a variety of different innovative startups to come to the field. What we're seeing is, a lot of the time, this is migrating from installed software to web services.

If we're setting up a reference implementation of the standards, like the Connect software or popHealth, we do it through a process where the result is open source. I think the government as a platform approach at the Veterans Affairs department, DoD, and so forth is tremendously important.

How is the mobile revolution changing healthcare?

We had Jay Walker talking about big change [at a recent ONC Grantee Meeting]. I just have this indelible image of him waving in his left hand a clay cone with cuneiform on it that is from 2,000 B.C. — 4,000 years ago — and in his right hand he held his iPhone.

He was saying both of them represented the cutting edge of technology that evolved to meet consumer need. His strong assertion was that this is absolutely going to revolutionize what happens in medicine at tech speed. Again, not "med speed."

I had the experience of being at my clinic, where I get care, and the pharmacist sitting in the starched, white coat behind the counter telling me that I should take this medicine at night.

And I said, "Well, it's easier for me to take it in the morning." And he said, "Well, it works better at night."

And I asked, acting as an empowered patient, "Well, what's the half life?" And he answered, "Okay. Let me look it up."

He started clacking away at his pharmacy information system; clickity clack, clickity clack. I can't see what he's doing. And then he says, "Ah hell," and he pulls out his smartphone and Googles it.

There's now a democratization of information and information tools, where we're pushing the analytics to the cloud. Being able to put that in the hand of not just every doctor or every healthcare provider but every patient is absolutely going to be that third strand of the DNA, putting us on the right path for getting healthcare that results in health.

We're making sure that people know they have a right to get their own data, making sure that the policies are aligned with that. We're making sure that we make it easy for doctors to give patients their own information through things like the Direct Project, the Blue Button, meaningful use requirements, or the Consumer E-Health Pledge.

We have more than 250 organizations that collectively hold data for 100 million Americans that pledge to make it easy for people to get electronic copies of their own data.

Do you think people will take ownership of their personal health data and engage in what Susannah Fox has described as "peer-to-peer healthcare"?

Farzad Mostashari‏: I think that it will be not just possible, not even just okay, but actually encouraged for patients to be engaged in their care as partners. Let the epatient help. I think we're going to see that emerging as there's more access and more tools for people to do stuff with their data once they get it through things like the health data initiative. We're also beginning to work with stakeholder groups, like Consumer's Union, the American Nurses Association and some of the disease groups, to change attitudes around it being okay to ask for your own records.

This interview was edited and condensed. Photo from The Office of the National Coordinator for Health Information Technology.

Strata 2012 — The 2012 Strata Conference, being held Feb. 28-March 1 in Santa Clara, Calif., will offer three full days of hands-on data training and information-rich sessions. Strata brings together the people, tools, and technologies you need to make data work.

Save 20% on registration with the code RADAR20

Related:

January 06 2012

Top Stories: January 2-6, 2012

Here's a look at the top stories published across O'Reilly sites this week.

The feedback economy
We're moving beyond an information economy. The efficiencies and optimizations that come from constant and iterative feedback will soon become the norm for businesses and governments.

Epatients: The hackers of the healthcare world
The epatient community uses digital tools and the connective power of the Internet to empower patients. Here, Fred Trotter offers epatient resources and first steps.

The three topics that will define the developer world in 2012
It's a brand new year, time to look ahead to the stories that will have developers talking in 2012. Mobile will remain a hot topic, the cloud is absorbing everything, and jobs appear to be heading back to the U.S.

Understanding randomness is a double-edged sword
While Leonard Mlodinow's "The Drunkard's Walk" offers a good introduction to probabilistic thinking, it carries two problems: First, it doesn't uniformly account for skill. Second, when we're talking probability and statistics, we're talking about interchangeable events.

Traditional vs self-publishing: Neither is the perfect solution
In this video podcast, author Dan Gillmor talks about the pros and cons of traditional publishing versus self-publishing.


Tools of Change for Publishing, being held February 13-15 in New York, is where the publishing and tech industries converge. Register to attend TOC 2012.

January 05 2012

Epatients: The hackers of the healthcare world

I help build open source software tools that patients can use to have greater control and influence over their own healthcare (like the Direct Project and Your Doctors Advice). As as result, I've become quite familiar with other tools that do the same sorts of things. There is a community of patients who are deeply interested in the ways in which they can become more engaged and how they can specifically use technology to achieve this. This community calls themselves epatients. The epatient community asked me to write a short collection of resources for "becoming an epatient."

The "e" in epatient is intentionally obscure. The initial assumption is that the "e" stands for "electronic," as it does in "email." But in fact, the "e" stands for "engaged" or "empowered." Nonetheless, reference to email is intentional: The epatient community recognizes that leveraging data is a critical part of empowering a person who happens to be sick. Patients must be "electronic" to become fully "engaged." I think of epatients as the healthcare equivalent of makers and hackers. More importantly, they are the people I have in mind when I write software.

Engaged patients get better healthcare. Not just a little bit better. Much better. This is not a thesis I am prepared to defend here, except to drop a link to the Journal of Participatory Medicine, which is a good resource for those seeking a full chronicle of this engaged effect (the benefits of engagement have been documented in the healthcare literature for years).

Let's go over some simple concepts that the rest of my epatient advice and resources are based on:

  • Your doctors are probably not managing your healthcare information. You should assume it is your responsibility. Otherwise, the people involved in your treatment process will often presume that this information simply does not exist.
  • Other patients, with similar conditions to yours, can have better information about your health problem than your doctors have.
  • Like the highway system, the healthcare system is generally beneficial, but there are dangers, and you need to learn to avoid them.

And here are two things you should keep in mind:

  • Whenever I say "patient," I actually mean "the patient/caregiver team." Often, the patient will not have the energy to do what is necessary to be fully engaged. It is critical that when the patient cannot be an epatient, that at least the patient's team be an epatient proxy.
  • In regard to the "better information" I mentioned above, I don't mean that your doctor is typically wrong and another patient is typically right about your diagnosis or treatment options. While that does happen on occasion, it is not the norm. Another patient's information is "better" because your doctor typically does not have the visceral experience of being a patient. Your doctor doesn't understand which lotion can make all of the difference or what position might let you get some sleep after a rough procedure. There is simply no substitute for experience. Sometimes that experience can make your life a little easier, and sometimes it can help you get the right treatments that literally will save your life. (This is the gist of epatient Dave deBronkart's story.)

The first thing an epatient needs to do is find the right epatient community. For any common illness or group of symptoms, there is a community of people who are already connecting with each other over the Internet. For people with a recent cancer diagnosis ACOR is probably the right place to start. This is one of the oldest, largest and most active epatient communities. Sometimes, the tools that a particular community of epatients choose might be a little old school — things like traditional forums, or even list-serves. Do not judge a community by its adoption of technology, judge it by its activity level.

There are efforts to create technology solutions that are specifically designed to enable patient communities. For a good example, check out PatientsLikeMe, which is representative of patient communities drifting more toward "patient social media." I am happy to say that epatient tool makers like me are coming up with cool stuff constantly. But the mature epatient is not impressed by new and shiny. Remember, it is the relationships and insights that matter here, not the technology. Whenever possible, you want the right information delivered over the wrong technology medium, rather than the other way around.

For any serious common healthcare condition, there are probably several different communities of patients online that you can meet with. For common conditions, you might also be able to find a specific meetup in your area, or at least some kind of epatient meetup. If you have a rare disease, you might have trouble finding local resources, and you might only have one or two online communities to choose from. But for rare diseases, the online patient community as a whole is typically better informed than the average primary care physician on a particular condition. Sometimes a physician might not understand or recommend treatment options that are offered outside their local healthcare community, an issue that can be compounded when they are unfamiliar with a particular type of diagnosis. It is even more critical for rare disease patients or caregivers to find a patient community and listen to them. For rare diseases and conditions, it is critical to understand what treatment options are offered in other areas and to be fully informed regarding sham clinics that often operate in under-regulated areas.

How do you know you've found the right community? Here's a good rule of thumb: If you can't get a real response to a simple health question from the community within 24 hours, you should probably move on if there are other options. Healthy epatient communities are vibrant and alive.

You should also consider joining the Society for Participatory Medicine (SPM). The mailing list for the SPM is one of the most important cross-condition meeting places for epatients.

If you are interested in the technology side, also pay attention to Health 2.0 (#health20), which has a Patients 2.0 (#patients20) community that is concerned with the "electronic" part of epatient. Generally, I find that Health 2.0 is the right place to find out-of-the-box thinking on healthcare information systems, especially those offered directly to consumers. I go there to get the down-low on my competitors and to find collaborators. Matthew Holt from Health 2.0 cross pollinates the healthcare blog, which is also worth adding to your RSS reader.

The cross-disease epatient community uses Twitter more than Facebook or Google+ (for the time being), and the #epatient hashtag is your friend. I also recommend following @epatientdave, @reginaholliday, and @hhask as good starter accounts. If you care about the tech aspects of epatients, then check out @NateOsit or myself (@fredtrotter). And if you're interested in the activist portion of the epatient community, then look at the Occupy Healthcare roster.

Once your healthcare information gets past a certain basic level of complexity, it becomes important that you have a personal health record (PHR). Your doctors should, eventually, be able to update your PHR. That means you need a PHR that supports the Direct Project. Right now, that is a short list, with Microsoft's HealthVault at the top. As a FOSS advocate, that is not an endorsement I make lightly, but Microsoft's health IT team has been surprisingly supportive of open source (i.e. patient empowering) technologies and they have relatively mature Direct support. Indivo is pretty much the only one to consider if you want to run your own PHR (it's open source), but its Direct support is lagging. Something you should keep in mind: If you have only one doctor at a time, you do not need to obsess about the coordination of your own healthcare information; if you have more than one doctor, you do. You can manage this information with a PHR, or a notebook, or even an infographic. What matters is that you need to do it, and do it carefully.

Some of the people in the Quantified Self movement are patients who are trying to use data about themselves to improve their health. If that interests you (if you have a chronic condition, it should), then take a look at the Quantified Self website.

There are two types of patients: those who are in crisis mode and those who are in maintenance mode. If you are in crisis mode, and you feel like your whole world has been turned upside down, then I recommend you read Dr. Carolyn Oliver's book "Cautious Care: A Guide for patients." The newest edition of this book is also available as a series of free PDF downloads from the Cautious Patient Foundation website. Here are direct links to the hospital part and the outpatient part. Dr. Oliver's book is like a "defensive driving crash course" for the healthcare system. If you are going to be staying up all night at the hospital (as a caregiver or a patient), and you have no idea what you should be paying attention to, this is the book that you should be reading. (Disclosure: I work for Dr. Oliver at the Cautious Patient Foundation.)

If you are in maintenance mode, you should still start with Dr. Oliver's books, but you can also extend your reading to the classics of the epatient movement. That process should always begin with the e-patient white paper, and I also recommend the book "Laugh, Sing, and Eat Like a Pig" for ethos purposes. Go to e-patients.net and click "categories" to find the content on that blog that seems relevant to you.

If you are well, consider spending some time with these resources. When you become sick you do not want to be learning how this stuff works. You will probably ignore this advice, and that's fine. Just try to remember that this advice is here when you need it. Also, remember that these are not instructions for how to handle your illness; they're instructions for finding the instructions on how to handle your illness.

If you are newly sick, then what I have written here will sound overwhelming. You are tired, scared and confused (and you don't need some arrogant geek telling you that you need to use technology to look over your doctor's shoulder). Recognize that you will not have the capacity to bring your intellect to bear on this the way you could when you were healthy. It is very tempting to just check out and trust that the healthcare system is going to take good care of you. But please trust me on this: That's a bad idea. The default settings on the healthcare system really suck. Your doctors will provide you with options, but they do not have the right perspective to help you make the right choices. Patients often ask their doctors, "What would you do if you were me?" The very, very best doctors reply, "But I am not you." What you need to find are other people who share your values, who are living with the consequences of having made the choices that you are facing. I say this with both a deep sense of pride and a great deal of humility: My spiritual predecessors (health geeks) have made sure that the Internet can provide you with connections to these people.

The Internet will make it easier to connect, which is awesome. If you cannot summon the strength to do this, fine — entrust someone you love with the task of connecting for you. I truly believe that it is impossible to be an epatient alone. Moreover, I believe that it is impossible not to be an epatient if you have shared your burden with even one other patient.

For those who need encouragement with their ongoing efforts to connect to others with the same suffering, I leave you with some video happiness. Be sure to watch the whole thing:

Meaningful Use and Beyond: A Guide for IT Staff in Health Care — Meaningful Use underlies a major federal incentives program for medical offices and hospitals that pays doctors and clinicians to move to electronic health records (EHR). This book is a rosetta stone for the IT implementer who wants to help organizations harness EHR systems.

Related:

Older posts are this way If this message doesn't go away, click anywhere on the page to continue loading posts.
Could not load more posts
Maybe Soup is currently being updated? I'll try again automatically in a few seconds...
Just a second, loading more posts...
You've reached the end.
(PRO)
No Soup for you

Don't be the product, buy the product!

close
YES, I want to SOUP ●UP for ...