The Daily Sign-Out

Early adopters of using social networking in health care

I decided to tackle The Histories by Herodotus this summer, after having enjoyed reading Thucydides' The Peloponnesian War last summer, and came across a fascinating description of Babylonian medicine by Herodotus in Book 1 that I connected with social networking via the Internet. In contrast to Thucydides, Herodotus, called "the father of history" by Cicero, has many little asides and colorful and curious  descriptions of the people, places, and culture of the late 6th/early 5th century eastern Mediterranean and Near East world, his "Oikoumene" or inhabited world.

At 1.197, Herodotus states that the Babylonians did not use physicians, but instead took their sick into the public square and allowed people who either suffered the same illness or saw someone else who did to advise the sick person. Further, it was not considered acceptable by the Babylonians to just pass by a sick person or not ask what disease he had!

I imagine such a sick man or woman being bombarded and overwhelmed with all kinds of diagnoses and advice about how to rid themselves of whatever was ailing them--kind of like when patients go online and search for their "disease," signs, symptoms, lab results, etc., right?!  I see a similar phenomenon with the myriad groups focused on patients with different syndromes and diseases.  I'm certainly not disparaging these at all--they are extremely useful to patients, families, and caregivers and serve to not only a resources for information but support and advocacy.  I just find it interesting and fascinating that an ancient group of people did pretty much the same thing over 2,500 years ago!

I thought this would be a nice re-entry into more regular blogging again after a bit of hiatus.

Hope to post more on a plethora of recent articles on lung pathology, cancer biology, and transfusion medicine soon.

Lab Report Makeover!

Anyone read this month's issue of Wired (December 2010)?

There is a fascinating article for us lab folks in which the author (Steven Leckart) tapped three designers to re-design the standard lab report.  First, let me say that the standard lab report design harkens back to the days of dot-matrix printers and green bar fanfold paper.  There seems to be little evolution since.  The lab reports from my lab invite more questions from clinicians and I field at least 3 calls per week just trying to cipher the results for the ordering physician!  Imagine a patient trying to make sense of their own lab results.  Actually, I can.  Every few months I receive a pdf by email from my dad or mom wondering what their lab results mean and if the "H" or "L" next to the result is bad.  And these are intelligent, health-conscious people who have a pathologist for a son.

The designs are interesting and thought-provoking.  See which one you like the best and send your comments.  The design "test" somewhat misleading because it focuses on specific panels, e.g. PSA, cardiac risk profile, but the "basic workup" is a fair test.  While these designs might have value in the outpatient or office setting, I think they would be unusable for inpatients.  Not to say that we couldn't dramatically improve those.  But the point of the article is to provide lab reports for patients so that these reports are de-mystified and that patients might be more empowered to manage their own health if there was a more graphical illustration of their "blood work."

In any case, there is lots of food-for-thought for us as pathologists and laboratorians as we address post-analytical issues regarding getting the right information to the right person at the right time in a context for a specific patient so that appropriate action can be initiated.

Low expectations for future of clinical data mining--a study

I picked this up from Fierce Health IT newsletter:

Anvita Health commissioned a newly released HIMSS Analytics study on clinical data mining. HIMSS Analytics convened a focus group of CMOs and and CMIOs of provider and payer organizations for the report.

Payers and providers alike generally don't often employ clinical data for real-time decision-making, in part because information is in so many disparate formats, some important data elements are missing and because they believe the costs generally outweigh the benefits. "These challenges are consistent with what we've seen and heard from our payer and provider customers," Noffsinger explains. "Interoperability of data is a hurdle, but it's not insurmountable."

"A key finding for us was that both payers and providers had limited expectations for how clinical analytics could improve the quality of patient care--especially at the point of care--and lower costs through that improved quality," Richard Noffsinger, CEO of San Diego-based data analytics firm Anvita Health, says, Healthcare IT News reports. "Comprehensive real-time analytics can take these stakeholders beyond just evaluation, and provide a blueprint for action by physicians, care managers and others in the care continuum."

One of the promises of the Health Care "Reform" bill rammed through Congress is that (unfunded but mandated) improvements in and use of health care information technology will lead to improved health and lower costs.  What is interesting to me from this study is the "limited expectations" that both payers and providers have for data mining for routine clinical use.  Such low expectations could lead to a "feedforward" feedback on the implementation of health IT creating a self-fulfilling prophecy where low expectations for IT improving quality of care leads to underutilization which fulfills the lower expectations, etc.

Here is the link to Health Data Management which has a link to a pdf of the study.

New Pathology blog: StemPath

Welcome to Dr. David Braxton and his new pathology weblog  StemPath which will focus on stem cell biology.  Best of luck to Dr. Braxton--make sure y'all check up on this one regularly as he gets off the ground.

Smartphone use increasing amongst physicians

The California HealthCare Foundation issued a report last month on the uptake of smartphones by physicians and consumers and the implications this has for health care.  You can download the pdf at the link above.

The National Comprehensive Cancer Network site also picked up on this and sent out an eBulletin earlier this week saying their plans to launch NCCN Guidelines™ apps for Android and iPhone next month.

The report found that about two-thirds of physicians reported using smartphones compared to 42% of the general public.  As of February 2010, there were nearly 6,000 apps releated to health and health care within the Apple AppStore. However, 73% of these apps are intended for use by consumer or patient end-users, while 27% were targeted to health care professionals.  Interesting.

Abstracts solicited for Pathology Informatics 2010 Conference

Dr. Bruce Friedman at LabSoftNews blog has announced a call for abstracts for the Pathology Informatics 2010 Conference in Boston on September 19-22, 2010.

The conference Web site is up which has links for additional information about the conference, online registration, abstract submission, etc.  This really is a premier conference and well-worth the time and expense!  Please check out the Web site--it is pretty amazing what this conference has evolved into since I attended my first conference in 2000 (ouch!).

Disruptive Integration and Health Care

When Disruptive Integration Comes to Health Care

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Interesting article containing an interview with Dr. Jason Hwang co-author of The Innovator’s Prescription: A Disruptive Solution for Health Care (McGraw-Hill, 2009).

It got me thinking about niches where "disruptive innovation" may occur in laboratory medicine and pathology.  Please share any thoughts you may have--let's get a conversation started about this!

One area is lab testing for wellness or serial monitoring of chronic diseases managed on an outpatient basis.  The traditional hospital-based lab (like mine) just has not evolved to meet these needs.  Your lab may still be focused on inpatient lab testing.  Outreach efforts may want to incorporate marketing for these niches.

Another niche might be for outside or independent "second-opinion" diagnosis utilizing digitized slides either transmitted electronically or (so '90s!) dropped onto a CD-ROM.

Word!

James Fowler on the Power of Social Networks

I referred to the book, Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives, by James Fowler and Nicholas Christakis, in my recent lecture at SIU's Symposium on Teaching and Learning.  I've been thinking about the implications of this book with respect to medical education and how to incorporate these findings into teaching strategies.  This video podcast is a nice introduction of the book by one of the authors, James Fowler.
PopTech : popcasts.

Practicing medicine and social-networking Web sites

Dr. Sachin Jain writes an insightful editorial  (free text) in the Thursday last (August 13) New England Journal of Medicine.  On the "friend request" on Facebook of a former patient:

"The anxiety I felt about crossing boundaries is an old problem in clinical medicine, but it has taken a different shape as it has migrated to this new medium."

Dr. Jain brings forth some pertinent issues regarding social-networking sites as they relate to individual physicians, to doctor networking groups, and to institutions.  One point of interest for me in this editorial is the issue of "professional distance."

Societal trends over the last 50 years have radically foreshortened this distance between doctors and patients, doctors and other members of the "medical team," and between doctors themselves.  Something to reflect on: compare depictions of these relationships with respect to professional distance in literature, movies, and television over the last 150 years or so.  Social-networking seems to be only accelerating an on-going trend--but, as Dr. Jain presciently observes, "(w)hat is different about the online arena is the potential size of the community and the still-evolving rules of etiquette (my emphasis)."  I wonder sometimes if there is any notion of "etiquette" in any aspect of American life.  Perhaps there is hope.

Finally, Dr. Jain points out the inevitable conflict between physicians as "members of real-life communities" and personal behavior that is discordant with our professional "persona."  This also is an old problem but becomes magnified and amplified when we launch ourselves into cyberworld.

Very cool post from Dr. Kaplan at Digital Pathology Blog regarding MEDTING.