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Not so elementary, my dear Watson

In just the last few hours, I’ve seen a huge wave of pushback and doubt about Watson, the IBM supercomputer, being used for clinical decision support.

Yesterday, I covered a “healthcare leadership exchange” at IBM’s new Healthcare Innovation Lab in downtown Chicago. I posted some of my observations on the EMR and HIPAA blog, and made the case for diagnostic decision support.

I also wrote a story for InformationWeek, but that hasn’t run. Instead of posting my story, InformationWeek healthcare editor Paul Cerrato wrote a column about Watson already being “beaten in the medical diagnostics race” by Isabel Healthcare, a diagnostic decision support tool that’s been available for years. I have to admit, he’s right. I first interviewed Isabel founder Jason Maude probably in 2002 or so, and I first blogged about the company in 2005. I mentioned Isabel in a 2007 post that, interestingly, also alluded to the work of Don Berwick and Larry Weed.

Cerrato mentioned Jerome Groopman’s 2007 book, “How Doctors Think,” which discussed, in part, how IT could help doctors avoid many types of cognitive errors. “[D]octors tend to lean toward diagnoses that are most available to them in their day-to-day routine,” Cerrato wrote (emphasis in original). That’s exactly what Weed has said for decades, and exactly what Atul Gawande talked about in his groundbreaking book, “Complications.” Computers should not make decisions for physicians, but rather should help them reach the right conclusions, particularly when they see rare cases.

Wouldn’t you know, “e-Patient” Dave deBronkart commented on my EMR and HIPAA post to say he just finished reading Groopman’s book. He tweeted a link to my post, which a few of his 6,500 other Twitter followers noticed. They also noticed EMR and HIPAA grand poobah John Lynn’s comment that the example in yesterday’s Watson demo, a 29-year-old pregnant woman being prescribed doxycyline was “pretty weak.” (He’s right, by the way.) Aurelia Cotta, who blogs about issues such as infertility and adoption, started this thread that also got South Carolina nurse Sunny Perkins Stokes interested:

@ @ @ I can see great uses for this, but I find it funny the example they give of doxy in pg is wrong.
@AureliaCotta
Aurelia Cotta
@ @ @ because it's still using the FDA's pg categories, which are 30 years out of date. GIGO anyone. Heh
@AureliaCotta
Aurelia Cotta
RT @: @ @ @ find it funny the example they give of doxy in pg is wrong.| How so?
@sunnystill
Sunny Perkins Stokes
@ @ @ sorry to reply late--but FDA is binary, and Motherisk is risk vs reward ratio. Critical difference
@AureliaCotta
Aurelia Cotta
@ @ @ doxy is an excellent drug, and cheap. Lyme disease can cause m/c + stillbirth. What if pt needs it?
@AureliaCotta
Aurelia Cotta
@ @ @ baby teeth that have a line on them as a remote chance, might be worth the risk to a pt with no $
@AureliaCotta
Aurelia Cotta
RT @: @ @ @ baby teeth might be worth the risk to a pt with no $ ?Amoxicillin not just as good?
@sunnystill
Sunny Perkins Stokes
@ @ @ maybe to you, but what if the pt is allergic? Or they've already tried amoxicillin, and it didn't work?
@AureliaCotta
Aurelia Cotta
@ @ @ context matters is all, and I just think any sources used should be good, not "lawyer endorsed"
@AureliaCotta
Aurelia Cotta

 

Well, there’s a reason why I call myself a “healthcare” reporter and not a “medical” reporter. I don’t know the science, and I do occasionally get myself in trouble when I start talking about things like whether doxycycline is contraindicated during pregnancy. (To my credit, I did attribute the statement to IBM’s chief medical scientist, Dr. Marty Kohn.)

As I was reading the above tweets and contemplating this blog post, I came across a link to some tongue-in-cheek pushback against Watson in healthcare. An anonymous radiologist who blogs about PACS as “Dr. Dalai” compared Watson to HAL, the diabolical mainframe in “2001: A Space Odyssey.” Dr. Dalai wrote: “Watch out, boys and girls, Watson is headed to a hospital near you, and he (it?) may challenge you as much as he did Ken Jennings.” Jennings, of course, is the Jeopardy! champion whom Watson beat earlier this year.

At first glance, I thought Dr. Dalai was yet another whiny physician clinging to the status quo. But he hit on the real issue: application of knowledge. Quoting from an interview with one of Watson’s programmers, Dr. Dalai noted that the supercomputer is being loaded with all kinds of medical reference material in preparation for “learning” human physiology and ultimately gathering experience in medicine. “This isn’t fair!  If I could just take a text book, stick it up my, ummmm, brain, and have it instantly memorized, I would be whiz, too!” he wrote.

Yeah, isn’t that the whole point of clinical decision support?

June 3, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

News and notes: Cool healthcare tech, telemed pushback and more

It’s Friday afternoon, and I realize it’s been days since I’ve posted here. (Make sure you catch my posts on EMR and HIPAA every Thursday, including my latest on Dr. Larry Weed and his critiques of current health IT systems.) I think it’s time for a rundown of some interesting developments this week.

Weed apparently is not the only one who’s disappointed in the pace of change in healthcare. Dr. Bill Crounse, senior director of worldwide health for Microsoft, was at the World of Health IT conference in Budapest, Hungary, to deliver some scathing remarks at about North American health IT. According to Canadian Healthcare Technology, Crounse called the U.S. and Canada the “worst of the worst in the industrialized world in the use of IT in healthcare.”

He explained: “I see physicians in perhaps less developed countries bypassing all that legacy technology and using commodity off-the-shelf contemporary solutions, using tablets and speech recognition and doing their discharges, all with technology that costs pennies on the dollar, and then I come home to America and look at these $150 million systems and say, ‘wouldn’t we be better spending that on patient care instead of IT?’”

EMRs just store health information, Crounse said. “It’s really what you do next that counts. Once we have information digitized, that doesn’t buy you value. It’s what you do with the information, how you use it to manage care, and to collaborate.”

While we’re talking about overseas events, Hello Doctor, a telemedicine service in South Africa, apparently is on hold less than a month after its April 17 launch. In an e-mail newsletter (not available on the Web, as far as I can tell), Telemedicine & E-Health reported:

Under fire from South Africa’s healthcare bureaucracy, Hello Doctor has suspended its telemedicine services, pending a meeting between representatives of the company and the Health Professions Council of South Africa (HPCSA). The council referred to its undesirable business practice committee Hello Doctor and two companies that have announced plans to offer a joint telemedicine service later this year, MTN Group and Sanlam. HPCSA has alleged that the companies violated rules that require a healthcare practitioner to do a physical examination and assess a patient before a diagnosis can be made. [News Alert, May 6 ]. HPCSA is drafting its own guidelines for telemedicine, an emerging competitor to nationally-licensed doctors.

The South African Medical Association also is fighting the service. “”It is no different from blind-dating. How sure are you whether you are getting the real doctor or not?” SAMA Chairman Dr. Norman Mabasa told Independent Online. Hmm, aren’t these the same kinds of objections we see in America? When will the medical establishment wake up and see that telemedicine is not a threat to their authority?

Well, at least some physicians are embracing new technologies. That’s the subject of a feature I just had published on Medscape,  “10 Totally Cool and Incredibly Useful Medical Gadgets: Technology That’s Changing Medical Care.” Feel free to argue with me and add your own.

And speaking about telehealth and arguing with me, I was the victim of intimidation of the media this week. A certain story I wrote about a telemedicine technology vendor was pulled from the Web yesterday after the company threatened to sue the small company that published it. The company accused me of writing a “defamatory” story and wondered if a competitor didn’t actually help me write the piece. Sorry, but I have a lot more integrity than that. I also was accused of mischaracterizing the state of the deactivated ambulance telemedicine service in Tucson, Ariz., which I said was “failed.”

The accuser referred to an April article in Telemedicine & E-Health written by Dr. Rifat Latifi, one of the driving forces behind Tucson ER-Link, and several colleagues that showed the efficacy of ER-Link in performing remote intubation. That’s great, but there needs to be a working network to support the “videolaryngoscope.” Tucson, unfortunately, no longer has one.

 

May 20, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Blogging by Twitter?

Oh man, I’ve been busy. I filled in as writer of the Midwest edition of Payers and Providers the last two weeks because regular editor Duncan Moore, a former colleague, had been hospitalized. (Get well soon, Duncan.) I’ve been at the Institute for Health Technology Transformation health IT summit in Fort Lauderdale, Fla., since yesterday, and I’ve also had my regular deadlines for InformationWeek and MobiHealthNews.

I moderated two IHT2 conference sessions yesterday, on how health IT underpins Accountable Care Organizations and how business intelligence can create a framework for health information exchange. I haven’t had time to blog about those, but several people seem to have tweeted during those sessions. I therefore present a rundown via Twitter.

@narmi91 #iHT2 FMA #HIE strategy: Simple HIE gives physicians instant value, allows them to dip their tow in the water.

@narmi91 #iHT2 #HIE strategy: Adopt exchange before adopting #EHR. Which would you choose Internet (HIE) or PC (EHR)?

@narmi91 #iHT2 #HIT for #ACO: Primary care medical home is a must for ACO. Paying patients to perform. Also focus on medical assistants & nurses.

@narmi91 #iHT2 #HIT for #ACO: Changing patient behavior: need to engage patients. BCBS has new benefit plan $300-700 cash for manage health and qual.

@narmi91 #iHT2 #HIT for #ACO: Fed/state gov are more on the side of privacy but security always comes down to human behavior.

@narmi91 #iHT2 #HIT for #ACO: Pace of tech adoption in healthcare is much slower than other industries: Privacy & security, care coord, social sci.

@ICALeader Dr Freeman says healthcare is more focused on quality assurance than quality improvement, need multi-disciplinary groups to achieve QI #iHT2

@narmi91 #iHT2 #HIT for #ACO: Quality improvement process can help identify clinical decision support.

@narmi91 #iHT2 #HIT for #ACO: Victor from HRSA – HIE challenges include security issues and not enough discrete data. Most #EHR not designed for qual

@ICALeader Kevin Mather says upside & downside risk must be high & metrics must be measured for quality & cost monthly for ACO success #iHT2 #HIE #ACO

@ICALeader Dr. Freeman reminds #ACO & #HIE not to forget federal healthcare DOD, VA & IHS agencies in effort to coordinate care @ #iHT2 FTL

@bhparrish: Patient-centered #HIE with secure communication will be essential infrastructure for #ACO development. <RT @ICALeader> #iHT2


May 11, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

My week in review

Since I’m starting to write a lot of daily/breaking news, I’m going to try something new today that might become a regular Friday feature: posting my week in review. It will consist of a quick rundown of stories I’ve written this week. Here goes:

Monday

“Patient Safety Initiative To Leverage Health IT: The $1 billion federal Partnership for Patients initiative aims to cut $35 billion in healthcare costs, save 60,000 lives, and decrease hospital-acquired conditions by 40% by 2013.” (InformationWeek)

Tuesday

“Medicare Opens EHR ‘Meaningful Use’ Attestation” (InformationWeek)

“How mobile health can abide by HIPAA” (MobiHealthNews)

“State of mobile and wireless healthcare” (video/slides of my recent presentation to Meharry Medical College)

Wednesday

“CMIOs to begin testing BlackBerry PlayBook” (MobiHealthNews)

Thursday

“More Unrealistic Expectations From the Public, This Time Involving CDS” (EMR and HIPAA)

 

I’ve got another InformationWeek story to crank out this afternoon that may or may not get posted until Monday, and a podcast in the works, too. Bring on the weekend!

 

April 22, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

CDS commentary on EMR and HIPAA blog

I’ve just written my first post for the well-established EMR and HIPAA blog, one of the flagship sites for the Healthcare Scene network. (This site belongs to Healthcare Scene as well.) My post is a commentary about public perceptions of clinical decision support and a critique of failures by health IT developers, the healthcare industry and the media to design easy-to-use technology and communicate the purpose of CDS to the public. I’ll be writing weekly for that site, usually on Thursdays.

I quote Dr. Larry Weed in that post. If you want more on this pioneer in health informatics and healthcare quality, check out some of my previous posts and stories about him:

April 21, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Heritage Health Prize launching next week

Just a reminder, the $3 million Heritage Health Prize competition will kick off on April 4. Sponsored by the Heritage Provider Network in Southern and Central California, the competition is meant to promote innovation in predictive modeling and clinical decision support, with the goal of helping physicians develop care plans to keep high-risk patients healthy and out of the hospital.

In a story I wrote for Inside Healthcare IT (formerly Inside Healthcare Computing) in January, I explained that HPN will provide contestants with three years worth of de-identified claims data on 100,000 patients, from which they are expected to develop algorithms to identify high-risk patients. “We’re looking for an algorithm to allow us to predict, based on a person’s history, the likelihood of a person’s hospitalization over the next year,” HPN legal counsel and executive Jonathan Gluck told me.

March 27, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Slams on Berwick are getting pathetic

The slams on Dr. Donald Berwick, frankly, are getting pathetic.

Today, Fox News medical contributor Dr. Marc Siegel dismissed Berwick as a “basically a policy wonk” who “hasn’t really practiced since 1989.” Siegel tried to score points with sound bites. “This guy has more quotes than Yogi Berra, and let me tell you something, these quotes are an indictment on people that want clinicians to make decisions,” Siegel said on Fox this afternoon.


According to Siegel, comparative effectiveness “doesn’t work in the real world.” Well, sure, that’s the point of clinical decision support. Best practices are for common conditions, and clinical decision support is to help physicians either follow best practices in the case of common conditions or, just as importantly, diagnose and treat ailments that they don’t often see. (Read Dr. Atul Gawande’s best seller,  “Complications,” for a description of the chaos that ensues when physicians see rare cases.)

Fox News anchor Megyn Kelly tried to feign fairness by saying of President Obama’s recess appointment that installed Berwick as CMS administrator last year, “lots of presidents do it.” But she later said that that Berwick “loves” the British National Health System, trying to paint Berwick as a socialist. Once again, this isn’t about socialism or capitalism or any other ism that has unfortunately been the focus of “health reform” in this country. It’s about trying to improve the quality of care. (It’s not about insurance, no matter how many politicians or pundits say so.)

Defending Berwick was Dr. Cathleen London, a family practitioner at the Weill Cornell Iris Cantor Women’s Health Center in New York City. London took issue with Berwick’s opponents relying on sound bites to make their thin arguments. (Siegel smugly laughed this off.)

When Kelly again tried to tie Berwick to the NHS, London said, “He likes that we do evidence-based medicine, that the British have NICE that actually oversees what the NHS should cover and shouldn’t.” Yes, the British National Institute for Health and Clinical Excellence (NICE) is an independent advisory board that helps the NHS make coverage decisions. You know, the same way any insurance system, public or private, has to decide what and what not to cover.

To his credit, Siegel praised Berwick’s work at the Institute for Healthcare Improvement for helping to reduce deaths in hospitals. “He’s apparently very well liked among patient safety advocates,” Kelly added.

London noted that former CMS Administrator Tom Scully, a George W. Bush appointee, is a fan of Berwick. Still, Siegel continued on his argument that comparative effectiveness is restributive in that it takes healthcare away from some people. “You’re not going to be able to pay for very expensive care,” Siegel said.

Why exactly would we want very expensive care in cases where less expensive but equally effective treatments are available? Is it because of the public perception that more expensive care automatically means better care? It sounds like Siegel is either trying to perpetuate that myth or protect the profits of pharmaceutical and device manufacturers. But then he made the salient point that “insurance is overused” and that healthcare reform, which he derides as “ObamaCare,” did little to address that problem.

All that says is that both sides of the political debate are wrong, and the Senate Democrats are cowards for not standing up for better care.

March 23, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

On the road to meaningful use

If you follow my Twitter feed, you know I had a little accident early Wednesday morning during the just-concluded HIMSS conference. I stumbled into the bathroom in my Orlando, Fla., hotel room in the dark about 6:30 a.m., did my business, then turned to my left to use the sink. Unfortunately, the sink was not to my left. I fell down and hit my face against the edge of the bathtub and immediately started gushing blood.

It took a while, but I mostly got the bleeding stopped with the help of some towels (I’m sure the cleaning

The result of my clumsiness

The result of my clumsiness

staff wondered if I had murdered someone), ice and, courtesy of the front desk, moist towelettes, antibiotic ointment, gauze pads and surgical tape.

The clerk at the front desk offered to call an ambulance to get me to an ER. I have a high-deductible health plan, so this early in the year, I’d have to pay the hefty bill entirely out of pocket. I wasn’t going to die from a cut just above my eye. Fortunately, there was a Walgreens right across a parking lot from the hotel, so I was able to get some other first-aid materials to clean the wound and completely stop the bleeding.

After going back to sleep for a couple hours, I got myself over to the convention center around lunchtime, still wondering if I needed to get the cut checked out. This being HIMSS, there were plenty of clinicians around. I happened to be in a session where HIMSS Vice President Pat Wise, R.N., and Chicago medical informaticist Lyle Berkowitz, M.D., were present. They both recommended I get medical attention as soon as possible. (Too bad nobody carries suture kits to IT conferences.)

With the help of Google Maps on my BlackBerry, I found two options: a hospital 0.7 miles south of where I was in the convention center or a walk-in urgent care clinic 0.9 miles north. The single review connected to the clinic listing said it wasn’t worth it, go to a real hospital instead. Again, though, I have a high-deductible plan and this wasn’t a life-threatening injury. Having followed this industry closely for more than 10 years, I think I have more realistic expectations of how a healthcare consumer should behave. I chose the urgent care clinic.

Rather than waiting hours in an ER, I was in and out in about an hour with six stitches slightly below my eyebrow. Instead of a $300 (minimum) ambulance ride plus who knows how many hundreds—if not $1,000 or more—for ER services, I got there for $7 in a taxi. This clinic, which doesn’t accept insurance as a way to keep costs down, charged $55 for the visit (after a $20 coupon that I didn’t know about until they volunteered it), plus a couple hundred for a physician assistant to clean and stitch up the wound.

This clinic was in an aging, shabby strip mall not far from the tourist traps and second-class chain restaurants of International Drive. It seemed like a typical, old-fashioned, paper-based practice. I filled out my medical history and presenting condition on the hated, ubiquitous clipboard, then sat down in the waiting room, surrounded by outdated magazines. Shortly thereafter, a nurse brought me back into an exam room, took my vitals and got everything ready for the PA to fix the cut.

After the stitching, I was pleasantly surprised to learn that the practice wasn’t so stuck in the past after all. The PA ran my credit card, then told me to sit tight for a few minutes while he documented my case so I can take a report back to my own physician when I get the stitches removed next week. He sat down at a computer and started typing away. About five minutes later, I was handed a printed, detailed, discharge summary.

That’s right, this practice, that seemed old-fashioned on the surface, had an electronic medical record (I didn’t catch or bother to ask who the vendor was). Since the practice doesn’t accept Medicare, Medicaid or any other insurance plans, it’s not eligible for federal EMR incentive payments, but it probably wouldn’t qualify for “meaningful use” anyway since it’s not totally electronic. I didn’t see any orders entered electronically (though they still may have been), nor was I offered the option of receiving the clinical summary electronically. I think they ran the lidocaine they ordered as a topical anesthetic through an interaction checker to make sure it didn’t contain any sulfa, which I had indicated I’m allergic to.

I imagine this is where countless thousands of small medical practices are on the road to meaningful use. They have some elements of an EMR that fit existing workflow, but nothing comprehensive and no interoperability. I’m glad the summary was at least typed so there won’t be any issues with handwriting when I go to my regular internist next week. I’m also happy they checked for drug-allergy interactions.

Score two points for patient safety and one more for consumerism. I’m confident I got the right care for a reasonable cost, and that I’ll recover quite nicely.

February 25, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Clinical decision support and meaningful use

Before I forget, here’s a link to a feature story I wrote for the March issue of CMIO. It’s about how to decide on which rules to build clinical decision support for when going for meaningful use.

March 12, 2010 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Answering the mail

I have to admit I’m shamefully behind on blogging this week. Between the AMA House of Delegates meeting, deadlines for FierceMobileHealthcare Tuesday and FierceEMR Thursday, plus a dentist’s appointment thrown in for good measure, I’ve been too busy or too tired to post here. I also submitted an entry for the BNET Healthcare blog, but it hasn’t been posted yet.

Meantime, I’ve left some people hanging.

While I was on the air with news anchor Andrea Darlas of WGN-AM 720 in Chicago to discuss President Obama’s speech to the AMA, I promised this link to a story about a high-schooler in Washington state who correctly diagnosed herself in science class with Crohn’s disease after doctors were stumped for years. Folks, this is why we need clinical decision support.

Fellow blogger Lodewijk Bos of the Im-Patient blog commented that he would like to see examples of the paranoia I observed at the AMA meeting. OK, but I have to link you to commentaries I wrote elsewhere, for FierceMobileHealthcare and FierceEMR. I humbly offer my “The audacity of ‘nope’” headline from the latter commentary for the Headline Hall of Fame.

Tonight, “Anonymous,” my biggest fan, left a comment asking where the proposed definition of meaningful use is. It’s right here, my friend. Actually, that page contains instructions on how to comment on the proposal. Scroll down for links to the preamble, a matrix of the proposed requirements and the CMS backgrounder on Medicare and Medicaid health IT provisions in the American Recovery and Reinvestment Act.

June 18, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.