Category: SOS Blog

Clinical Decision Support: Is Watson up to it?

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Are you a Jeopardy fan? If you are, I am sure you know that in January of 2011, IBM’s supercomputer, Watson beat two of Jeopardy’s all time money winners, Brad Rutter and Ken Jennings. Watson is an Artificial Intelligence that can understand questions posed to it in natural ‘human’ language.

WellPoint, a BlueCross collaboration, is the largest provider of health benefits in the country. Their plan is to utilize Watson to sift through their patient databases to make diagnosis and treatment recommendations to WellPoint physicians.

This idea is not at all far-fetched and certainly a reasonable way for IBM to make some money off their huge research and development investment in Watson. They have also purchased some other companies that position them well for movement into the medical sphere.

Over the last four years, IBM has spent more than $7.8 billion to acquire database analytics specialists Cognos and SPSS, both formerly public, as well as data warehouse company Netezza, along with other private companies. In the first half of 2011, IBM spending on research and development exceeded $3.15 billion.
—International Business Times, 9/19/2011

What WellPoint is proposing to do is a starting point for a task all EMR’s will ultimately need access to and participation in. In order to meet the requirements for ARRA stimulus funds, eligible providers will need to utilize their EMR’s to help them make clinical decisions.

Clinical Decision Support (CDS) is a process whereby the physician gets notices and alerts from their software to assist them in making clinical choices that are based on data and evidence rather than memory and intuition. The Centers for Disease Control and Prevention (CDC) hopes to see public health organizations utilizing population data and statistics to guide their choices. They believe this will be one of the most impactful effects EMRs can offer the public health. The Office of the National Coordinator for Healthcare IT (ONC) wants to see individual physicians using Clinical Decision Support to advise their patients. Clearly, WellPoint plans for this level of intervention: physicians will have access to the data Watson can provide to assist them in making diagnoses and recommending treatments.

We talked in this blog about some of the potential benefits of CDS back in 2009. Since then, research on the benefits of supported clinical decision making has continued. A Google Scholar search of ‘decision support emr’ results in 16,800 hits. There have also been noted some shortcomings, most notably a phenomenon called ‘alert fatigue‘, wherein a provider gets so many alerts and notices that they stop attending to them or turn them off altogether. Obviously, we have lots to learn about how to present information to healthcare providers so they can use it most effectively for the benefit of their patients. WellPoint has decided to dive right in!

What do you think about being diagnosed by a computer? Will it be more effective or less so? What is the relevance of CDS for behavioral health?

Please share your thoughts below.

 

PHRs, EMRs, Data Security and Other News

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Last week I asked you if you were using a Personal Health Record (PHR). I got only one response…from a college friend who is a technical writer. John is involved with a PHR company called medkaz. This company believes that all electronic medical records should be driven by and owned by the patient. Accordingly, they have developed a thumb-drive based product that the consumer will carry around with them. It is fully encrypted, so the privacy of the patient is guaranteed.

I believe the idea is that the patient will bring their personal record with them when they visit a doctor. The doctor can download relevant information of the patient’s choosing into their own electronic medical record (EMR) system. At the end of the visit with the patient, they will upload their note onto the patient’s thumb drive. The doctor can subscribe to this system themselves, but even if they do not, they will be able to use the patient’s information. This is one way to make sure that the people treating you have the most current medical information about you.

Over the course of the last few weeks, the reason for concern about what information health systems have and how they manage it again came into the public light. The Stanford Hospital in Palo Alto, CA reported that 20,000 records of emergency room patients had been revealed online by their collection agency…one of their Business Associates. The information had been posted on a web site for just short of one year. One of the affected patients saw the posting of the information and reported it to Stanford Hospital and Clinics.

According to IDExperts, there is good reason for concern about the security of medical data. The street value for a stolen medical identity is $50. Using that information, a Medicare or Medicaid or other insurance fraudster can file claims for services never provided….and often get paid.

In other news this week, the White House has proclaimed September 11-16, 2011 to be National Health Information Technology Week. The purpose of the proclamation is to call attention to and educate the citizenry of the benefits of and need for Health IT that will protect the privacy of the patient and involve patients in their health care.

Finally, the Office of the National Coordinator for Health Information Technology (ONC) has announced their new website, HealthIT.gov, designed to become the leading national resource on health IT for both consumers and health care professionals. The goal of the site appears to be to encourage personal responsibility for one’s health and health care through wise use of technology and coordinated efforts with one’s providers.

It was a busy week! Is there news you would like to share?

 

EMRs, PHRs, Patient Portals…and your privacy

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In August, the National Coordinator for Health IT, Dr. Farzad Mostashari, spoke about the need for a ‘targeted strategy’ to involve consumers in eHealth. He is concerned that all of the efforts being expended to acquire EMRs and for eligible providers (EPs) to achieve meaningful use of those EMRs must become more patient-centered.

One provision of the meaningful use requirements that will become increasingly important is the need to be able to provide an electronic version of the medical note to the patient. While there are a variety of ways by which this can be accomplished, Personal Health Records (PHRs) and Patient Portals into the provider’s EMR are two.

My own insurer provides a PHR on their website. I can enter lots of personal information about myself and my health if I choose to do so. Superficially, it appears this information can be accessed only by me, but I do not believe this is the case. The insurer can likely access the information too. Since it is mostly info they can get from my claims (and the claims history is available on the page), I am not too concerned about it, but I have been somewhat careful about entering things. If I were not pretty healthy, I think I would enter nothing.

The PHR to which I have access is a proprietary one. In August, Google removed their hat from the ring by discontinuing Google Health as a service effective January 1, 2012. Microsoft is well-entrenched in the healthcare arena, so I believe they will keep their product, Microsoft HealthVault, around. I wonder of what use these will be until providers can send information to the PHR for the patient.

For the last few weeks, I have been working with our web designer on re-writing our website. Now that so many people access the internet from their smart phones, we want to be sure the site works well on mobile phones and tablets. This focus has me wondering about a few things. I hope you can clear up some of these for me.

  1. How many of you use a PHR?
  2. Do you feel secure storing your personal medical information online?
  3. Do you use a smart phone for email?
  4. If so, for what other purposes do you use the smart phone?

I am hoping I will get some comments and responses from you. I wonder how many of you feel comfortable with the speed with which our lives are moving into ‘the cloud’.

Please jump in now. This inquiring mind really wants to know!

Creativity: Running out of ideas…

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I have been struggling with a topic for this week’s blog. The only thing that has come across my path that feels compelling is the hummingbird who showed up at our coral honeysuckle on Sunday. Unfortunately, integrating that ruby throat into my article does not seem like an easy task.

Sometimes, I feel like I have run out of ideas. When that happens, I am reminded of feelings I experienced as a child and young adult. I knew I was not an artist and felt myself also to be not creative.

It took many years before I learned that my creativity takes forms different than that of artistic individuals. At some point in the process of doing psychotherapy with some very difficult clients, I realized that most of my creativity takes the form of what I will call creative alternativism. Generating possibilities…especially possibilities for different types of behavior and different kinds of thinking…was the primary manifestation of that creativity. Helping my clients find different ways to be in the world in order to overcome their pain and problems was the most important way I expressed that creative urge.

I have since realized that I often apply that process to myself as well. Since I can be a pretty rigid person when it comes to my own thinking and behavior, I have found that I need to make systematic efforts to implement the alternatives I generate for myself. I may well come up with many ideas about how to change my behavior, but I need structure to implement those changes.

Three years ago, I knew that adding yoga into my fitness efforts would benefit my arthritic joints and relieve some of my stress. Signing up for a yoga class was the structure that allowed me to make that a regular part of my activities. After three years, I have found other structures to help me extend that one class to two and now into a daily practice. I need and use structure to implement the possible changes I creatively generate for myself.

I had an email this week from a colleague I have not seen in years. I was delighted to learn that for the past year, she has been painting! At age 60, she took a pastels class at her local community college. She was hooked on the medium and has found a new outlet for her creativity. In my experience, she has always been creative. She has been a psychologist and psychotherapist for her entire professional life. She has researched and written and published…an aspect of her professional creativity; and now, she paints!

I am delighted to know that a new aspect of creative expression can manifest itself at any age, as long as we are open to it.

How do you express your creativity? Do you manage to do this within your professional life? Does the place you work benefit from your creative endeavors, or is it just for you?

Please share your thoughts about creativity, regenerating it, and keeping our lives…and blog topics…fresh.

UCLA and WellPoint Fined for Data Breaches

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I am sure many of you remember the reports dating back to 2005 that celebrity patient files were being viewed by casual lookers…employees who had access to the University of California at Los Angeles (UCLA) Health System electronic medical record (EMR) but who had no legitimate reason to view those records. Well, the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has entered into an agreement with UCLAHS to settle potential HIPAA violations for $865,500. Additionally, UCLA has made a commitment to correct gaps in their security, to improve their policies and procedures to better safeguard patient information, and to adequately educate their employees.

In a separate case, FierceHealthPayer reported that WellPoint will pay $100,000 to the state of Indiana because they waited several months before notifying Indiana officials of a security breach that could have exposed the data of 32,000 members.

It also will reimburse each affected member up to $50,000 for any breach-related losses as part of the settlement reached with the Indiana Attorney General.                                                                  [Read more; Subscribe]

For me, the important issues here are the following:

  • OCR is serious about data breaches and safeguarding patient protected health information (PHI).
  • State laws are just as important as Federal law. You must know and follow those local regulations as well as HIPAA and HITECH.
  • The cost of a data breach is significant and would put many small provider organizations out of business.

Have you reviewed your security and privacy practices and policies this year? Are you confident that your PHI practices are solid and that your employees are using the procedures as written? How do you review these and how do you educate your employees?

Please share your experiences and concerns about data privacy and security with us below.