IEEE and Personalized Health Informatics Standard

IEEE KICKS OFF WORK ON PERSONALIZED HEALTH INFOMATICS STANDARD WITH MEETING IN LONDON

http://standards.ieee.org/announcements/pr_P2407_wg.html

"PISCATAWAY, N.J., USA, 3 January 2007 The IEEE has begun work on a standard to create a comprehensive personalized health informatics system that will give individuals a set of easy-to-use Internet tools to can help them stay healthy and improve their health. The working group creating this standard will hold a workshop in London, UK, on 24 and 25 January 2007 to form an action plan for developing the standard. ...

...The workshop is open to all professionals interested in helping to develop IEEE P2407™, “Architecture and Framework Reference Implementation for Personalized Health Informatics (PHI)”. IEEE P2407 will create an Internet-based system that places the individual at the center of a broad set of services designed to enhance health. This health-improvement system will encompass nutrition, environmental issues and other health information and help individuals manage all relationships that influence their health."


Information about the standard is available at http://www.ieee2407.org/.

Into the New Year

Hospital CIOs across country tackle demanding projects in 2007

"As 2007 dawns, CIOs at healthcare organizations across the country are gearing up for major IT revamps. They run the gamut from rolling out new clinical systems, installing new servers, and boosting wireless capacity. Some organizations are planning new facilities, and the new construction, in turn, is spurring new IT – across campus."

There's talk of "the need to leverage information systems to automate paper-based processes to reduce the risk of medical errors and improve patient care and safety, while simultaneously improving department workflows to reduce costs."

2007. Year of change, year of more costly migrations, or a year of true innovation?

Synergy in Medicine

There have been some very interesting developments in the overlap between biotech and medicine in recent days. First this report on the Department of Health and Human Services:

"HHS team tackles genetics, EHR integration"

The Department of Health and Human Services is launching an effort to integrate genomics into clinical information systems so that a patient’s genetic makeup can be considered in preventing, diagnosing and treating disease.

HHS Secretary Mike Leavitt said he has “put together a team that is working together across HHS,” with representatives from the National Institutes of Health, the Food and Drug Administration, the Centers for Medicare and Medicaid Services and other health agencies.

Innocuous enough -- fairly interesting and quite timely. Then, this week:

"Americans Share Nobel Prize in Medicine"

NEW YORK (AP) -- Two Americans won the Nobel Prize in medicine Monday for discovering a way to silence specific genes, a revolutionary finding that scientists are scrambling to harness for fighting illnesses as diverse as cancer, heart disease and AIDS.

Andrew Z. Fire, 47, of Stanford University, and Craig C. Mello, 45, of the University of Massachusetts Medical School in Worcester, will share the $1.4 million prize.

They were honored remarkably swiftly for work they published together just eight years ago. It revealed a process called RNA interference, which occurs in plants, animals and humans. It's important for regulating gene activity and helping defend against viruses.

Great news! But wait -- there's more! Later this week:

"American Wins Nobel Chemistry Prize"

NEW YORK (AP) -- Nearly a half-century after his father was awarded a Nobel Prize, a Stanford University professor won his own Wednesday for groundbreaking research into how cells read their genes, fundamental work that could help lead to new therapies.

Discoveries by Roger D. Kornberg, 59, have helped set the stage for developing drugs to fight cancer, heart disease and other illnesses, experts said.

At a press conference, Kornberg said the immediate application of his work is in making better antibiotics for diseases such as tuberculosis. ''There will be specific cures for several
diseases in the next decade,'' he said.

Wow! Great news again! Especially for Stanford, which seems to be hosting a lot of Nobel activity these days. Interestingly enough, work recognized for both the medicine and the chemistry prize was done in the past ten years, a relatively short "marinating" time in Nobel Prize terms.

Great news but a little eerie as well. Genomics for clinical and medical applications is a pretty well-established business already -- but why all this interest all of a sudden?

I think it's synergy. These are exciting times for healthcare IT. We're moving way past worn-out debates about EMR's and whether physicians, patients, and providers ought to be networked in a Web 2.0 world. This is really progressive IT stuff, the stuff that innovations are made of. The synergy is between information technology and bioinformatics, leading to a brave new world that those two disciplines will foster. If you have any doubts, check out initiatives such as the Personal Genome Project. That's just the tip of the iceberg.

Medicine will never be the same.

Mediconomics

Just finished reading Andy Kessler's recent book (July 06), The End of Medicine. The book got a lot of well-deserved press. "Entertaining," "smart-aleck," "captivating" -- a business book with a great story. Here's what Kessler says it's about:

I spent the last several years following doctors around, digging around research labs, going to imaging conferences and getting myself poked, prodded and scanned. And I hate the sight of blood, what was I thinking? In the end, it really comes down to finding silicon so diagnostics can get cheap enough for insurance companies and Medicare to make it mainstream.

Here's what I say it's about:

More than a story, more than a quest for the next great leap in healthcare technology -- this is about "mediconomics," the secrets that the medical profession and the pharmaceutical industry are keeping on the costs of care and profitability of outcomes. (...In My Humble Opinion) Healthcare IT and frontier healthcare technologies (diagnostics, prevention, nanomedicine) will open up a radically new world of possibilities for preserving health and preventing disease. Unfortunately, current economic incentives in the healthcare industry instead promote chronic care to ease us out of disease states we probably never needed to get into in the first place.

Going for a checkup

Going to the clinic for my annual.

Hand the agent my insurance card. Hand the agent my credit card. Verify the appointment, transact the co-pay. Walk upstairs, fill out the top line of the form on the clipboard ("no change since last year"), ignore the rest of the request for history. Doc comes in, stethoscope, BP, pulls out PDA for a med check, signs scrip & blood order, shakes hand, bye bye. Two weeks after blood stick, lab results paper copy (the green one -- the canary one stays with my chart, I think) arrives via snail mail at my home. Note scribbled on it "you're fine."

Now rewind.

Let's start at Step 1: "Hand the agent my insurance card." The agent sits in front of a screen. The agent's machine is hooked to the Internet. Matter of fact, at every station in my journey through the clinic, there's a machine, maybe three, hooked to the Internet. Some, like my doc's device, are wireless. How about instead of handing the agent my (laminated paper) insurance card, I hand the agent the URL to my PHR. I negotiate with the agent to make my "personal" health record temporarily my "public" health record, within the confines and guidelines of this particular visit. One negotiated as such, you'll notice that my PHR becomes a clear, succinct, effective mediating agent of its own to guide me along my clinic path (or, more to the point, to guide the medical professionals providing me care along my treatment path). Clean, secure, private, and trackable.

All I have to do, starting at Step 1, is insist that they launch my PHR -- or, no co-pay. Heck -- stick your URL on your cell phone and beam it over to all those agents along the way. It would help if I could get my payer to set up our mutual PHR -- our "Partner Health Record." Seems once you reach critical mass -- that point at which more people are handing over URLs instead of laminated paper -- the providers will be gently influenced into accepting this type of treatment flow. No PHR, no pay for service.

All I have to do -- all we all have to do -- is insist.

IT 101

It's rather interesting what passes for IT these days. "Healthcare IT" seems to refer to Microsoft Azyxxi, EMR's, health information exchange certifications, and telemonitoring from patients' homes all in the same breath.

So far, I think people think "healthcare IT" means a "monolithic on-premises application, derived most likely from MUMPS, that's HL7 compliant and too expensive to port to physicians' offices unless it's Vista in which case it's probably free but has shall-we-say a learning curve." Somewhat like the situation not too long ago with products and vendors such as SAP for ERP in the manufacturing field.

In manufacturing, market forces and the steady progression of real IT shaped the acceptance and use of a wide variety of products and systems to manage business processes. And still the major players came out ahead -- primarily because they were agile and because the business of IT supporting business is serious business.

Insofar as healthcare IT is at a crossroads today similar to that when mainframes went client/server, and again when client/server went web (and now that portals are going Web 2.0), it's probably a good idea to review the basics -- IT 101, as it were -- of what constitutes information technology, its adoption, and its evolution for a particular industry. For now, we see, the business of IT supporting the business of healthcare is serious, serious business.

Here's my hierarchy of information technology support levels for an organization:

• Infrastructure
• Applications
• Processes
• Technology
• Customer Service

Infrastructure support provides the "basal metabolism," as it were, for IT functions that are pretty much common across all industries.

Support for Applications addresses the differentiators that are important to healthcare to serve functions for service delivery (electronic medical record, imaging systems, patient bedside monitoring, CPOE, the standard stuff).

Support for Processes refers to the true purpose of IT implementation -- namely, effective use of technology and evolution of that effectiveness to help ensure that business processes succeed in their intended goals. (What is the business of a provider organization? What processes serve the business? What IT applications, and sequencing of those applications, ensure the success of those porcesses in serving the business?)

Technology support paves the way for agile, innovative "invocations" of the organization's fundamental business processes. As the technology grows and matures, so do the processes and their results improve. (What's the measure of improvement? Cost? Quality? Profitability?)

And finally, Customer Service rests at the pinnacle -- that is the true business of healthcare, is it not? and the true target of IT support for healthcare business processes.

There's a particular reason I find this hierarchy really helpful: when you look at IT this way, you can start to identify separate metrics for the different levels that let you assess the performance of your IT implementation choices based on the business performance they target. For example, try these measures for analyzing your IT systems, and for analyzing how they associate with measures of your business systems' performance:

• Infrastructure: Reliability, Efficiency
• Applications: Cost, ROI, Availability
• Processes: Effectiveness, Efficiency
• Technology: Cost-of-Conversion, Earned Value
• Customer Service: Responsiveness, Quality-of-Service

This way you can begin to understand the components of your IT installations, and begin to compare accurately the value and effectiveness of different implementations (systems, technologies, processes) that the IT organization serves. Now there's a way to measure business performance...

Patient Flow - OR in Healthcare

OR/MS Today recently published a good overview of an important Operations Research application in healthcare: Patient Flow: The new queueing theory for healthcare. The author, Randolph Hall, leads a progressive systems engineering group at USC, with research in queueing theory focusing on modeling, simulation, analysis, and optimization. Here is a general assessment from the article of how useful those techniques can be in a healthcare setting (large urban county hospital):

Healthcare systems can be changed for the better through a strategy that combines participation and creativity. But change cannot be sustained without vigilance and without analysis based on data. Herein lies the opportunity for the O.R. community. For instance, the O.R. community can work with hospital clinicians and administrators in these areas:

• Process modeling to ascertain how patients are currently served, to determine where inefficiencies exist and to prioritize future changes. Process modeling can reveal unnecessary repetition, miscommunication, and inconsistency in methods.
  
• Simulation modeling both to evaluate new processes and to understand and demonstrate the current causes of delay. For instance: simulating delays before and after, implementing a new appointment system, changing the methodology for assigning patients to beds, or implementing an electronic patient record system.
  
• Optimization can be used in many aspects of system design, such as scheduling nurses, scheduling operating rooms or facility layout.
  
• Queue analysis is invaluable when executed on a real-time basis to highlight the delays currently experienced throughout a hospital, and to make this information available to all key decision-makers, so that they can better understand delays both upstream and downstream, and act on these delays through reallocation of resources and appropriate prioritization of patients.

Queue analysis in this context is a springboard to other "downstream" optimization methods based on simulation, such as finite-horizon integer programming methods mentioned in the article for analyzing effects of surgery demand on hospital length-of-stay, or capacity analysis / revenue management methods and how these are specialized in the healthcare setting. The point is that these methods are now mainstream in a lot of service areas, and should be made so in healthcare analystics as well.