health information technology


Take Two Aspirin And Download This App (At Your Own Risk)

Don’t be surprised if one day soon your doctor ends an appointment saying, “Here’s a prescription for a drug that will help, and download this app.”

Medical apps are turning our phones and tablets into exercise aides, blood pressure monitors and devices that transmit an EKG. But the proliferation of apps is way ahead of tests to determine which ones work.

Christine Porter is hooked on the My Fitness Pal app.

Christine Porter posts food, drink and exercise infofmation to her health app every day and says she's almost always honest. (Martha Bebinger/WBUR)

Christine Porter posts food, drink and exercise infofmation to her health app every day and says she’s almost always honest. (Martha Bebinger/WBUR)

In October, after deciding to lose 50 pounds, Porter started recording everything she eats or drinks and any type of exercise she does.

“It’s telling me I have about 1,200 calories remaining for the day,” Porter said. She took a long walk at lunch and built up some calorie credits so she wouldn’t have to skimp so much at dinner.

Porter heard about the app from her health coach at the Ambulatory Practice of the Future, a primary care clinic for Massachusetts General Hospital employees.

“I usually give patients a choice of several apps that might help them,” said health coach Ryan Sherman. “Some patients won’t even look at them and then others might say, ‘Oh, yeah, this could work for me.’ ”

Increasingly, Sherman says, patients are coming in, pulling out their phones and asking, “Hey, have you seen this one?” The options are both exciting and hard to manage.

“There’s a new one every day so it’s trying to keep up with that,” Sherman said. “And if there’s not one place to look that can be hard.”

Which is one reason doctors at this Mass General clinic are suggesting — but not prescribing — apps. It’s hard to know which of the roughly 40,000 choices work.

Experts who are trying to figure out which apps are safe and effective generally separate them into two categories: those that actually turn your phone into a medical device and everything else. Continue reading

Trying To Get Excited About Mass. Health Information ‘Golden Spike’

(Wikimedia Commons)

I try to keep my Dogs of Snark reined in, but I was just so helplessly baffled by the state’s “Golden Spike” event yesterday that I asked an expert on health information technology for a scathing comment. The reply: “I think it reflects the abysmal state of low expectations given the thin gruel served up by current health IT.”

Let me stipulate: What happened yesterday — the official opening of a state Healthcare Information Exchange that’s being likened to the golden spike that launched the intercontinental railroad — is surely a wonderful thing. It should become far easier for hospitals and doctors to share medical information. Dr. John Halamka blogs on his Life As A Healthcare CIO that state history was made:

“At 11:35 am Governor Deval [Patrick] and his physician sent the Governor’s healthcare record from Massachusetts General Hospital to Baystate Medical Center. It arrived and was integrated into Baystate’s Cerner medical record. The Massachusetts HIE [Healthcare Information Exchange] is now open for business.”

Read the full post for his description of the appalling health information disconnects that his wife encountered in her breast cancer care. He concludes ringingly:

“Just as the original golden spike in 1869 issued in a new era of connectness, so does today’s HIT [Health Information Technology] golden spike change business as usual in Massachusetts. Over the next year, we’ll be building new “bridges”, ensuring that every payer, provider, and payer can join the ecosystem. Here’s to innovation!”

I’m all for innovation. But in a world where a billion people are connected on Facebook, how do I get excited about a medical record crossing a state? Instead, I just get depressed at the tremendous obstacles that have tended to keep health information technology from keeping pace with the rest of this brave new technological world. A June “Perspective” article in The New England Journal of Medicine points out that doctors are “increasingly bound to documentation and communication products that are functionally decades behind those they use in their ‘civilian’ life.”

Dan Munro, a contributor to Forbes magazine, expresses the disturbing contrast here better than I ever could. He compares the inspiring technological feat of Felix Baumgartner‘s 24-mile fall to earth Sunday — including YouTube’s ability to stream the event live over 8 million concurrent streams — with the ‘Golden Spike’ press release he received. He writes:

The juxtaposition here is truly embarrassing and reflective of just how far adrift our Governmental healthcare IT thinking seems to have become. Felix Baumgartner is pushing the boundaries of human achievement from quite literally the edge of space – with some breathtaking technology (both aloft and here on terra firma) and the State of Massachusetts is looking for National recognition and applause for “Sending [the] First Electronic Health Record from Boston to Springfield.” The Federal Government has already spent billions – with billions more in the pipeline – to transition to Electronic Health Records – and the leading State in many of our healthcare IT efforts wants to announce with National fanfare the equivalent of a point-to-point telegraph transmission?

His full piece is worth a read, and if you want to correct him — and me — about the state of health information technology, we welcome comments below.

Dr. Blumenthal Went To Washington

For the last two years, Dr. David Blumenthal was the czar of Health Information Technology for the Obama administration, overseeing its monumental efforts to push the country toward electronic medical records. This is his first week back at his Harvard home. In case you missed it yesterday, CommonHealth featured him in the above brief video, on what we should all be asking of our doctors, electronically speaking. Today, we continue our debriefing, lightly edited:

Q: You’re just back from two years in Washington, DC. What will you do now?

To be absolutely frank, I’m exploring lots of different options. It’s virtually impossible to plan your next step while you’re in government, because of all the potential conflicts of interest. I’m back as a professor at Harvard and I’m sure I’ll be doing some writing, and probably some academic work, and a lot of speaking and guest-lecturing. I also have acquired something of a taste for having an impact on the real world — I spent two years trying to do that in Washington — so I’m looking for opportunities to affect health care delivery, and I’m not sure what form that will take.

I’ve become a convert to the idea that information really is power, in health care just as in everything else. The information platforms that systems work with are vital to their success, and getting those better-integrated into the day-to-day delivery of care is important for patients, doctors, nurses, hospitals — everybody. I don’t see a pathway to accomplishing everything we want to accomplish, in the commonwealth or nationally, until we have much more powerful information systems.

You can make big changes in the delivery of health care just by giving people better information. Most health care professionals go to work every day wanting to do a good job, and when they fall short, it’s often because they don’t have the information they need.

Q: Could you share a telling example of the power of information in health care?
Continue reading

What’s The Least You Can Expect Electronically From Your Doctor?

For the last two years, Dr. David Blumenthal was the czar of Health Information Technology for the Obama administration, overseeing its monumental efforts to push the country toward electronic medical records. This is his first week back at his Harvard home, in a Massachusetts General Hospital office about the size of a walk-in closet, bookshelves still waiting to be filled. Rachel and I spoke with him today about his experiences in Washington, his current plans and the state of Health IT in the country and the state.

We’ll share more of that debriefing tomorrow. But first, the news you can use: in the video above and the text below, he answers the practical question: What’s the least we should expect from our doctors, at this point, in terms of using computers?

I think you should expect your doctor, nurse, and pharmacist to have your personal health information in electronic form. That means they should be entering it pretty much at the time you see them. You should be able to find your medicines, your problems, your X-ray and lab results, in their computers.

And I think increasingly you should expect your doctor to be able to communicate with you by secure email. That’s going to increasingly be a standard. Some physicians are reluctant to do that because they’re afraid they’ll be overwhelmed, but objectively, we’re at the stage we were at with the telephone 70 years ago. It’s hard to imagine a physician without phone access, and its going to be hard to imagine a physician without electronic communication.

It’s a little too soon to expect them to be in electronic communication with other doctors and hospitals. Our systems in many parts of the country are not yet capable of that. We should be capable of doing this soon in this market, in the Eastern Massachusetts market. And I think the obstacles are more a matter of will and effort and money than they are of technology.

Tomorrow: Dr. Blumenthal went to Washington. What surprised him there? How can technology help cut health care costs? And what is the current state of play in terms of federal incentives to go electronic?

Analysts: Republicans Not Targeting Health Technology

There seems to be no target on the back of health information technology. Republicans in the next Congress are expected to come after various pieces of health care reform, but not electronic medical records, the Times reports today.

“The tech spending is set to go on,” said Lynne Dunbrack, an analyst in the Health Industry Insights unit for IDC, a technology research company. “The better use of health care technology to reduce costs and improve care has bipartisan support.”

Some new evidence of industry’s confidence in the future of health IT: AT&T has just announced a new division called AT&T ForHealth, the Times reports in its Bits blog.

AT&T will offer data-center and hosting technology for [EMR] exchanges. It also plans to provide telehealth services for remote diagnosis and treatment, and a wide range of support for preventive and disease management applications on smartphones.