Physicians and SocialMedia

Interesting blog post by KevinMD, exhorting health providers to become as Internet savvy as their patients,  lest and I quote:

the medical profession risks losing further influence of the online message, as more patients will be persuaded by charlatans, who now rule the web’s health information.

One primary care doctor I visit says “don’t believe what you read out there”…

Firstly, I think that KevinMD’s blog post has a misleading title “….engage in social media”.  Engaging in social media can rapidly become offering free advise over the web about medical conditions. I think a better title would be “…becoming web savvy.”

Secondly,  I think that physicians have several duties with respect to social media:

  1. Become informed on what medical information the web offers the patient, so that they can understand what information patients are reading.
  2. Direct patients to official websites such as medline , or well respected commercial websites such as webmd rather than the “charlatan” websites that KevinMD suggests.
  3. Understand how to mediate “self diagnosis” that a patient performs on themselves from the Internet and what symptoms the patient presents at the time of the doctor visit.

Patients are encumbered to:

  1. Don’t believe all you read online.
  2. Symptoms that one patient encountered and published online, may not apply to you.

In closing, here is a chart of hospitals currently using social media and a request from the USA government to find out how the public search for medical information.

HITECH act …who is the victim? an old PKI key management problem re-emerges

A NetworkWorld article discusses the requirements of the HITECH act (two page PDF).  (Also reference the Federal breach notification guidelines here (five page PDF)

A few comments:

1.. The encryption requirements of the Act are not new nor are the complexities of sharing and reading encrypted data; years ago I worked on XKMS which did not succeed in solving the problem of key management.

2. The article suggests that:

Fraud involving stolen patient healthcare data, primarily Medicare/Medicaid identity theft for making money off submitting fraudulent claims, is not uncommon…..

I think the major difference between stealing credit card numbers for fraudulent purposes is that in the case of credit card fraud, the victim is the unwitting individual who was scammed. The victim of a medicare fraud is the government who is responsible for reimbursing the health provider.

Who owns the patient data?

When a new medication is developed, pharmaceutical companies conduct a clinical trial: a controlled study of the effect of a medication on selected group of volunteers, perhaps 1000.

Imagine if the benefits and side effects of a new medication could be gauged from not a thousand people but one million of all ages, genders, races and who may or may not already have other diseases complications and may or may not be taking other medications.

One of the benefits of electronic health and medical records is there are vasts amounts of data to be mined and analyzed. Anonymize the patient data and you can create statistics and analysis of the effects of medications, diseases and treatments.

But who owns that patient data? In speaking with a relative of mine who is a physician, he told me that certain very large medical institutions will not release their valuable data for other researchers to use and analyze. They consider that patient data their intellectual property, their treasures.

I posit that the data belongs to the patient, that the patient should be able to control who can access that data even if it is anonymized. The patient, using HIPAA guidelines, should be able to control who has access to his/or her data and not the medical institution.

Using XML to exchange electronic health data, ice no water.

Yesterday evening I had the distinct pleasure of enjoying Scotch on the rocks with Eve. In Pat’s honour we drank single malt, and reminisced over glory days at Sun and our current tribulations with MS Exchange email and calendaring.

As I discussed my forays into HealthIT, Eve alerted me to what Gerry, another fine Sun fellow, is up to:

ProjecthData may well take us where HL7 cannot, to the nirvana of fully interoperable health and medical records.

A RESTful approach sounds great and I look forward to learning more.

Cheers! <clink>

Development of open EMRs/EHRs

John Halamka posted a refreshing entry about development of APIs that allow easier integration with EMRs and EHRs. Since I have been concerned in recent blog entries about how EMRs, EHRs and HIEs will integrate this was refreshing news.

I am going to dive in and examine some of the technologies described: XDR, XDM and XDS.

Some other initiatives I found that promote development of open healthcare technologies:

  • ihe – integrating healthcare enterprise
  • oht – open health tools
  • ohf – open health framework
  • openehr
  • openmrs

‘Meaningful use’ toward HIEs – questions for Dr David Blumenthal

I read with interest update 3 by Dr David Blumenthal of the Department of Health and Human Services.

Firstly Dr Blumenthal, consistently uses the term EHR (Electronic Health Record).  Per my definition of EHR vs EMR (Electronic Medical Record) an EMR is used by one vendor such as a physician, whereas an EHR is a patient’s collective record of medical data sourced by several healthcare providers.

Questions for Dr Blumenthal:

  1. Did you mean that health care providers should implement EMRs,  not EHRs?
  2. How will the various EMRs share data between each other (and their regional HIEs/RHIOs )  so that patients can move with ease from provider to provider? Will HITSP provide standards that EMRs can adhere to? Will HL7 be updated?
  3. What about medical terminology? Will EMR vendors adhere to LOINC or ICD-10 so that a universal EHR can be created for patients?