Positive vs Negative Reinforcement to Promote Use of EHR

Secretary of Health and Human Services Kathleen Sebelius says in Kaiser Health News:

Today, in almost every other sector besides health, electronic information exchange is the way we do business. A cashier scans a bar code to add up our grocery bill. We check our bank balance and take out cash with a debit card that works in any ATM machine.

But despite the clear benefits of health IT, only two in ten doctors and one in ten hospitals use even a basic electronic record system.

The most promising sign for the future of our health care system is not what stakeholders were saying, but what they’re already doing.

• Major insurers like Aetna, United and WellPoint announced their own provider loan and training programs for electronic health records.
• The Federation of State Medical Boards announced that is taking the first steps toward encouraging the use of health IT to maintain professional licensing.
• And two of the nation’s largest provider groups, Delaware’s Christiana Care Health System and Partners HealthCare in Massachusetts, said that in the future they’re going train and support providers who adopt electronic health records, and avoid providers who don't make the switch to health IT.

http://www.kaiserhealthnews.org/Columns/2010/August/082610Sebelius.aspx

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We've all been hearing about positive reinforcement like bonus payments for meaningful use of an EHR. Negative reinforcement in the form of being dropped by insurers, avoided by provider groups -- and losing one's license! -- would be more effective.

Five Drawbacks to Converting Professional Guidelines into Decision Support

Effective decision support must be integrated into the referring physician workflow to qualify for meaningful use incentives beyond 2012 and avoid penalties beyond 2014.

As the radiology community searches for the best source of decision support and decision support to quell inappropriate use, the question of tapping into professional guidelines such as American College of Radiology (ACR) Appropriateness Criteria inevitably arises.

"These guidelines serve many critical functions … but there is little evidence that the traditional methods of guideline dissemination lead to substantial improvement in the test-ordering behavior of referring physicians," wrote Ramin Khorasani, MD, MPH, vice chair of radiology at Brigham and Women’s Hospital.

One of radiology’s top decision support experts, Khorasani identified five drawbacks to converting professional guidelines into decision support:

1. Guidelines are not actionable. Most describe the relative merits of one approach over another rather than prescribe an appropriate course of action.
2. The professional societies that develop and disseminate guidelines fall short on EMR and health IT know-how.
3. Many existing guidelines lack the strength of evidence necessary to spur widespread adoption by clinicians.
4. Effective decision support must be up-to-date and frequently updated.
5. Decision support must incorporate consequences for ignoring rules in order to insure maximum impact.

http://www.cmio.net/index.php?option=com_articles&id=23704

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Issues 2-5 seem relatively straightforward (which isn't to say easy) to address, but issue 1 might require a fundamental rethinking of what constitutes a "professional guideline". What Khorasani calls the "next generation of decision support" may call for the next generation of professional guidelines.

Local Server vs Web Based EMR

In certain situations one type of EMR might win over another. For example, if you’re in a place where your internet connectivity is not reliable, then you probably should go with an in house EMR instead of a web based EMR. Many doctors who don’t have formal IT support avoid an in house server and go with a web based hosted EMR to avoid the lack of IT support of the in house server.

http://www.emrandhipaa.com/emr-and-hipaa/2010/08/18/emr-question-and-answer-local-server-emr-vs-web-based-saas-emr

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This reminds me of an issue we're going to be debating at AMIA, Customization vs. Standardization to Promote Adoption of EHRs. Local Server = customized, Web Based = standardized.

A rapid, Web-based method for obtaining patient views on effects and side-effects of antidepressants

Carlos Rizoa, Amol Deshpandea, Alton Inga and Neil Seeman report:

The method entails a systematized search of many URLs (Uniform Resource Locators, or Web page addresses), using keywords and phrases to extract the named drug and symptom that are reliably relevant to the medication being taken by the individual reporting the experience online.

Given the increasing number of patient narratives about drug experiences on open-access Web forums, this rapid novel method will have increasing utility in post-marketing surveillance and in comparing the effects of psychiatric medications.

J Affect Disord http://dx.doi.org/10.1016/j.jad.2010.07.027

(via @psydir and Neuroskeptic)

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I think it has more potential for post-marketing surveillance than comparing medications, since the methodology is anecdotal.

Are We Passionate or Psychotic about Social Media?

@PhilBaumann writes:

Passion enables you to seek out the things that help you get things done.

Psychosis drives you to see things that aren’t there, or to think in ways that are disconnected from reality.

http://philbaumann.com/2010/08/12/beware-psychosis-in-social-media

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Can anybody point to any examples of social media "psychosis"?

Healthcare Suffers More Data Breaches Than Financial Services

The high numbers [of disclosed breaches so far this year] are due to lax handling of how data is stored and accessed within these databases. This atmosphere, along with the extreme portability of healthcare data due to consumer devices and laptops and increasing numbers of malicious insiders seeking to profit from electronic medical records (EMRs) and other patient data, has formed a poisonous combination within the industry.

original article, requires cookies:
http://www.darkreading.com/database_security/security/attacks/showArticle.jhtml?articleID=226600307



summary, doesn't:
http://www.securitymagazine.com/Articles/Blog_Products/BNP_GUID_9-5-2006_A_10000000000000880240

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The problem isn't the technology, it's the people.

I think it's ironic that the original article is so secure that I couldn't access it (without accepting cookies were).

Should Walgreens train people in how to use social media?

Should Walgreens train people in how to use social media?

--Allan Khoury, MD, PhD, Chief Medical Officer, Walgreens Take Care Health Systems

health care can either take advantage of patients’ shared wisdom (and innovate) or ignore it (and fail)

--SusannahFox, Associate Director, Digital Strategy, Pew Research Center's Internet & American Life Project

http://e-patients.net/archives/2010/06/patient-communities-at-walgreens.html

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That same "privacy advocate" is quoted again!

Using the Internet to Promote Health Behavior Change

A Systematic Review and Meta-Analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy

Interventions had a statistically small but significant effect on health-related behavior. Their effectiveness was enhanced by:

• use of theory
• behavior change techniques
• SMS

Webb TL, Joseph J, Yardley L, Michie S. J Med Internet Res 2010;12(1):e4

amia sessions

I was delighted to learn recently that two submissions of mine were accepted for the AMIA 2010 Annual Symposium:

• Should AMIA Enforce Its Code of Ethics? Or at Least Be Transparent?
  with Peter Winkelstein and Peter Embi
  workshop sponsored by the Ethical, Legal and Social Issues Working Group
  November 13, 2010 from 5:00 PM to 7:30 PM


• Is an EHR More Like a Pair of Pants or a Bridge? Customization vs. Standardization to Promote Adoption
  with Kim Unertl, William Hersh, and David Bates
  panel sponsored by the People and Organizational Issues Working Group
  November 16, 2010 from 3:30 PM to 5:00 PM

Hope to see you there!

crime rate one of the highest in the world

There was an interesting piece about South African President (and polygamist) Jacob Zuma in the the NewYorker last month:

http://www.newyorker.com/reporting/2010/07/05/100705fa_fact_huntergault

What grabbed my attention: South Africa's crime rate is one of the highest in the world, and 2/5 women say rape was their first sexual experience.

always juggling

Steve Daviss MD wrote:

I typically have more balls in the air than I have hands to deal with, so am always juggling to keep some on top and let others fall to the ground through lack of time and/or attention. The ones that bounce back up, for whatever reason, get another chance to stay in the air.

Balls bouncing back up is "push": you subscribe to an e-mail list or follow a blog or someone on Twitter, and messages ("balls") are pushed to you. Balls having to be picked up is "pull". How many of you return to web sites just because you feel a pull to?

And what does it mean that we accept balls falling to the ground?

Consumer rating sites can be beneficial to patients

People are very familiar with [consumer rating sites], so I think this is an opportunity to engage them in the process of improving health care quality, to really let hospitals and doctors know what they are doing right and what they are doing wrong.

http://www.boston.com/news/health/articles/2010/08/09/social_media_meets_health_care

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This made me wonder if consumers will be represented at Medinfo. And at our workshop!

Mayo Clinic starts social media center to train physicians and hospitals

The Mayo Clinic's effort to start a social media center to train physicians and hospitals in the ways of Facebook, Twitter, YouTube and podcasting is one of the biggest signs yet that social media in health care has gone mainstream.

http://www.ama-assn.org/amednews/2010/08/09/bil20809.htm

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This workshop is a similar, though of course also very different, effort. Is social media as mainstream in the informatics community?

FDA says use of Facebook Share button violates requirements

"The shared content is misleading because it makes representations about the efficacy of Tasigna but fails to communicate any risk information associated with the use of this drug," said the FDA letter

"We have addressed its concerns by taking the direct and immediate action of taking down the widget referenced by the FDA," the company said.

Facebook should be responsible for creating safeguards for the marketing of medications and other health products on its site, said Jeffrey Chester, a privacy advocate

http://www.businessweek.com/idg/2010-08-06/us-fda-warns-pharma-firm-about-facebook-promotion.html

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What I thought was especially interesting was how the FDA was concerned about content and the privacy advocate said Facebook should create safeguards.

overlapping online communities

Our online community is bumping up against a couple others. First, on Twitter, the hashtag we planned to use, #medinfo, is mostly in Korean. I think another community is using it for "medical information". Maybe we should switch to #medinfo2010 to disentangle us.

Second, the Medinfo2010-AMIA2010-bridge is "a collaborative group environment for exploring common themes in international health and biomedical informatics linking the Medinfo2010 and AMIA2010 conferences, and beyond". It seems duplicative to me to have discussions about the same issues going on in different places, but we need to use the structure we proposed, and I think they're committed to using grou.ps, so we may just continue to overlap. At least we know about each other!

learning curve

I did say I have a steep learning curve. This reply is to "reply to the group" Didn't know going forward when I respond should I "reply via the web post"?

We're learning together! I received your reply by email. That doesn't strike me as a very helpful distinction, "to the group" vs "via the web post". The less informative the software, the steeper the learning curve! :-)

Bob

access to online groups

I did not receive the invite to the yahoo group so [someone else] shared hers with me. I am not sure how this works in terms of Yahoo Groups since I clicked on her link and was able to sign up. As the moderator do you have a list of who was invited and who responded? If you do have such a list, am I signed up as [her] or was I able to join the group as me. The fact that I was able to click on the link on [her] invite and join the group demonstrated that others who did not receive an invite can join a group if someone in the group forwards an invitation?

These types of details on how the technology functions would be important if one was trying to establish a closed clinical group. Let me know what you see as moderator.

All members can access the list of who's joined:

http://groups.yahoo.com/group/medinfo_socmed/members

I set up this list as:

Membership Type: Open (anyone can join)

so it might be because of that that you were able to join using her link. You wouldn't want to make a closed clinical group open. :-)

Bob