Human Behavior

Found a great quote on Health Care Informatics blog related to following "checklists" within ICU and surgery:

"Human beings, who are almost unique in having the ability to learn from the experience of others, are also remarkable for their apparent disinclination to do so." Douglas Adams

Privacy or Security - what's more important?

While the standards are shaping up, and there is monumental work to be done in a relatively short amount of time. How do you choose which one to do first. It is clear that a reasonable prioritization is needed, some things are relatively more important than others.

Same argument applies to establishing a privacy and security policy. That begs the question - What's more important? Should an organization establish and implement a privacy policy first or should it ensure that a consistent standards-based security policy is implemented so no breach happens in the first place. If you answered "Both", you are on the right track as potentially judged by any reasonable person. However, an organization with limited resources can have the right intent but some things do need to take precedence over others so the implementation goal can be realized.

Establishing and implementing a consistent privacy policy takes precedence and requires unwavering support in any health care organization. Security policy is highly important but it need not be standards-based right for the get-go. You might have heard the saying "Security implementation is a function of the size of your wallet". You can build elaborate checks, audits, disk/server-space, authentication and authorization and make them consistent across the organization if you have the right kind of money to throw at it. With limited funds, you can still uphold the goal of data security by adopting security policies that allow for individual businesses within the organization to have their respective security policies which meet the data security aims. For instance, to fulfill the goal of role-based security, individual businesses can implement an elaborate suite of roles and implement a sophisticated and highly automated mechanism OR can decide a maintain a combination of spreadsheets and manual tracking to fulfill the goal. Either way, the security goal will be fulfilled.

Running national security is like executing a Business Intelligence program

Saw this picture of Obama surrounded by the security team.

Looks a lot like a BI program initiative:

* Interconnected: Multiple inter-connected functional groups in a business unit

* Collaboration: Each group has its own agenda, but must collaborate with other groups to achieve the goal

* Vision: Each group has its own view of the "world", yet select few see the complete picture

* Leadership: Someone must make the call when there is a stalemate

* Prioritization: Constantly reprioritize as new information comes in

* Impact: Doing nothing has a disastrous impact

* Behavior:

>> Some treat it like a project and have an end in mind, others know that this is a continuous program

>> Some are overly optimistic, many are pessimistic. Realistic people are needed instead.

HIT - naysayers & skeptics

Anyone who has engaged in Information Technology business for some time knows that most IT investments do not generate significant benefits until sufficient years have passed. In most cases, even 5-year ROI models are flawed since it may take a decade before significant gains from the investment are seen. That is what we know. Then, why would we treat HIT differently? I would challenge anyone who dismisses investing in EHR/HIT technologies solely because evidence of its positive impact on quality of care cannot be visualized over the short-term horizon.

Do not dismiss before you explore. The inclination to "do nothing" in face of mounting challenges and insistence on availability of absolute evidence prior to investment could be disastrous.

A case for modular EHR

Came across a great article on plug-and-play modular EHR by David C. Kibbe, MD, MBA, senior advisor to the AAFP’s Center for Health Information Technology. The author questions the push for adoption of comprehensive EHRs when in fact that the needs of a practice (market) might be for some its components such as e-prescribing or a registry function. He proposes a shift from vendor-centric approach to platform-centric one where the practices are able to purchase and adopt EHR "modules" that follow industry standards.

This idea is certainly not new, consider this blog post by John Halamka where he states that Partners Healthcare and Beth Israel Deaconess are using a platform-centric approach for EHR and quality reporting, and are on their way to meet the meaningful use criteria.

Interoperable plug-and-play modules make sense to me. Buy components (modules) you need, connect new components with ones you already have on the platform.

Ethical use of data for Clinical Decision Support

Noticed this ethics-related question on LOINC website http://loinc.org/articles/Bonney2009

“Is it appropriate, or ethical , to use health data collected for the purpose of direct patient care to develop computerized predictive decision support tools?”

I do not have access to the complete article, but the question itself triggered some thoughts in my mind. I guess the first question to ask is – does the end justify the means? Since use of CDSS (Clinical Decision Support Systems) has been shown on average to lead to better clinical decision-making for providers and hence impact patient care, is it okay to use patient care data for development of such tools?

I will attempt to answer this question using the ethical framework governing the research on human subjects to see if it may apply to this situation (source of framework: Emanuel EJ, Wendler D, Grady C. What makes clinical research ethical? JAMA. 2000;283:2701-11. [PMID: 10819955]).

Here is the list of 7 framework requirements and their applicability to CDSS development as assessed by me –

1. Social or scientific value: Benefits from CDSS should justify the resources spent and risks imposed on patients whose data has been used
2. Scientific validity: Predictive decision-making methodology used by CDSS should be properly structured to meet its objectives
3. Fair participant selection: Participant data should be selected to achieve a fair distribution of the burdens and benefits of CDSS.
4. Favorable risk-benefit ratio: CDSS should be designed to ensure that the risks to an individual human participant are balanced by expected benefits to the same participant
5. Respect for participants: Privacy of participant should be protected and confidentiality of their data should be maintained. This can be achieved by using de-identified data and obtaining patient consent for collection, use, and sharing of data
6. Informed consent: Participant consent to include data in development of CDSS must be obtained. The risk to participant should be measured relative to risk associated with receiving care without use of CDSS. This risk should be communicated to the participant when obtaining informed consent.
7. Independent review: CDSS development should receive independent ethical review that is appropriate to the level of potential risk it poses to participants.

Medical vs. Nursing Informatics - Part 3 (final)

Here is the final part of the comparison between medical and nursing informatics. Part 1 and Part 2 can be found here.

Medical and Nursing Vocabularies:

Number of medical vocabularies such as MeSH, SNOMED, LOINC have been developed over the years. 100+ separate controlled vocabularies were conceptually linked in 1986 to form a meta-thesaurus called the UMLS (Unified Medical Language System).

Some nursing products such as CINAHL (Cumulative Index of Nursing and Allied Health Literature) use a medical vocabulary MeSH as an underlying vocabulary for diseases, drugs, anatomy, and physiology, and have expanded the vocabulary to include unique nursing terms in the vocabulary http://www.universityhealthsystem.com/Research/docs/Searching%20sEBSCO%20CINAHL.pdf

Growth opportunities: Lastly, both medical and nursing informatics domains are ripe for innovation and improvement. Consider the emerging health care models such as Patient Centered Medical Home that are likely to impact the physicians and nursing professions, in addition to impacting the related informatics domains as well.