Category Archives: technology

PHAT Conference Schedule – May 1

The Public Health & Technology on May 1, 2009 schedule is below. It’s not too late to register: www.hsph.harvard.edu/phat. I will post all the video on this blog as soon as it is available.

10:00 am, Kresge Ground Floor
Registration Begins

10:30 am, Kresge G-2
Introduction – Health Information Technology: Where are we in 2009?

Ashish Jha, MD, MPH, Professor, Health Policy & Management, Harvard School of Public Health


11:00 am, Kresge G-2
Panel – Health Information Exchange

  • ModeratorBlackford Middleton, MD, MPH, MSc; Director of Clinical Informatics Research & Development; Chairman of the Center for Information Technology Leadership (CITL); Partners Healthcare System
  • Ray Campbell; Executive Director & CEO, Massachusetts Health Data Consortium
  • David Cerino, MBA; General Manager, Consumer Health Solutions Group, Microsoft Corporation
  • John Loonsk, MD; Vice President, CGI Federal, Inc.
  • John Moore; Founder and Managing Director, Chilmark Research

12:30 pm, Kresge G-1
Keynote – Connecting Patients, Providers, and Payers

John Halamka, MD, MS; Chief Information Officer, CareGroup Health System; Dean for Technology, Harvard Medical School; Chairman, New England Health Electronic Data Interchange Network; CEO, MA-SHARE; Chair, US Healthcare Information Technology Standards Panel (HITSP)


1:30 pm, FXB Atrium
Networking Lunch with Speakers and Invited Guests

2:30 pm, Kresge G-1
Panel – Health Information Technology & the Stimulus Bill

  • ModeratorKaren Bell, MD, MMS; Sr. Vice President, Health Information Technology Services
  • Jonathan Bush, MBA; CEO, President, & Chairman, AthenaHealth
  • Sharona Hoffman, JD, LLM; Professor of Law and Senior Associate Dean, Case Western School of Law; Co-Director, Law-Medicine Center
  • Isaac Kohane, MD, PhD; Director, Boston Children’s Hospital Informatics Program; Professor, Pediatrics and Health Sciences & Technology, Harvard Medical School
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How Kaiser Permanente Went Paperless

A great article in Business Week from April 7, 2009: How Kaiser Permanente Went Paperless. Describes Kaiser’s $2 billion electronic health record implementation and the resulting benefits. The major conclusions:

  • Return on investment is a wash at best, although quality improves in some areas
  • Implementation isn’t transferrable to small providers

Mobile Health and the Inter-American Development Bank

In a previous post, More on Mobile Phones, I discussed the potential for mobile phones to change the way the development community approaches global health. The Inter-American Development Bank, Science and Technology Division just released an excellent white paper entitled Mobile Health: The potential for mobile telephony to bring healthcare to the majority. According to the IDB, “there is no invention that has provided more distinct opportunities in innovation for development than the mobile phone.” The paper identifies 6 categories for innovation:

  • Surveillance – PDA-based data collection and disease monitoring
  • Information – appointment and prescription reminders
  • Consultation – information on waiting times or questions on STDs, for example
  • Education – primary care behavior information
  • Monitoring – chronic disease severity information
  • Diagnostic – remote diagnostic assistance

Mobile health is becoming an important component in the current movement to consumer-centric care, allowing greater interactivity between patient and provider, enabling remote care and notification, increasing accessibility of health information, and facilitating chronic disease management. The value chain below illustrates how comprehensive an effect mobile health could have on delivering additional value to health consumers. Mobile networks have access to all paricipants in the health system–patients, doctors, administrators, etc.–and mobile telephony, as a systems integrator, has the potential to connect the health system to healthcare providers, pharma industry, high-tech industry, and handset manufacturers. All of these have the potential to deliver increased value to citizens.

m-health-value-chain

The document ends with some great additional resources which I will re-post here:

more on mobile phones

“We’ll have one mobile phone per child before we ever have one laptop per child.” -Inspired by Jason Grigsby, co-founder of Cloud Four, at a June 2008 presentation Web Visions event (see his blog post here: Going Fast on the Mobile Web)

There are now 3.3 billion mobile phones in use in the world, which means that 1 out of every 2 people worlwide uses a mobile phone. This makes the mobile phone the most widespread electronic device in the world. To put this into perspective, there are 900 million computers, 1.3 billion fixed landline phones, and 1.5 billion televisions. (See Communities Dominate Brands entry on Putting 2.7 billion in context: Mobile phone users)

mobile-comparison-chart

– from Cloud Four, The Mother of all Markets

The global market penetration of cell phones is noteworthy, but the incredible rate of growth even more so. In 2000, there were about 800 million mobile subscribers (12% of the world’s population). By the end of 2008, there are expected to be over 4 billion subscribers! See a September 2008 article from the International Telecommunications Union: Worldwide mobile cellular subscribers to reach 4 billion mark late 2008 for more details. China already has the most mobile subscribers in the world (see my previous post on Mobile Phones) and by the end of 2008 the BRIC countries (Brazil, Russia, India and China) will have approximately 1.3 billion subscribers, or one-third of all mobile phone users. Last year, Pakistan added more new mobile connections than the USA!

worldwide-mobile-subscribers 

The US has actually fallen behind many countries in Asia-Pacific region with only 80% subscriber penetration. President Bush made widespread broadband and mobile access a priority in 2004 (although did very little to make this happen). President-Elect Obama has also stated that access is a priority of his administration. Ellen Romer of Experian Consumer Research published a report entitled U.S. Closing Mobile Usage Gap in April 2008 with statistics on US mobile usage.

Mobile connectivity is no longer exceptional, even in rural, underdeveloped regions. Mobile phones, broadly categorized as information and communications technologies (ICTs) along with internet and landlines, enable stronger and larger social networks, increase knowledge dissemination and creation, freedom of expression, political, societal, and economic participation, and adoption or creation of new technologies. 3rd-generation networks will become the norm, making internet access possible anywhere in the world without a computer. The increase in individual access to information that the internet provides is perhaps one of the most empowering and capabilities-enhancing functions of modern technology and has the potential to transform the developing world.

health, crowds, and data mining

Google released Google Flu Trends yesterday, which analyzes search terms for indicators of flu activity. With the onset of flu season, people start searching for keywords such as “flu vaccine” which Google detects and charts. The example below reveals that we are just a couple weeks away from a time of year that has experienced a large outbreak:

Google Flu Trends Sample

The true genius behind this system is that Google is not directly involved in data collection. Data is collected passively as searches are submitted by users. Incredibly, Google Flu Trends reliably performs flu surveillance up to 2 weeks faster than the CDC (US Center for Disease Control)! For details on Google’s tracking method, check out their blog post Tracking Flu Trends.

In a similar fashion, David Bates of Harvard Medical School is creating an epidemic surveillance system that analyzes electronic health records of several Boston-area medical centers every night. When an outbreak is in the works, not all the sick people go to one hospital. 2 might show up at one hospital and 3 at another. The next day several more go. By the time authorities are aware of an outbreak, it is weeks too late. Performing surveillance on data from several hospitals simultaneously greatly expands quantity of information available and can potentially prevent outbreaks from occurring.

Data mining in health that transcends a single unit (like a hospital) has only just begun. Personal health record systems like Google Health and Microsoft HealthVault optionally aggregate health data from a variety of sources (e.g. hospitals, clinics, insurers, pharmacies). Determining health trends is one of Google’s primary goals with this system:

Google will use aggregate data to publish trend statistics and associations. (http://www.google.com/intl/en-US/health/privacy.html)

Once again, while Google and Microsoft are both investing heavily in platform development and partner recruitment, the data is entered, imported, and managed by the consumer. For an interesting post on the positive and negative ramifications of Google Health, check out Tree of Knowledge.

singularity

Why singularity?

In a nutshell, a singularity is a mathematical term for a region at which a quantity becomes (nearly) infinite. Analogously, a singularity is a point in time at which a critical mass is reached making radical transformation inevitable.

Globalization and the integration of the world economy, rapid evolution of technology and widespread adoption of communications technology (mobiles and internet), and growing political will and social activism all point towards a time of dramatic transformation. An internet-connected individual now has convenient, free access to volumes of information. The number of internet users has quadrupled from 360 mil to 1.5 billion since 2000, and most growth is in the developing world (see http://www.internetworldstats.com/stats.htm for more charts).

Internet Users in the World by Geographic Regions

Ray Kurzweil is the king of the technological singularity, an idea largely based on the observation that Moore’s Law has held true for 25 iterations. Moore’s Law states that computer processing power doubles every 18 months. About 456 months have passed since Intel introduced the first widely used microprocessor (the Intel 4004), which means the microprocessor has experienced 25 doublings!

According to many scientists, there is no other phenomenon in the universe that has experienced 25 iterations of exponential growth–and no end is in site. For theories of how this rapid change might effect us, how to copy our brains onto computers, and stories of telekinetic monkeys, check out Joel Garreau’s book, Radical Evolution.

Radical Evolution, Joel Garreau

Given how pervasive technology is, this transformation must also affect health. In the short-term, this means advances in health data mining, Health 2.0, dramatic improvements in medical imaging, and customized treatment based on patients’ DNA. Medium-term: accurately simulating protien folding and drug interactions using computers, and an AIDS vaccine. Long-term: nano-robots fight cancer and other infections on a cellular or molecular level and altering the DNA of fetuses.

Widespread use of the PC began only 25 years ago. The World Wide Web Consortium (W3C) formed in 1994. In many ways, computers and the internet are immature technologies that are still evolving. The interface between machines and humans is only beginning to be explored. It is probable that these evolutionary forces, combined with globalization, collaboration at the intersection of knowledge domains, and technology-facilitated revolutions in nearly every sector of industry, will have even greater long-term effects on the average person and society as a whole.

mobile phones

“This year China overtook America as the country with the largest number of internet users–currently over 250 million… In China, over 73 million people, or 29% of all internet users in the country, use mobile phones to get online.”

-Excerpt from The meek shall inherit the web,  The Economist: Technology Quarterly, 9/6/2008

Mobile phones are perhaps the best example of the leapfrogging technology in the developing world. Internet usage has grown every year worldwide since the internet was born, but now that communications infrastructures have caught up in many countries, many of these new users will be accessing the web through their phones.

Many companies are already trying to leverage mobile phones to expand their markets, such as M-PESA for mobile phone based payments, Assured Labor for hiring short-term contractors, or Jott for personal productivity. Banking customers can now check balances via text message. Patients of some hospitals can receive appointment and prescription reminders via text message.

Integration of cell phones into business strategies is still new and companies have just begun to explore this. We are going to see a lot of new companies spring up, especially in countries like China and Brazil where cell phone usage is high but computer-based internet access still relatively low.