Monthly Introduction to Tech Medicine

What's this blog all about?

My goal in Tech Medicine will be to explore the intersection of medicine, new technologies, and the Internet. This is a purposefully broad topic. Several times weekly I will post focused reviews of issues interesting to health professionals and nonprofessionals alike. Posts may include examinations of medical devices, pharmaceuticals, scientific advances, internet services, and other technologies involving health care and the practice of medicine. Mirroring as it does the nature of the Internet and the sometimes surprising nature of new technologies, the content may also include topics that are wonderful, unusual, hilarious, or strange.

What are some recent posts on Tech Medicine?

Recent posts have included a new type of mobile medical practice, my talk on Health 2.0, a visual medical dictionary, a collection of interesting links, and digitizing paper medical records (and more medical uses of the iphone).

Who are you?

I'm trained as a nephrologist (a kidney and blood pressure specialist). For the last two years I've written Kidney Notes, a blog designed to filter and process medical news. Most recently, Kidney Notes has become a collection of links, commentary, and scraps of information -- a reference database of interesting things with the help of a popular social bookmarking service called del.icio.us. While I will continue posting to Kidney Notes, several friends have asked me to write longer posts of original content -- and this is what I will be writing on Tech Medicine. (Recently, I have also written a blog on personal productivity called The Efficient MD.)

There are many topics I plan to cover, but I'm also open to suggestions and tips. Please email them to techmedicine@gmail.com.

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A Mobile Medical Practice -- Dr. Jay Parkinson

Dr. Jay Parkinson (MD, MPH) runs an unusual type of medical practice in New York City. Like many "concierge" physicians, he accepts no insurances -- the flat rate is $500 a year. He has no office -- he makes housecalls to your home or work. $500 gets you two visits and "unlimited e-visits": email, phone calls, video chat, or instant messaging.

In order for this system of primarily mobile medical care to work, Dr. Parkinson chooses his patients carefully. They must be accessible in Manhattan or Brooklyn, and they must be young (less than 40) and generally healthy.

He runs his practice on a laptop, an electronic medical record system (Life Record), and an iPhone.

Many of his patients don't have insurance and must pay "out of pocket" for their medical care. To make his practice more appealing, Dr. Parkinson has contacted local laboratories, pharmacies, and radiologists to obtain the best prices on their services. Not only does he see patients, but he acts as their personal medical shopper for products.

While there are many potential problems with this model of practice, the reality is that many younger people (who are generally healthy) don't have insurance, are very comfortable with instant messaging and electronic communication, and would prefer this type of online relationship with their doctors.

Some potential problems include HIPAA privacy issues with electronic communications, providing immunizations, the problems with diagnosing patients remotely, patients using electronic communications too frequently, and availability during emergencies. For an interview with Dr. Parkinson and a detailed discussion in the comments section between him and many skeptics and supporters, please see the Wall Street Journal Health Blog.

Labels: jay parkinson, mobile medicine, new york city

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My Talk on "Health 2.0" for the 5th Annual Healthcare M&A and Corporate Development Conference

This is the talk I gave at the 5th Annual Healthcare Mergers and Acquisitions (M&A) and Corporate Development Conference on September 24, 2007. I was part of a panel titled "Healthcare 2.0: Technology & Healthcare Services of the Future," and we were asked to talk about disruptive changes in healthcare.

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Good afternoon.

I'm a bit out of my element here, because I'm a practicing kidney and blood pressure specialist in New York City, but I do have a lot of friends and patients on Wall Street.

I'm going to talk briefly about the disruptive potential of online communities of physicians and patients.

These online communities are an big part of what people have called "Health 2.0." Of course, this is just a buzzword, like "Web 2.0," but it's a buzzword that means something.

Early this month the Economist had an article about Health 2.0, which they defined as "user generated healthcare." In Health 2.0 communities, the content and value is not generated by outside experts, but by the users themselves, by healthcare providers and patients, who interact to share information and insights.

These online communities may be very different from one another -- and I'll give you some examples of them in a minute -- but they all have a couple of things in common: they're all public, collaborative, and simple to use. And this combination can be very powerful and disruptive.

For example, there's a website called Wikipedia which is perhaps the best example of a community that's a major source of health information for a lot of people. If you haven't seen it, Wikipedia is a free online version of an encyclopedia that anyone in the world with an internet connection can read and edit. I'll say that again -- anyone in the world can read it and edit it.

This idea seemed crazy at first and still seems kind of crazy, but it actually seems to work. Wikipedia is now 15 times as large as the entire Encyclopedia Britannica. And partly because of Wikipedia, very few people read the Encyclopedia Britannica anymore.

And what's written on Wikipedia definitely matters. Wikipedia is one of the top ten websites worldwide. Wikipedia is often one of the first places people go if they're diagnosed with a new disease, or if they want to research a person or a corporation. The definitions on Wikipedia are often near the top of any Google search.

But again, it's amazing that Wikipedia works at all, because anyone with an internet connection can change any of the definitions. And that's potentially very scary.

But the system works because it's self policing -- errors are picked up and changed by the users. But of course that still leaves some potential for significant inaccuracies and abuse.

[The author Charles Stross points out that if you extrapolate from current trends in computing, sooner or later everyone in this room will have an entry on Wikipedia. Try to imagine what they might be like.]

I'm going to talk about some other Health 2.0 communities that have the potential to be as disruptive as Wikipedia.

For example, there's an online community for physicians called Sermo. Sermo was founded on the idea of information arbitrage, that there's valuable information locked in the heads of physicians, if you could only figure out a way to get to it.

The way Sermo works is this: physicians ask and answer anonymous questions, but some of the questions are also asked by firms. When physicians answer some of these questions, they get paid, but they don't know which questions will pay them. So the incentive is to answer as many questions as possible. Sermo is basically an experiment in classical conditioning, it mines physicians for information by turning them into compulsive gamblers and taking advantage of their desire to collaborate. And it works very well.

It's only about a year old but Sermo is the largest online network of physicians that's ever existed. Sermo is also partnering with the AMA and the FDA, who are interested in information from Sermo about the safety of medical products. Sermo may actually be a better way to encourage physicians to report problems with drugs and devices than the FDA's own website.

There are also many online communities for patients, including sites with names like Organized Wisdom, Revolution Health, and Patients Like Me. These sites offer a number of services. They function as support groups for people whose physicians may not know enough about their disease or who don't have the time to explain it. They also allow patients to share their collective insights with one another. And they allow them to rate different sources of health information on the web. Some people like to use the phrase that "people are the new algorithm."

And some of these sites also allow patients to rate their doctors, health systems, and health products. And this is potentially disruptive, but not necessarily in a bad way. If people can search on Google for a review of your organization as easily as they can search for a review of a toaster, that can be a powerful incentive to change for the better. But as with Wikipedia, there's obviously a potential for inaccuracy and abuse.

And finally, there's also thriving community of medical blogs, which are online interactive journals written by patients, physicians, and other health care professionals. Many healthcare blogs contain hidden gems of information. And there's a sustained level of discussion on blogs that's hard to find anywhere else.

For example, there's a blog called "Kevin, MD" which collects all the most interesting stories in the media in one place. There's a blog called "Running a Hospital" by the CEO of Beth Israel Deaconess in Boston. And the Wall Street Journal even now has it's own excellent Health Care Blog, which I recommend to anyone interested in the business of healthcare. And the interactive nature of blogs is essential, because sometimes the comments can be more interesting than the original posts themselves.

To summarize: technologies like Wikipedia, blogs, and online communities have the potential to dramatically change and improve communication in the healthcare industry.

Thank you.

Labels: blogs, health 2.0, medical blogosphere, organized wisdom, patients like me, revolution health, running a hospital, sermo, wall street journal, wikipedia

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5th Annual Healthcare M&A and Corporate Development Conference

On September 24th, I'll be appearing on a panel at the 5th Annual Healthcare M&A and Corporate Development Conference. The panel topic is "Healthcare 2.0: Technology & Healthcare Services of the Future." I'll be speaking on online communities of physicians and patients.

If you'll be at the conference, please feel free to look me up.

If there's time, I'll be posting pictures from the conference on Kidney Notes and posting observations on Twitter.

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A Visual Medical Dictionary and the CureHunter Engine

Curehunter.com offers a free "visual medical dictionary" at https://www.curehunter.com/public/dictionary.do. The idea is similar to Healthlines' HealthMaps -- an interrelated web of complex terms is displayed as a simple map or diagram to enhance understanding. But unlike HealthMaps, which are (I believe) created by an actual human being, Curehunter's visual medical dictionary displays terms that are chosen by their importance to the primary search term in medical databases such as MEDLINE. For example, this is the map created when you search for "focal segmental glomerulosclerosis" (a kidney disease):


Hovering over each term with the cursor gives you a detailed definition. For example, "prednisone" is described as a steroid hormone and "nephrotic syndrome" is described as a large amount of protein in the urine. It's interesting and visually appealing, but I'm not certain how useful it's likely to be for either physicians and patients compared to, say, a Healthline or Google search.

The products offered by Curehunter are far more ambitious than a simple medical dictionary:

The CureHunter Discovery Engine is the world's only fully unified and integrated numeric index of all known drugs, biologically active agents, diseases and empirical statements of all effective clinical outcomes published in the United States National Library of Medicine.

The engine you are accessing online right now computes: 121,000 drug and biological agent data points X 11,600 diseases X 15,000,000 peer-reviewed research articles X several hundred thousand additional variables of Gene, Protein, Enzyme, Hormone, Growth Factor, Ligand, Kinase, Receptor, Inhibitor and other important small biologically active molecules.

The CureHunter Engine essentially defines the Clinical Outcome in cross-comparable numerical weights for all successful agents and allows discovery clustering and pattern finding that illuminate both pathogeneses and cures.

The idea is that the Engine can create an automatic analysis of all published data from provide a snapshot view of the best available treatments for any condition. The key word is "automatic" -- my understanding is that the analysis is created by a computer with no direct human intervention. Here's another screenshot:


I haven't seen any of the CureHunter reports myself, but my initial reaction is skepticism. While visual representations of the medical literature are aesthetically interesting, I'm not sure how helpful they would be in actual practice.

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Grand Rounds Call for Submissions: Healthcare Innovations and New Technologies

The next medical blogosphere Grand Rounds will be held at The Efficient MD on September 11, 2007.

The theme of Grand Rounds will be "Healthcare Innovations and New Technologies." Submissions broadly related to innovations in healthcare are welcome: new technologies, models of practice, and ways of improving efficiency or the quality of care. Speculations about the future of healthcare are also encouraged. Old posts are welcome. If you haven't written about this topic before, feel free to use this opportunity to write on the future of healthcare. Be creative.

Please send your submissions to efficientmd@gmail.com with the subject "Grand Rounds" by Sunday, September 9 at 6 pm EST.

Some background on the topic of this Grand Rounds: I chose "Healthcare Innovations" because I will be participating in a panel discussion titled "Healthcare 2.0: Technology & Healthcare Services of the Future" at the 5th Annual Healthcare M&A and Corporate Development Conference. (And by all means, if you'll be at the conference, look me up.) Particularly interesting ideas from this Grand Rounds may also be mentioned prominently at the panel discussion. I'll also explore topics from this Grand Rounds in future posts on Tech Medicine.

(As an aside, the conference will be held in Nashville. Coincidentally, the last time I was in Nashville was on a trip away from New York on September 11, 2001 -- the date of this Grand Rounds -- but that's another story.)

Of course, if you don't have a formal submission to Grand Rounds but would like to mention an important link or idea, please feel free to comment.

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Grand Rounds is Up

Grand Rounds, this week's best posts of the medical blogosphere, is up at Parallel Universes. Thanks for including my post on How Doctor's Think.

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