Quality of Online Communication

A commentary on the quality of communication on “newage” communication platforms may be better understood with a short description of their niche audience and their unique characteristics. Typically communications via social and professional networks are more of a conversation, extension of every day interaction, not well organized content and driven by a group. YouTube has been elevated to a #2 search engine status and has been leading the transition between push and collaborative models. Key observation is that the secret sauce to get more viewers is to provide more details. Since the entry barrier is low, it is the easiest and safest for hospital to renew exposure to existing and new consumers. Facebook has the largest audience with 200m active users. The user demographics is shifting to match that of the real population. Even though it can be a confusing place, it has been emerging as a great place for patients to share stories. Twitter is the new kid in the block. It had generated quite an amount of media attention. It is simple to understand and start using. It is best used for conversation and not to push communication. It has evolved into gaining the fastest acceptance by hospitals. Typically the discussion earlier covers many other players in similar domains. Overall these communication platforms are efficient and effective in Community outreach, Real time education, Referring physicians and Crisis communication. ePatients (who are proficient on these tools) typically play an active role seeking out information, partner in their healthcare and is more participatory in their medicine (when compared to their paternalistic peers).

Typical areas of improvement on the quality of online communication (Blog and Facebook) are:

• Blog: Blog requires the right target audience to be successful. The author needs to depict a blog “personality” that caters to the right audience. This can be accomplished by including a tagline with a logo and/or including a paragraph/phrase that depicts to the audience what this blog is and who it is for (Please refer http://www.webdesignerdepot.com/2009/10/blog-headers-20-great-examples-and-best-practices/ for a list of examples)
• Facebook: Facebook success is all about reader participation. Configure Facebook Page Settings to allow more participation. Raise questions that can spark conversation and activity. Adding a Twitter Tab and YouTube Tab can further expand participation. Limit the frequency of Status Updates to an optimal level (may be once a day). Using TwtPoll can engage the audience. Embedding the Facebook Page into a e-newsletter and requesting your current audience to suggest to Friends frequently can expand the audience pool.

It is exciting to experience the explosive growth in the Second Life for HealthCare domain. Most of the sites are geared towards training medical professionals, followed by research initiatives. The most impressive ones that I had experienced are Ann Myers Medical Center that assists students to become more proficient in initial exam history and physicals and the UC Davis’ Virtual Hallucinations that provides virtual hallucinations experiences.

The key observation is that unlike the fast paced world where the physicians and students are hard pressed for time, second life provides physicians and patients more interaction time, thus providing more time for patients to share and more time for physicians to listen and more time for both parties to know better. The escalated interaction between physician and patient provides opportunity psychologists to promote alternate treatment plans such as psychoimmunobiology that stimulates body’s ability to heal itself through the stimulation of the immune system and fight disease. Second life provides a digital brick and mortar environment where institutions such as UC Davis with its reputation provides the required creditability for patients to transport to and leverage the physician advice and digital resources offered at the UC Davis Second Life facility. With 60% of the Second Life avatars from outside of US, the Second Life institutions tend to cater to patients from across the globe. This enables patients to seek holistic treatment approaches from around the globe. The physicians training programs tend to expose them to treatment approaches and diseases that are currently not available locally in their home country and thus equip them to be treat patients from across the globe.

There are multiple challenges. Ability of the patient to articulate their symptoms or state of health is very critical. Physical expressions (that physicians observe) out number the subset of “Gestures” that are available in Second Life menu. Metaphors and linguistic expressions widely vary across the various parts of the world. Limitation of the technology to assimilate them into digital communication (for now) is still being worked in advanced labs such as LindenLab. Na'vi language (in Oscar nominated movie Avatar) that has a limited vocabulary of about 1000 words may be the preview of a global language that can be used to communicate in Global communities such as Second Life. Adoption of Second Life physician training and preliminary patient screening is critical for its success. Hospitals and research institutions have leveraged Second Life as a test bed for new technologies and processes (e.g., Electronic Medical Record had been experimented in various shapes and forms in many Second Life Medical institutions).
Here is my avatar gazing at the various Healthcare options in Second Life.
Here are a few of them that may be of interest to the readers:

UC Davis’ Virtual Hallucinations - experience virtual hallucinations
Ann Myers Medical Center: detailed in the write up
Centers for Disease Control and Prevention - an educational opportunity
Heart Murmurs - listen to cardiac murmurs
Medical Library at Health Info Island - a medical virtual community
Virtual Neurological Education Centre - training for neurological disorder treatment on a virtual environment
Hottie Hospital - gynecology, sperm donation, sex therapy etc..
Wheelies @ Second Ability – Identify with people with disability by experiencing the use of a wheelchair
Play2Train - training for emergency preparedness such as mass casualty incident simulation.
The Gene Pool – take on your favourite chromosome

WebMD- a critique w.r.to key aspects

http://www.webmd.com/

Authority/Source – This website is considered a credible consumer knowledge repository for health information. In spite of its affiliation with multiple products and services the website had insisted on its unbiased provision of trustworthy and accurate health information that is both practical and relevant.
Accuracy – Reaction from WebMD readers (hopefully not filtered) suggest that the information that they came across are consistent with the information from the other reliable sites such as National Institute of Health, Medline and the Mayo Clinic.
Credibility - The senior staff and editorial team of WebMD is constituted by three physicians whose specialization spans Nutrition, Heartburn, Epilepsy and Weight control. The process of ensuring the relevance and credibility of content in other areas is not transparent to the consumers. It is left for each consumer’s imagination as to why the current specialties were chosen to fill the editorial team.
Objectivity/Content – WebMD insists that information that it provides is not a substitute for professional healthcare. Since the references to the information on this site are clearly identified to the consumer, the consumer is aware of the sources.
Currency/Timeliness – WebMD displays the date for most or all of the health information articles. The site appears to be updated regularly.
Structured Access – Amidst all the ads, website is fairly easy to navigate. Consumers seem to be forgiving for the excessive ads for the credible content. The search engine is powerful in bringing the relevant sections. For most of the searches (that can be as simple as "back pain" or as complex like "spondylolysis,") the websites is capable in providing its consumers with information that not only spans just the causes and symptoms but also prevention, medications and treatment options. The search can lead you to videos and other reliable websites as well.
Beyond the “Call of Duty” – WebMD's drug finder is an outstanding tool that helps research a particular prescription or side effects due to a combination of multiple medications. It stretches itself to determine whether a generic brand is a suitable substitute to a name brand.
Overall Impression - First impression of the site can be negative as there is too much information packed into its home page with limited real estate (cluttered with blogs, articles, and advertisements). But once a consumer enters the site with a specific motive, it is apparent that the information is up-to-date, referenced, and credible. The site also provides many links to other known reputable sites for healthcare information. To summarize, in spite of the design flaws of the website its content make up for the lackluster design and make it one of the best consumer health research service provider. WebMD tirelessly works to earn the consumer trust (a critical success factor for Health Information Service Providers). One of the earlier WebMD homepage title tag listed - “WebMD—Trustworthy, Credible, and Timely Health Information.” The current title tag is “WebMD—Better Information Better Health.” May be, WebMD believes that they had earned the consumer trust and they are moving the consumers to its second phase (of a lead player in influencing Health decisions with Better information).

WebMD had scored 3.71 on a 4.0 scale on a Mequoda Website Scorecard in 2005. The Best practices indexes that it scored below an A (4.0) are Relationship Building (C – 2.0), Content Density & Readability (B - 3.0) and Page Load Time (B – 3.0). Please refer the url for details: http://www.mequoda.com/reviews-and-studies/website-design-reviews/webmdcom-website-design-review/

Healthcare revenue models

It will be an interesting discussion to explore whether HealthCare revenue model will evolve into a model based on Patient (Customer) satisfaction and Service Excellence.
http://medicounlimited.com/EckertMGMA909.pdf provides a few KPIs that captures Patient Satisfaction.

Electronic health records need monitoring - A Sixth Stage

http://bx.businessweek.com/american-medical-association/view?url=http%3A%2F%2Fesciencenews.com%2Farticles%2F2010%2F02%2F03%2Felectronic.health.records.need.better.monitoring.ut.prof.reports

The five stage proposal by Dean Sittig PhD and David Classen, M.D. is a great approach

One of the key benefits of EHR is the cost benefit that it bring about. It will be a worth-while consideration to include an ongoing CostBenfit analysis as the sixth stage (in addition to the five stages outlined by Dean Sittig and David Classen). This Sixth stage will stimulate continued innovation in EHR domain even after its implementation.
The approach can be very similar to the one that is outlined in "A cost-benefit analysis of electronic medical records in primary care" by Samuel J. Wang MD, PhD, Blackford Middleton MD, MPH, MSc et al.. The approach can be extended across various specialities and care givers. The study results estimated net benefit from using an electronic medical record for a 5-year period at $86,400 per provider. Savings primarily came from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. The one-way sensitivity analyses, identified proportion of patients as most sensitive. The magnitude of the return was dependent on several key factors.

HealthCare consumers are susceptible but resilient to Security Threats (on Social Networking Sites/Email/Data Piracy):

Social networks are evolving into a much sought after resource for individuals seeking healthcare information. Patients leverage social networking groups to explore the experiences of others that are battling similar diseases. Clinicians connect via Social Networks to share information and learn from each other.

• 57% of users report they have been spammed via social networking sites, a rise of 70.6% from last year
• 36% reveal they have been sent malware via social networking sites, a rise of 69.8% from last year
• 72% of firms surveyed are worried that employee usage of social networking sites places their firms at risk
• Survey respondents identified Facebook as the social networking site posing the greatest security risks
• 49% of companies survey allow their employees unrestricted access to Facebook, up from 36% a year ago

Data protection is listed in four out of five computer security risks for Healthcare identified by Computer theft recovery firm Absolute Software published a year ago (Feb 2009)

1. Failure to Protect Sensitive Data Beyond Encryption
2. Inability to Accurately Manage Mobile Computer Assets
3. Sensitive Information on Public Terminals
4. Difficulty Implementing a Comprehensive Data Security Plan
5. Reluctance to Create a Data Breach Policy

Fortunately the biggest data losses of the last decade (http://informaticians.blogspot.com/2010/02/biggest-data-losses-of-decade.html) do not have an entry from HealthCare Industry. This may change in the next decade due to the extensive digitization in the HealthCare Industry and the high value of health records.
HIMSS had published steps and tools to effectively leverage HIPAA compliance to incorporate Data Security into a portfolio of risk management strategies thus protecting Data Privacy and Security Rule requirements and aligning Healthcare organization’s policies, procedures, and practices with an identifiable standard of practice.

Email and Web: One of the areas that Partnerka (Criminal affiliate networks) targeted extensively in 2009 is the online pharmacies promoted through spam to sell illegal, off-prescription and often unsafe pharmaceuticals. A report by web security company MX Logic states that pharmacy and other healthcare-related junk e-mails accounted for almost 69% of all spam during the month of Aug 2009. Source: http://www.sophos.com/sophos/docs/eng/papers/sophos-security-threat-report-jan-2010-wpna.pdf and http://www.mxlogic.com/pdf/forecast/threatforecast0909.pdf

What do consumers do now? If the digitization and internet statistics are any measure, the consumers are not running for cover. The consumers need to get savvy and protect him/her against such pranks and illicit trade on the internet. Consistent with any other facets of public life, consumers need to be alert of the illegal and anti-social activities in this exploding public domain of internet.

The biggest data losses of the decade

• January 2000: 300,000 credit card numbers are stolen from online music retailer CD Universe—news is leaked to the web after ransom demands are rejected.
• November 2000: Travelocity exposes data on 51,000 customers on a company web server.26
• March 2001: Bibliofind.com, an Amazon-owned service website, is breached and records of 98,000 customers are compromised.
• April 2001: Hackers announce the theft of personal data on 46,000 customers from US web hosting firm ADDR.com.
• February 2002: A former employee of US financial services firm Prudential Insurance Company is charged with stealing a database of 60,000 clients to sell online.
• March 2003: Five million credit card numbers and expiration dates are stolen from Data Processors International—an insider attack is suspected.
• June 2004: 92 million email addresses of AOL subscribers are sold to spammers.
• June 2005: 40 million credit card numbers are taken from a hacked credit card processing firm.
• May 2006: Details of 26.5 million US Army veterans are stolen by hackers.
• June 2006: Japanese telecom firm KDDI admits data on 4 million customers was leaked.
• January 2007: TJX Companies Inc., the global conglomerate that includes T.J. Maxx, T.K. Maxx, Marshalls and Winners, loses at least 45 million sets of credit card details after systems are penetrated by hackers.
• November 2007: UK HM Revenue & Customs loses detailed records of 25 million taxpayers.33
• March 2008: 12.5 million sets of records on backup tapes are lost by BNY Mellon shareholder services.
• September 2008: Two CDs containing records on 11 million people are found on a Seoul scrapheap. The data is traced to oil refinery GS Caltex.
• October 2008: T-Mobile Germany loses a hard disk containing information on 17 million customers.
• January 2009: Networks at Heartland Payment Systems are hacked, exposing data on 130,000,000 credit card users.
• May 2009: Secret information on the Joint Strike Fighter and President Obama’s personal helicopter were leaked through P2P networks.
• October 2009: Hard drives sent for repair are found to contain data on 76 million US Army veterans

Sources:

http://www.sophos.com/security/topic/privacy-data-security-compliance.html
http://attrition.org/dataloss/2000/01/cduniv01.html
http://news.cnet.com/2100-1017-251344.html
http://news.cnet.com/2100-1017-253601.html
http://attrition.org/dataloss/2001/04/addr01.html
http://www.nytimes.com/2002/03/02/nyregion/us-says-ex-prudential-worker-stole-colleagues-id-s-and-sold-them-online.html
http://www.sophos.com/pressoffice/news/articles/2005/02/sa_aolemail.html/
http://attrition.org/dataloss/2006/06/kddi01.html/
http://www.sophos.com/pressoffice/news/articles/2007/03/tjx.html
http://www.sophos.com/pressoffice/news/articles/2007/11/hmrc-id-theft.html
http://www.sophos.com/blogs/gc/g/2009/08/18/men-charged-130-million-credit-card-identity-theft/

Computer Security Risks for Healthcare

Computer theft recovery firm Absolute Software publised a year ago (Feb 2009) a list of top 5 computer security risk for healthcare institutions
http://www.securityinfowatch.com/root+level/1288605
1. Failure to Protect Sensitive Data Beyond Encryption
2. Inability to Accurately Manage Mobile Computer Assets
3. Sensitive Information on Public Terminals
4. Difficulty Implementing a Comprehensive Data Security Plan
5. Reluctance to Create a Data Breach Policy

Email experiences in Telemedicine - It is not all about Cost, but also about the Quality of Service

Location: Urban teaching Hospital in Western India and a Rural Primary Care-center
Subject: 182 newborn babies
Email traffic: 309 messages sent from the Rural Primary Care-center and 272 messages from the Urban teaching Hospital at an average response/reply time of 11.3 hrs.
Outcome:
38 babies were referred to the intensive care unit at the Urban teaching Hospital after these consultations and the remaining 144 babies were managed at the Rural Primary Care-center.
Telemedicine (via email) helped in the diagnosis, referral, treatment and follow-up of patients.
Cost to benefit ratio of 1:45
http://www.ncbi.nlm.nih.gov/pubmed/12217120

Alert and Caution on the Security threats to Social Networking sites

Consistent with any other facets of public life, it is prudent to be alert of the anti-social activities in this exploding public domain. The higher enrollment and traffic (reported by the networking sites) may account to the rise in security threats as well.
Here is a summary of Sophos report - http://www.sophos.com/sophos/docs/eng/papers/sophos-security-threat-report-jan-2010-wpna.pdf

• 57% of users report they have been spammed via social networking sites, a rise of 70.6% from last year
• 36% reveal they have been sent malware via social networking sites, a rise of 69.8% from last year
• 72% of firms surveyed are worried that employee usage of social networking sites places their firms at risk
• Survey respondents identified Facebook as the social networking site posing the greatest security risks
• 49% of companies survey allow their employees unrestricted access to Facebook, up from 36% a year ago

Focus on HealthCare IT

US Govt. is funding $975 million in grants to states and healthcare providers to implement health information technology. The funding is available for 100,000 hospitals and primary care physicians across US by 2014. The funding is to advance the exchange of health information at the state level, develop regional extension centers to assist health care workers on health IT and support 55 training programs in 30 states to develop job skills of, as many as 15000 people in the health IT field.

http://www.pharmacychoice.com/News/article.cfm?Article_ID=535065

Comprehensive view of the future of health care by Dr. Yellowlees

Dr. Peter Yellowlees ebook at https://www.smashwords.com/books/view/1465 is a very well written, comprehensive view of the changing face of healthcare with the widening influence of the Internet, especially in the most populous parts of the world. The book makes the reader think whether he/she is ready for the evolution in healthcare. Dr. Peter Yellowlees is in an elite league that blends the view of a health practitioner, leading academician, technology evangelist and visionary.

Intent

The intent of this bloging effort is to share ideas and thoughts in the various fields of informatics that spans Health Informatics

Introduction

I lead an Analytics team that spans Health Services. I am fortunate to work with Software product companies, information audit services and finally Analytics (out of interest and opportunities that opened out on the way). Health Informatics is a field of interest and hence a natural career choice for me. I am looking to get a deeper understanding of the various sub-specialties (such as telemedicine) within HealthInformatics.