Andy Oram

Andy Oram is an editor at O'Reilly Media. An employee of the company since 1992, Andy currently specializes in open source technologies and software engineering. His work for O'Reilly includes the first books ever released by a U.S. publisher on Linux, the 2001 title Peer-to-Peer, and the 2007 best-seller Beautiful Code.

Building the Brain of Dr. Algorithm

Archimedes advances evidence-based medicine to foster model-based medicine

This posting is by guest author Tuan Dinh, who will speak about this topic at the Strata Rx conference.

Legendary Silicon Valley investor Vinod Khosla caused quite a stir last year when he predicted at Strata Rx that “Dr. Algorithm”–artificial intelligence driven by large data sets and computational power–would replace doctors in the not-too-distant future. At that point, he said, technology will be cheaper, more accurate and objective, and will ultimately do a better job than the average human doctor at delivering routine diagnoses with standard treatments.

I not only support Khosla’s provocative prophecy, I’ll add one of my own: that Dr. Algorithm (aka Dr. A) will “come to life” in three to five years, by the time today’s first-year med school students are pulling 30-hour shifts as new interns. But what will it take to build the brain of Dr. A? And how can we teach Dr. A to account for increasingly complex medical inputs, such as laboratory tests results, genomic/genetic information, family and personal history, co-morbidities and patient preferences, so he can make optimal clinical decisions for living, breathing patients?

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OneHealth: Combining Patient-Generated Data With Communities and Feedback Loops

Evolution from a research tool to a platform for patient engagement

Bruce Springer of OneHealth will speak about this topic at the Strata Rx conference. This article was written by Patrick Bane of OneHealth in coordination with Bruce Springer.

According to a recent study performed by the Jesse Brown VA Medical Center and University of Illinois at Chicago, patient-centered care has demonstrated positive outcomes on patients’ health, patients’ self-report of health, and reduced healthcare utilization. The study’s results are consistent with previous research that the patient-centered care model improves the quality of care while simultaneously lowering the cost of care.

OneHealth’s behavior change platform extends the patient-centered model by connecting members anytime, anywhere through mobile and web applications. Member generate data in their daily lives, outside of a clinical setting, which creates a much richer dataset of behaviors that are required to understand the patients’ condition(s), and their readiness to change. Members freely choose what to do and their choices actively generate data in five classes of information:

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How to bend fate in the health care field

Data that matters to patients

This article is by guest author Amik Ahmad. He is speaking on this topic at Strata Rx.

Distractions didn’t have a chance. My phone was devoid of reception. The New York Times mobile application searched impossibly for a Wi-Fi connection. Conditions perfect for focus: away from a world always on and connected, noisy, and belligerent with information overload. I could have found joy in a single byte. But instead, I was pushed to the limit of sensory deprivation, and I teetered on the edge of insanity. I spent nine hours of my life in a hospital waiting room.

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Combining personal data with ratings for targeted medical information

HealthTap refines the answers returned to specific health queries

HealthTap is a community of doctors and clients seeking answers to health questions. Its central service provides immediate access to doctors and their knowledge either by doctors answering client questions in real time, or through a large database of previously answered questions and answers from doctors that are peer reviewed and tagged with recommendations by other doctors. By combining the doctors’ recommendations with data provided by each client on himself or herself, HealthTap provides customized results to queries. In this video, HealthTap CEO Ron Gutman explains unexpected lessons they’ve learned from offering the intelligent search service.

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Ginger.io: Putting the Patient-Provider connection at the center

A tool for outreach to patients produces unexpected benefits

This posting was written by guest author Julia Bernstein of Ginger.io. Ginger.io’s CEO Anmol Madan will be speaking on this topic at Strata Rx.

The traditional, office-based model for health care is episodic. The provider-patient relationship exists almost completely within the walls of the exam room, with little or no follow-up between visits. Data is primarily episodic as well, based on blood pressure reading done at a specific time or surveys administered there and then, with little collected out of the office. And even the existing data collection tools—paper diaries or clunky meters—are focused more on storing data that on connecting the patient and provider through that data in real time.

There is no way to get in touch when, for instance, a patient’s blood sugar starts varying wildly or pain levels change. The provider often depends on the patient reaching out to them. And even when a provider does put into place an outreach protocol, it is usually very crude, based on a general approach to managing a population as opposed to an understanding of a patient. The end result is a system that, while doing its best within a difficult setting, is by default reactive instead of proactive.

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Clinical discovery in the age of “Big Data”

Modern data processing tools, many of them open source, allow more clinical studies at lower costs

This guest posting was written by Yadid Ayzenberg (@YadidAyzenberg on Twitter). Yadid is a PhD student in the Affective Computing Group at the MIT Media Lab. He has designed and implemented cloud platforms for the aggregation, processing and visualization of bio-physiological sensor data. Yadid will speak on this topic at the Strata Rx conference.

A few weeks ago, I learned that the Framingham Heart Study would lose $4 million (a full 40 percent of its funding) from the federal government due to automatic spending cuts. This seminal study, begun in 1948, set out to identify the contributing factors to Cardiovascular Disease (CVD) by following a group of 5,209 men and woman and tracking their life style habits, performing regular physical examinations and lab tests. This study was responsible for finding the major risk factors for CVD, such as high blood pressure and lack of exercise. The costs associated with such large-scale clinical studies are prohibitive, making them accessible only to organizations with sufficient financial resources or through government funding.
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One-click analysis: Detecting and visualizing insights automatically

Arijit Sengupta of BeyondCore uncovers hidden relationships in public health data

The importance of visualizing data is universally recognized. But, usually the data is passive input to some visualization tool and the users have to specify the precise graph they want to visualize. BeyondCore simplifies this process by automatically evaluating millions of variable combinations to determine which graphs are the most interesting, and then highlights these to users. In essence, BeyondCore automatically tells us the right questions to ask of our data.

In this video, Arijit Sengupta, CEO of BeyondCore, describes how public health data can be analyzed in real-time to discover anomalies and other intriguing relationships, making them readily accessible even to viewers without a statistical background. Arijit will be speaking at Strata Rx 2013 with Tim Darling of Objective Health, a McKinsey Solution for Healthcare Providers, on the topic of this post.

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Donald Berwick discusses health care improvement: goals, exemplary organizations,and being at a turning point

A video interview with entrepreneur Colin Hill

Last week, a wide-ranging interview on data in health care took place between Dr. Donald Berwick and Colin Hill of GNS Healthcare. Dr. Berwick and Hill got together in the Cambridge, Mass. office of the Institute for Healthcare Improvement, a health care reform organization founded by Dr. Berwick, to discuss data issues related to O’Reilly’s upcoming Strata Rx conference.

Berwick returned to IHI after his year as administrator of Centers for Medicare & Medicaid Services. Throughout these changes he has maintained his stalwart advocacy for better patient care, a campaign that has always been based on a society’s and a profession’s moral responsibility. Even an IHI course for the “Patient Safety Executive” program puts “Building a just culture” on its agenda.

Among the topics Berwick and and Hill look at in these videos are the importance of transparency or “turning on the lights,” ways of learning from the health provider system itself as well as from clinical trials, types of personalized medicine, the impediments to collecting useful data that can improve care, exemplary organizations that deliver better healthcare, and how long change will take.

The full video appears below.

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Open source software creeps in to health care through clinical research

Report from OpenClinica conference

Although open source has not conquered the lucrative market for electronic health records (EHRs) used by hospital systems and increasingly by doctors, it is making strides in many other important areas of health care. One example is clinical research, as evidenced by OpenClinica in field of Electronic Data Capture (EDC) and LabKey for data integration. Last week I attended a conference for people who use OpenClinica in their research or want to make their software work with it.

At any one time, hundreds of thousands of clinical trials are going on around the world, many listed on an FDA site. Many are low-budget and would be reduced to using Excel spreadsheets to store data if they didn’t have the Community edition of OpenClinica. Like most companies with open-source products, OpenClinica uses the “open core” model of an open Community edition and proprietary enhancements in an Enterprise edition. There are about 1200 OpenClinica installations around the world, although estimation is always hard to do with open source projects.

What is Electronic Data Capture? As the technologically archaic name indicates, the concept goes back to the 1970s and refers simply to the storage of data about patients and their clinical trials in a database. It has traditionally been useful for reporting results to funders, audit trails, printing in various formats, and similar tasks in data tracking.

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Ways to put the patient first when collecting health data

Report from 2013 Health Privacy Summit

The timing was superb for last week’s Health Privacy Summit, held on June 5 and 6 in Washington, DC. First, it immediately followed the 2000-strong Health Data Forum (Health Datapalooza), where concern for patients rights came up repeatedly. Secondly, scandals about US government spying were breaking out and providing a good backdrop for talking about protection our most sensitive personal information–our health data.

The health privacy summit, now in its third year, provides a crucial spotlight on the worries patients and their doctors have about their data. Did you know that two out of three doctors (and probably more–this statistic cites just the ones who admit to it on a survey) have left data out of a patient’s record upon the patient’s request? I have found that the summit reveals the most sophisticated and realistic assessment of data protection in health care available, which is why I look forward to it each year. (I’m also on the planning committee for the summit.) For instance, it took a harder look than most observers at how health care would be affected by patient access to data, and the practice of sharing selected subsets of data, called segmentation.

What effect would patient access have?

An odd perceptual discontinuity exists around patient access to health records. If you go to your doctor and ask to see your records, chances are you will be turned down outright or forced to go through expensive and frustrating magical passes. One wouldn’t know that HIPAA explicitly required doctors long ago to give patients their data, or that the most recent meaningful use rules from the Department of Health and Human Services require doctors to let patients view, download, and transmit their information within four business days of its addition to the record.

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