Ramblings: Soft Launch of NYP-HIMSS Centre of Excellence

While this might be common news amongst the nursing and nursing informatics community in Singapore, it might be somewhat remote to the rest of the local healthcare informatics community given that it is still work-in-progress – HIMSS Asia Pacific is collaborating with Nanyang Polytechnic (NYP) in Singapore to set-up the NYP-HIMSS Center of Excellence for delivering quality healthcare through IT innovations here in Asia. (More information can be found here).

The focus of this Center of Excellence is on Nursing Informatics and I take great pride in sharing that I serve as the architect (solution, workflow, integration etc. ) for this initiative.
(Thanks to Steven Yeo for the opportunity to contribute)

Work pertaining to the COE has been taking place for about a year (from idea to concept etc.) and the good news is – the soft launch for the centre is scheduled for next week, on the 3 April at NYP.

I am actually quite excited about the soft launch because after that, we will be working on the solution for actual launch at HIMSS Asia Pacific’s Digital Healthcare Week 2013!

Ramblings: Healthcare Innovation 2013, Singapore

As usual, I thought I will provide some updates on the events where I delivered a topic. This post is on Healthcare Innovation 2013 that took place from the 27-28 March at Singapore Marriott Hotel.

This “Healthcare Innovation” conference is in its fourth year and I must say, it is getting even better!

The speakers this year are pretty good (I am not saying that the speakers last year were crappy  so do not misquote me) although there were a fair bit of vendor-organised talk, not that it is necessarily bad as some of the vendor speakers shared some really good insights.

As usual, I had the pleasure of meeting many old friends, many from overseas, as well as the opportunity of meeting new people.

With reference to the exhibitions, Microsoft was one of the sponsors and they had the Surface Tablet (both versions) at their exhibition booth. I had to mention the Surface Tablet because I have wanting to get my hands on the Surface Tablet (Its not officially released for sale in Singapore yet) so thanks to exhibition (and to Gabe Rijpma), I got a chance to fiddle with the device.

For this conference, I participated as;

  • A panelist for “Integrating clinical services to connect primary, secondary and tertiary care”
  • Panel Moderator for “Building vendor neutral medical imaging informatics in Asia”
  • Speaker delivering a topic titled “Standards for Consumer Healthcare – Enabling the Enabler”

I think I did pretty well for both panels but I must admit, I ‘slipped up’ for my presentation.

Not serving as an excuse – I reduced the number of slides recently (after being notified that my speaking slot has been shifted to the last item of the day – I didn’t want to overrun my timing and have everyone staying back) and was a little ‘unfamiliar’ with the new deck of slides. During my presentation, I ‘jumped the gun’ (by mistake) on a particular sub-segment by skipping two whole slides and totally lost my pace and train of thought.

While I tried to recover from the mistake, I realized that trying to clarify the concepts would confuse the audience so I decided to plough through it. So if you were one of the participants in audience and wonder why my message was a little disjointed – well, this is the reason why.

Again, it is not an excuse, I will definitely learn from this experience and for those who didn’t catch my message, what I was trying to convey was;

  • Determine the end-goal, assess the current state, define the proper workflow before selecting the technology, followed by the relevant standard
  • Consumer health should always be patient centric so ensure that your workflow is catering to that (and not system limitations)
  • There is no one de-facto standard for consumer health, there are different standards for different segments but there is no one-size-fits-all

Initially, I felt terrible as this is the first time I made such a mistake (the presentations I delivered after jet-lags were better than this) but the saving grace (in my opinion) was when Professor Steven Boyages came to discuss some of the points I made during the presentation, agreeing with me on two major points I made on why it is difficult to codify healthcare.

So that is it from me for Healthcare Innovation 2013, Singapore. Till the next presentation in April!

Update: Professor Steven Boyages sent a LinkedIn message after I posted  this blog entry, mentioning that he enjoyed my presentation. I guess I did managed to recover from the mistake (well, at least to a certain extend!).

Ramblings: Why it is important for us to help Low And Medium Income Countries

Yesterday, I had the pleasure of attending a Continuing Medical Education (CME) session conducted by the College of Public Health and Occupational Physician, Singapore at the Duke-NUS campus in Singapore General Hospital. (Thanks to Dr. Jeremy Lim of Insights Health Associates for inviting me).

The title of the topic was “Public Health Capacity in Afghanistan: Who, What, How and When”, by Dr. Dauod Khuram, BRAC Afghanistan’s Project Coordinator.

At this time, I am going to repeat the answers for a few frequently asked questions;

  • The reason why I am interested in public health is because I believe that prevention is better than cure and the modern healthcare system where we pour resources into acute care is unsustainable
  • This is also the reason why I am undertaking a Masters of Public Health (MPH) even though it is perceived as a ‘unprofitable segment’ in healthcare. I am doing the MPH out of personal interests, not for the potential monetary ROI
    (No one does a MPH to make money because there is none)
  • The reason why I am interested in Afghanistan or any Low And Medium Country (LAMIC) is because I think they need help (seriously). This is also why binaryHealthCare exists

So what was I trying to achieve by attending Dr. Dauod Khuram’s lecture? Well, one of my pet projects is to develop training materials on effective public health informatics in low resources setting as a capacity building tool in LAMIC (not the usual stuff I do in health informatics but I think this is equally if not more urgently needed) and I want to contribute it to Afghanistan when it is completed.

However, this is not the point of my post.

After attending Dr. Dauod Khuram’s lecture, I proceeded with other activities for the day (I do have to work in order to bring home the bacon 🙂 ) and by good fortune, I bumped into some old friends in another hospital’s cafe.

As I have not seen these folks for years, I sat down to chat and because we have not met for so long, I had to explain what I was ‘up to’ these days.

While I didn’t go into specific details, I did share the mission and vision of binaryHealthCare. Of course, it was with no surprise that I drew ‘blank looks’ and the usual puzzles on ‘why I want to spend time running a social enterprise to help Africans instead of utilising the time and skill sets earning lots of money’.
(There is also the usual misconception that being an ‘independent consultant’ means I am an ‘odd job labourer’ – which is not true but that is a story for another day).

So why help Low And Medium Income Countries (LAMIC)?

At this point, it is important to define help; I meant help as in “teach a man to fish” and not help as in “give a man a fish”, hence the rationale to ensure sustainable capacity building as oppose to just donating money – which I don’t have much to begin with!

Now back to my point to why help LAMIC. What many people do not realise is that the world is connected and we are all neighbours on the same planet. Some of us are fortunate to be born in developed countries while others had lessor luck and was born in areas with huge disadvantages.

If we do not help rectify some of the problems in other parts of this planet, it will come to affect us in one way or another. Using public health as an example, if there is a pandemic outbreak somewhere in a LAMIC and it is not contained properly (due to lack of infrastructure or knowledge/capabilities to do so), it will affect us globally because we are so connected (remember SARS?).

I have another example that is even better.

This morning, I came across an interesting TED talk by Allan Savory on reversing desertification in places like Africa and why it is important for humanity’s survival. In my humble opnion, this talk amplifies the message why it is important to help LAMIC if we have the capability. (Do watch the TED talk if you have the time, its very educational).

So think about it, how can you make a difference to others (so your children and their children can benefit from the butterfly effect

$8 camera, iPhone a breakthrough for diagnosing intestinal worms

I would like to share an article from The Australian that illustrates  what I  teach in the classroom (for my health informatics courses);

  • Innovation doesn’t need to be expensive
  • Effective implementation of health informatics doesn’t have to be expensive
  • Its all about being ‘contextually relevant’

SCIENTISTS used an iPhone and a camera lens to diagnose intestinal worms in rural Tanzania, a breakthrough that could help doctors treat patients infected with the parasites, a study says.
Research published by the American Journal of Tropical Medicine and Hygiene showed that it was possible to fashion a low-cost field microscope using an iPhone, double-sided tape, a flashlight, ordinary laboratory slides and an $8 camera lens.
The researchers used their cobbled-together microscope to successfully determine the presence of eggs from hookworm and other parasites in the stool of infected children.
“There’s been a lot of tinkering in the lab with mobile phone microscopes, but this is the first time the technology has been used in the field to diagnose intestinal parasites,” said Isaac Bogoch, a physician specialising in infectious diseases at Toronto General Hospital and the lead author on the study.

Intestinal worms infect two billion people around the world, mainly children, sometimes causing malnutrition. The malady can be difficult to diagnose, in part because of the high cost of a conventional microscope, which is priced at around $200.
Scientists used the cell phone microscopes to evaluate some 200 stool samples from rural children infected with intestinal worms, and compared the results against findings obtained using a conventional microscope.
They found overall that the iPhone microscope was able to detect the presence of eggs deposited by worms in about 70 per cent of the infected samples.
Although not as sensitive as the conventional device, the iPhone microscope can be made much more sensitive with refinements, Dr Bogoch said.
“We think cell phone microscopes could soon become a valuable diagnostic tool in poor, remote regions where intestinal worms are a serious health problem, particularly in children,” he said.
The researchers also pointed out that almost all medical staff already possess a cell phone, so the cost for a microscope cobbled together using the iPhone is deemed negligible compared to the cost for a conventional one.
Intestinal worms such as hookworms and roundworms, also known as soil-transmitted helminths, are particularly problematic in young children, hindering their physical and mental development by causing chronic anemia and malnutrition.
If quickly diagnosed, however, the negative health impact of the parasites can be greatly reduced

New software could help cut hospital admissions

Researchers from The University of Manchester, UK is demonstrating a new software, which will allow GP practice managers to improve healthcare for chronic illnesses including strokes, Alzheimer’s and cancer.

Do you see a trend here?

Experts have devised a computer programme which analyses how many patients in a practice have suffered from different conditions over a particular time period and identifies those who might require hospital treatment in the future.

Against a back drop of a drive for NHS efficiency savings, they believe the software will help practice managers to spot patterns earlier and reduce the number of costly hospital admissions for conditions like strokes by providing early intervention treatments. The breakthrough, which is already being trialled at a North West hospital, is one of a number of health innovations going on display at the Europe’s largest healthcare innovation event, the Healthcare Innovation Expo 2013, this month (March) held at the ExCeL Centre, London.

The software tool is part of the Greater Manchester Collaboration for Leadership in Applied Health Research and Care (CLAHRC) project. John Ainsworth, a Senior Research Fellow from The University of Manchester’s Faculty of Medical and Human Sciences, said the tool could lead to major changes in the way patients with certain conditions were treated. Known as COCPIT (Collaborative Online Care Pathway Investigation Tool), the software lets medics track patient journeys through the healthcare system and identify where care differs from guidelines.

“Our researchers have created an innovative software tool that enables health professionals to better understand the provision of healthcare services and opportunities for quality improvement,” Mr Ainsworth, who is also part of the Manchester Academic Health Sciences Centre – a partnership between the University and six NHS Trusts which aims to help implement research and innovation into practice, said. “This will improve healthcare planning by identifying inconsistencies and inequalities in healthcare provision and allow healthcare professionals to specifically focus on illuminating social inequalities in care. The tool will aid assessment of the clinical outcomes and economic impacts of intervention strategies and potential changes to care pathways intended to improve patient care and public health.”

Using the tool GPs, health professionals and commissioning organisations explore and analyse electronic health records. The tool allows professionals to:
• Identify at-risk patients,
• Audit current clinical practice,
• Investigate data quality issues,
• Explore inequalities in care.

Mr Ainsworth said: “By making it easier to explore electronic health records, COCPIT helps clinicians and managers to understand patient populations, target service delivery, reduce work repetition and improve patient care.”

One example might be that medics could re-trace the steps of patients who went on to have strokes to see whether their age, ethnicity, gender and socio-economic circumstances showed a common pattern. They could also look at any earlier identifying factors such as raised blood pressure and treat this, for example by offering medication, dietary and lifestyle advice.
The project was funded by the National Institute for Health Research (NIHR).

Web-based tool charts disease, risk factors around the world

I would like to share an article from the Washington Post, on the utilisation of Data collected via web-based tools, to track disease and risk factors over the world (Public Health).

Do you see a trend here?

Interactive graphics showing how causes of death and disability, and risk factors for disease, differ between countries and change over time were unveiled Tuesday.

The information is from the massive Global Burden of Disease project produced by 488 researchers and 303 institutions in 50 countries. It provides health profiles of 187 countries and allows the user to compare a nation to its geographic, economic or cultural neighbors.

The screens are interactive. Users can key in 291 diseases and 67 risk factors and see how prevalence has changed since 1990.

The graphs and lists are likely to function as a report card for policymakers, a hypothesis-generator for epidemiologists and an alternative to solitaire for global health wonks. The data are used in a study appearing in the Lancet this week that compares Britain’s health with that of 15 other European countries over 20 years.

Microsoft co-founder and philanthropist Bill Gates provided $8.2 million for the 2010 update of the project, which began in 1993. Speaking Tuesday at an event in Seattle where the Web tools were unveiled, he said that “it’s the areas where we go in and do a good job of measurement that we make the most progress.”

The foundation that Gates and his wife, Melinda, run has spent $26 billion since 1997, most of it on improving health in developing countries.

The Global Burden of Disease project is led by Christopher J.L. Murray, a physician and economist at the Institute for Health Metrics and Evaluation at the University of Washington. The institute was created in 2007 with a $105 million grant from the Gates Foundation.

Murray and another researcher, Alan Lopez, produced the first Burden of Disease report in 1993. It introduced the concept of the “disability-adjusted life year” (DALY), defined as the sum of years lost to premature death and years lived with disability.

Various disabilities — such as blindness, loss of a leg, chronic headaches, depression — were given the equivalents of fractions of a year of life lost. The idea was to go beyond mortality and capture how non-fatal illnesses also diminish life. Gates said he had an epiphany when he read the report and saw various health conditions described in terms of DALYs.

“I was completely stunned by the burden of disease in poor countries,” he said. “To see that diarrhea was killing literally millions of children, and that some of those causes of diarrhea, like rotavirus, were preventable. . . . It was seeing that data, that early visualization that’s nowhere near what we’ve got today, that got the Gates Foundation on the track of focusing on global health.”

Researchers will add to the data at least annually.

Ramblings: Big Data or Clinical Trials or both?

This article from New York Times illustrates the potential of drawing large amount of unstructured data (Big Data) in identifying medication safety, not just in the clinical setting but also the potential of addressing it in a public health context . Enjoy 🙂

 Using data drawn from queries entered into Google, Microsoft and Yahoo search engines, scientists at Microsoft, Stanford and Columbia University have for the first time been able to detect evidence of unreported prescription drug side effects before they were found by the Food and Drug Administration’s warning system.

Using automated software tools to examine queries by six million Internet users taken from Web search logs in 2010, the researchers looked for searches relating to an antidepressant, paroxetine, and a cholesterol lowering drug, pravastatin. They were able to find evidence that the combination of the two drugs caused high blood sugar.

The study, which was reported in the Journal of the American Medical Informatics Association on Wednesday, is based on data-mining techniques similar to those employed by services like Google Flu Trends, which has been used to give early warning of the prevalence of the sickness to the public.

The F.D.A. asks physicians to report side effects through a system known as the Adverse Event Reporting System. But its scope is limited by the fact that data is generated only when a physician notices something and reports it.

The new approach is a refinement of work done by the laboratory of Russ B. Altman, the chairman of the Stanford bioengineering department. The group had explored whether it was possible to automate the process of discovering “drug-drug” interactions by using software to hunt through the data found in F.D.A. reports.

The group reported in May 2011 that it was able to detect the interaction between paroxetine and pravastatin in this way. Its research determined that the patient’s risk of developing hyperglycemia was increased compared with taking either drug individually.

The new study was undertaken after Dr. Altman wondered whether there was a more immediate and more accurate way to gain access to data similar to what the F.D.A. had access to.

He turned to computer scientists at Microsoft, who created software for scanning anonymized data collected from a software toolbar installed in Web browsers by users who permitted their search histories to be collected. The scientists were able to explore 82 million individual searches for drug, symptom and condition information.

The researchers first identified individual searches for the terms paroxetine and pravastatin, as well as searches for both terms, in 2010. They then computed the likelihood that users in each group would also search for hyperglycemia as well as roughly 80 of its symptoms — words or phrases like “high blood sugar” or “blurry vision.”

They determined that people who searched for both drugs during the 12-month period were significantly more likely to search for terms related to hyperglycemia than were those who searched for just one of the drugs. (About 10 percent, compared with 5 percent and 4 percent for just one drug.)

They also found that people who did the searches for symptoms relating to both drugs were likely to do the searches in a short time period: 30 percent did the search on the same day, 40 percent during the same week and 50 percent during the same month.

“You can imagine how this kind of combination would be very, very hard to study given all the different drug pairs or combinations that are out there,” said Eric Horvitz, a managing co-director of Microsoft Research’s laboratory in Redmond, Wash.

The researchers said they were surprised by the strength of the “signal” that they detected in the searches and argued that it would be a valuable tool for the F.D.A. to add to its current system for tracking adverse effects. “There is a potential public health benefit in listening to such signals,” they wrote in the paper, “and integrating them with other sources of information.”

The researchers said that they were now thinking about how to add new sources of information, like behavioral data and information from social media sources. The challenge, they noted, was to integrate new sources of data while protecting individual privacy.

Currently the F.D.A. has financed the Sentinel Initiative, an effort begun in 2008 to assess the risks of drugs already on the market. Eventually, that project plans to monitor drug use by as many as 100 million people in the United States. The system will be based on information collected by health care providers on a massive scale.

“I think there are tons of drug-drug interactions — that’s the bad news,” Dr. Altman said. “The good news is we also have ways to evaluate the public health impact.

Ramblings: Speaking Slots for 2013

In line with binaryHealthCare’s mission, speaking at industry and academic conferences has always played a big part in my efforts for knowledge transfer and 2013 is no exception 🙂 .

As per usual, I have speaking slots lined up throughout the year and the first one would be for the 4th Annual Healthcare Innovation Summit Asia, held in Singapore from 27 – 28 March 2013 (this month).

The topic I will be delivering is Standards for Consumer Healthcare – Enabling the Enabler.

In addition, I’ll be moderating the Imaging Informatics Panel and joining in another panel for Integrating clinical services to connect primary, secondary and tertiary care: goal-setting, leadership, and the role of IT.

As per usual, lets catch-up if you will be attending the event.


Salford PhD student develops revolutionary elderly care robot

While the concept of having robots help in elder care isn’t a new one, this particular project at the University of Salford caught my attention – because the robot can tell jokes!

Antonio Espingardeiro, who is studying in Salford Business School and the School of Computing, Science & Engineering, has created the P37 S65 robot which has the ability to remind elderly people to take their medication and exercise, and can even tell jokes. It can also provide 24-hour emergency notifications and will directly connect to carers or GPs through video conference or SMS.

As resources to care for the elderly become more strained, Antonio believes that his robot can supplement the intensive care required by many care home residents and conduct routine tasks without significantly reducing the human contact that people need. Crucially, one person can monitor many robots – requiring fewer trained staff at each site.

In fact, based on his earlier studies in care homes he believes that his robot can actually improve quality of life for the elderly by promoting exercise, playing games and acting as a video link to family and loved ones. It will also support carers by following them around with meals and alerting them to emergencies and regular appointments.

His robot can be programmed with many routine health interventions that are designed for people with dementia – such as speech therapy and object recognition exercises. Through face recognition it can also remember the preferences and requirements of each patient, as programmed at the instruction of a human worker.

Antonio conducted initial fieldwork with existing commercially available robots and discovered that residents found them to be highly stimulating and a break from their normal environment. He feels that, with his bespoke P37 S65, there is even more scope for the robot to support the work of human professionals in the exercise of care.

“Care of the elderly is a difficult issue, but as populations age, we’re facing a difficult choice,” he said. “Do we employ more people from a smaller workforce to care for us in our old age, or do we provide lower standards of care with fewer resources?”

“With my robot I believe that we can avoid this problem. I’ve already established that robots can provide meaningful interaction to supplement human contact, and from my work with care homes, I’ve seen first-hand how both staff and residents benefit from their presence.”

While Antonio now has a prototype he is looking for investment to conduct field trials and perfect the robot’s systems ahead of a full product launch.

To find out more about P37 S65 watch this demonstration video..

Lack of Male Hormone Means Eunuchs Lived Longer

I thought I’ll share something ‘light’ with you guys – want to live longer? (I got this from Chosun.com).

During the Chosun Dynasty, poor young men often chose to castrate themselves to live within the relative comfort of the palace walls.

Most of the eunuchs seen in Korean costume dramas are elderly, and the question is whether eunuchs typically lived longer than other men. Scientists have found that the average life span of a eunach during the period was 70 years, while men from noble families had an average lifespan of just 51 to 56 years.

Even more surprisingly three out of the 81 eunuchs studied actually lived past 100.

This is the first time Korean researchers have used historical data to prove that male hormone reduces men’s life span.

“Scientists were aware that castration of mammals increased their life span, but we were not able to relate the findings to humans until now. This research proves that male hormones do cause an earlier death,” a researcher said.

The scientists say they hope to use the data to figure out ways to increase the human lifespan. The research paper titled “The lifespan of Korean eunuchs” is available on the website of Current Biology (http://www.cell.com/current-biology/).

Still interested in living longer?