Fujitsu Labs has been in recent years putting on technical symposia on various topics, and this week they held one on the subject of Healthcare Technology Convergence Smart Consumers Meet Care Delivery of the Future. Held at the Computer history Museum in Mountain View, it was completely sold out.
(1) Meredith Baratz, United Health Group. They have 70 million patient records going over 15 years. That can find groups of people with similar histories, that then diverge at some point of time. It is then possible to use the analytics to try to determine what the trigger of that change was. “Trigger Mining” — you read it here first. This is a form of process mining: you mine the patterns of care from the raw data. You then compare the patters, to find patterns that a similar at some points in time, but divergent at other points of time. Attempting to determine the triggers or indicators of the divergence is a lot like the effort known as decision mining where you try to determine the reason for a particular course of events when compare to other, divergent courses of events. Look forward to more of this in the future, I think this is very promising.
(2) Steve Evertelli from Intel Health Research gave a talk on “Sensors, what can they tell us?” A bit scary because it is talking about putting sensors in a living environment, and attempting to determine the health of the person there from the patterns of activity. Scary because while there is a clearly good side of this for monitoring patients whose health might be in need of monitoring, clearly the same technology could be used to determine other things about healthy people.
(3) Mike Liebhold, Institute for the Future said that every day a doctor needs to receive 11 pieces of research information per day. Most of this they get by visiting a conference, but that is inefficient. Would be better and more timely to be able to receive this information fluidly while they work. It is an interesting statistic for the Adaptive Case Management view because it quantifies the truth that new information is flowing to doctors every day, and they need to incorporate this information into their activities (their processes) on a daily basis.
(4) Dr. Joeseph Smith, West Wireless Health Institute, “We reward doctors for doing procedures, and we reward hospitals for being full. We are getting what the system rewards.”
(5) Dr. Mark Goldyne gave a talk to say that telemedicine is here today and working well. It is not surprising that the technology is good enough today that telemedicine is working well, but there is still a large amount of skepticism in the population at large. However, if you ask the patients that have been helped, they love the results, and it is important to let the population know how effective this can be.
(6) John DeSouza from MedHelp (http://www.medhelp.org/) is working on patient to patient healthcare. Consumer oriented health care. Doctors measure their time in 6 minute increments, and they are measured on how many patients they see in a given time period. There is a big need. This is “social” for healthcare. I am a big believer in this approach: I helped set up an on-line community in the mid-90’s around Cystinuria, a rare but serious disease, where the patient typically knew and shared more information than the average doctor, and this was life changing for many of the participants. He tell an amusing story about checking this community while at the hospital to give the doctor ideas of what the symptom might mean. People can, if they wish, share their data. I know, you might expect most would reject this idea, but actually a lot of people are willing to share information. The example was a chart of symptoms over the course of a pregnancy, and this really helps people feel that “they are normal.” One of the biggest difficulty is scanning for and eliminating spam – not surprising. Moderation is required. You might think that a community of patients and doctors might work, except for one thing: The AMA will revoke licenses of doctors that share advice in this way. For the time being patient to patient will probably be your only way to gain access to what is actually happening to others with your condition. Advertisement sponsored. A users bill of rights about what kinds of ads. Example, a video that was triggering epilepsy, and took it down right away.
(7) Mathew Holt, Health 2.0 conference. Focus on user generated healthcare. How do you democratize this, and how it is transforming healthcare.
- (a) Search: is so important to find healthcare data,
- (b) social network tools allow you to build dedicated healthcare communities,
- (c) tools for tracking and sensing.
The overlap of all of these is the most interesting. Spectrum of “content” to “transaction data” and trying to bring those together. Data meets “unplatform” (maybe cloud? His way of talking about mobile health.). Permissions and identity is an important part of this. Consider the internet enabled pillbox that can say whether a pill have been taken on schedule.
(8) Charles Kennedy, WellPoint, said that “Evidence based medicine costs less and improves the quality.” He seemed quite convinced that it is a win-win situation.
There were many more speakers, but I got dragged away and was not able to take notes.
- Event Details: http://flats2011.eventbrite.com/
- The Final Agenda: http://slidesha.re/iMOEI5
- Archived Healthcare technology convergence symposium video clips including, Keynotes, Panels and Fireside Chats are available at: http://www.ustream.tv/channel/fujitsu-technology-symposium-2011
Implementation of workflow engine technology to deliver basic clinical decision support functionality
Concidentally, the same day Vojtech Huser, who I originally met when he was working at the Marshfield Clinic, and who has been a supporter of standard approach to BPM and workflow, sent me a link to separate article about the intersection of Medical and BPM at Biomed Central called “Implementation of workflow engine technology to deliver basic clinical decision support functionality.” Long, and detailed, and shows how open source technology can be used to support the kinds of decision support that face a medical center. I often use medical care as an example of knowledge work that needs an adaptive process, and it is interesting to see how they have applied technology available today to this case.
Finishing up this post while at the Social Business Forum … need to make space for a new entry on that!
Tihs is a really interesting post 🙂
Concerning the delivering of CDS through workflow technology, maybe the readers of this post are also interested in our approach supported by AI hierarchical planning technnology, and that is based on the knowledge present in a previously defined Clinical Practice Guideline. Two papers will be presented next month on the conference of “Artificial Intelligence in Medicine” (AIME 2011)  and the Knowledge Representation for HealthCare workshop (KR4HC) .
1. “Careflow Planning: From Time-annotated Clinical Guidelines to Temporal Hierarchical Task Networks” (available already through google scholar).
2. “Task Network based modeling, dynamic generation and adaptive execution of patient-tailored treatment plans based on Smart Process Management technologies”.
Interesting stuff, Keith! One area is one that I have a strong interest in – what you call ‘Trigger Mining’. The mining of clinical data for treatment options is however not necessarily new. Clearly the past data may be interesting, but overall the problem is one of temporal accuracy. It is really difficult to take past data and turn them into a cause/effect network.
Which is why the approach with the User-Trained Agent that we use for all case/process situations will work equally well in patient care. ACTIONS that a ROLE user takes linked to related data patterns in the case state space is detailed by my 2007 patent (7,937,349 METHOD FOR TRAINING A SYSTEM TO SPECIFICALLY REACT ON A SPECIFIC INPUT). The neat thing is that it works in real-time for training as well as for recommendation and it learns from user feedback on the recommendation. Only the exact knowledge of what the state space looked like at the time of decision is practical.
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