$20 billion boost to online medical records systems sorely needed

Glad to see President Obama has earmarked $20 billion for bringing more medical records online. Believe me, it is terrifying to take someone suffering cardiac symptoms to the ER of the hospital that performed their open heart surgery and you are told the ER physicians can't find their records.

I guess some nay sayers are claiming it will take a long time to bring technology people up to speed to handle the new infrastructure. I agree with Greg Beese, head of the technology support firm Logic Group, who says he estimates that it would take only about two months for technology support professionals to become familiar with the medical-specific aspects of health care records. Database professionals understand the basic structure of related record storage and health care records are not that much different than storing legal records or anything else for that matter. Medical records require more multimedia container fields to store images and graphic data like ECGs but the real trick is not in the basic structure, it is in the proper tagging and cross tagging of data so interrelated causalities can be identified. That information will need to be provided by medical specialists - not technology specialists. Besides if existing systems can be leveraged as templates for systems not yet created, the conversion could be expedited.

Of course there are also the ultra paranoid in the crowd that are wide-eyed in terror over privacy issues. As long as sufficent encryption systems are placed to protect data from hackers, I don't see any reason to be any more alarmed about online medical records than online banking records. The biggest danger in shared medical records, whether paper or online, is the financial gain that could be made by insurance companies or medical groups "leaking" information to those willing to pay for it to reduce risk exposure. The current flap over Steven Jobs health and the impact it has on Apple's shares is a prime example of how certain health records could be coveted by those interested in reaping profits from the stock market. Still, a leak can occur whether the information is in hard copy or online. Placing information online may actually make such a leak easier to track. Record access logs are far more tangible than relying on a clerk's memory or trying to force a hostile witness to admit they have broken confidentiality agreements.

"The computerized records, when used properly, are an indispensable tool for measuring, tracking and improving patient care — yet only about 17 percent of the nation’s doctors are using them. They are commonplace at large medical groups, but 75 percent of doctors practice in small offices of 10 physicians or fewer.

Doctors often benefit from inefficiency, because the dominant fee-for-service payment system means they are paid for doing more — more doctor visits, tests, surgical procedures, pills.

“Paying to put computer hardware and software in physicians’ offices isn’t going to do anything unless you change the incentives in the system,” said Dr. David J. Brailer, former national health information technology coordinator in the Bush administration.

There are some experiments with a pay-for-performance approach, in which Medicare gives medical groups bonus payments for meeting certain benchmarks of quality care. Monitoring that performance requires electronic health records. Yet to date, these have been isolated tests.

“You want to pay for achievement — better health quality and efficiency,” said Dr. David Blumenthal, director of the Institute for Health Policy at the Harvard Medical School, who advised the Obama campaign. “But in the transition period, before financial incentives are reformed, you need to provide incentives or grants to use electronic health records because this technology is sort of the opening wedge to reform.”

Those eligible for grants to buy technology, a member of the Obama transition team said, will include inner-city and rural hospitals and small doctor practices. But most money, he said, will go to incentive payments to improve quality and safety of care."

But, I feel the rewards that could be realized in the advancement of treatment and quality of care will far outweigh these "chicken little (the sky is falling)" concerns.

New online law library looks more useful to lawyers than laymen

JDSupra.com, a new site, is stocking a free, virtual law library by persuading lawyers to do something highly unusual: to post examples of their legal work online for use by one and all, no strings attached. Many of the documents are articles and newsletters that can be understood by ordinary mortals who want more background on a legal issue, or who would like to find lawyers with expertise in a particular area.

It works like this: Lawyers who contribute to JD Supra dip into their hard drives for articles, court papers, legal briefs and other tidbits of their craft. They upload the documents, as well as a profile of themselves that is linked to each document. Site visitors who have a legal problem and are thinking about finding a lawyer can use an easily searchable database to look up, say, “trademark infringement,” find related documents and, if they like the author’s experience and approach, perhaps click on his or her profile.

Contributing lawyers get publicity and credit for the socially useful act of adding to a public database, and visitors get free information, said Aviva Cuyler, a former litigator in Marshall, Calif., who founded the business. “People will still need attorneys,” Ms. Cuyler said. “We are not encouraging people to do it themselves, but to find the right people to help them.”

I performed a general search on the term "copyright" and came up with a number of documents. However, the type of documents listed did not appear to be particularly useful to the average person without a legal background since they are formal motions without concise summaries to aid in the understanding of all of the verbose legalese they contain. Many appear to be motions to amend original motions to add other parties to legal actions filed by someone else. These types of documents contain little useful information about a particular issue and their presence just adds a lot of chaff to sift through looking for something useful (if you are not a lawyer looking for boilerplate).

Web-based database system opens up Baltic museum collections

I see some of the museums in the Baltic states are banding together to create a public database of their collections. I wonder if they'll allow non-commerical use of the images for teaching and education, though.

More and more museums are providing online access to their collections, making it possible to visit great cultural and historic treasures from the comfort of your home or office. The key to simple use is well-structured information, data access and site architecture. The EUREKA E! 2918 ONLINE CATALOGUE project has developed a cost-effective and easily configurable database system, simplifying access to almost any type of museum collection.

This web-based approach was developed to widen and deepen cooperation between museums in the Baltic States by improving functionality and ease-of-use, enhancing research, education and training. The system is already providing Internet access to museum collections in Latvia, Lithuania and Estonia for European and world citizens. The resulting open-architecture system will be marketed worldwide.

Evaluating Timeline programs and producing a Timeline with Filemaker Pro 7

This week I have been evaluating programs that can produce a Timeline. Although I have the Timeliner 5.0 program from Tom Snyder that lets you export a Timeline in HTML, I really wanted the ability to collaborate with colleagues at other locations on a Timeline site so I wanted a program that enables you to not only interactively view a Timeline but add Timeline entries from the web. Most of the online interactive Timelines I found were developed with a combination of PhP, MySQL, and Flash (to provide the graphic animation).

I even discovered that our own New Media Center had developed such a Timeline for one of the campus history courses. However, being a Filemaker Developer, it dawned on me that I could probably produce a Timeline program using Filemaker Pro 7 since it essentially provides the same capabilities as Php and MySQL and the new flexible relationship features of Filemaker Pro 7 coupled with its powerful scripting features and multimedia container fields could probably produce enough graphic complexity to avoid the introduction of a Flash component.

I also wanted the ability to provide a tool that could be used by Faculty to easily produce comparative Timelines and Timelines that could include entries grouped in different ways. So I sketched out a scheme that relates a Timeline definition table to a Timeline entries table. I also related a Timeline Entry Media table to the Entries table.

The Timeline Definition record includes a start and stop date and year, a container field for a banner image, a category field that is a muti-key field, and calculated time increment fields based on elapsed time from the start date or year. Using the start year field you can also define calculated fields for decade and century.

The Entry record includes the Entry Type (person or event - I will colorcode events by type), Title (name for a person), Description, Representative Image, Date, Year, a multikey Category field, a multikey Comparator category field, Select Image, Select Audio, Select Video (used for linking to the Media table), and the Entry ID (Key field for relationship to Media table). Using the Date field you can also define calculated fields for month, year, decade, and century.

The Media Table has the fields Entry ID, Media Type, and a container field to contain the media object.

By relating the Timeline Definition start year (or decade or century) field to the entry record event year, decade, or century calculations using the <= operator then relating the stop year (or decade or century) to the entry record event year, decade, or century calculations using the >= operator, you can produce a display of all events recorded in the entry table that fall between the two dates. By adding a relationship by category, you can filter the events displayed. For example, if the outline definition category field includes the values New York, United States, or North America and you relate it to the category field of the entry records in the Entry table, only events in New York or the United States or North America will display in the Timeline. If you want only events in New York, you place the single value New York in the Timeline Definition category field. If you want to compare a timeline of events in New York with events in the United States, you define a relationship between the Timeline Defintion field Comparator with the Entry category field. Then design a layout that displays the entries from the first relationship above a timeline displaying entries from the second relationship.

Vertical timelines can be produced easily by designing a layout in list view with fields placed in a single column. A horizontal timeline is produced by using the calculated Time increment fields spaced along a demarcated line then linking the Time increment fields to the Entry table with the >= and <= operators and defining portals that refer to these relationships.

If you're interested in looking at my prototype, it is available for download at:

http://interact.uoregon.edu/techweb/Timeline.fp7