Comments on "Advance Health Informatics"

The web based VistA system should be mandated for implementation in the US. It would speed up implementation of a national system of EMRs by at least 30 years and save billions of dollars. And the PHR must be an abbreviated version of the EMR. The present direction the government is taking, fostering the development of many different systems, will never work..

Health care is critically informed by images—Xrays, ultrasound, CT, MRI, PET—and quality of care is dependent on having those images and the information contained in them readily available to physicians and caregivers. Imaging informatics has advanced substantially and most hospitals and practice have digital imaging acquisition and storage capabilities. However, these images are usually separated from the electronic medical record and often not immediately available outside of the imaging suite. This is merely inefficient when the patient, images and physician are all in the same location, but when transitions in care occur or a patient is referred to another physician or hospital, the lack of accessibility of images and the information they contain can jeopardize care—causing delays, requiring expensive repeat testing with associated radiation exposure or even inaccurate decision making simply because all the data are not available. One Solution is to create a HIPPA-compliant, patient driven way to allow review of images amongst caregivers. The universal use of the DICOM standard and digital archiving means that the images are available in a ‘transportable’ format. Using a patient token or other secure permission granting process as well as only allowing viewing and not down loading would ensure privacy. The Challenge is to establish and broker the connections between the now-isolated PACS systems and any caregiver authorized by the patient to view his/her images

When babies are born, they need to have their DNA referenced and stored for future adjustments to their bodies when genetic malformaitons crop up. Corrections could be made and faulty genes could be replaced. It should be possible in the future to reverse the aging process and keep people at an optimum age for the rest of thier lives thanks to DNA referencing and genetic manipulation. Synthetic organs and body components will allow people to live longer and healthier lives. My synthetic heart that uses an electrochemical reaction to expand and contract the artificial muscles would be more natural and with the organ using the body's energy, a nuclear battery, and a chemical catalyst that would use the sugar in the body to generate more energy, the heart may not need to be serviced for years. With sensors in it, the heart will be able to beat more and stronger when needed and slower when the person is at rest. My chemical catalyst device that will take simple chemicals and produce substances that he body needs would save people hundred or even thousands of dollars annually. Also, there would be no side effects since the chemicals produced would be what the people need. Also, the device should work faster than the liver or kidneys in removing harmful substances from the body. My nerve bypass, the first version which was proposed in 1974, could allow people to live normal lives again. Biojunctions may be needed so that the natural nerves can be joined to the artificial ones. Originally I thought an energy supply and a transformer may be need for the bypass. With electrochemical stimulation, there may not need to be a power source except for the body. My pain bypass would work almost on the same principle except that a shut off device would prevent pain signals from reaching the brain. They would be monitored but not felt. In hospitals, pain bypass units would tell doctors if a person is healing or still in pain even though they don't feel anything. People wouldn't be hooked on them like they would on morphine or other pain killing medication. Healing would be more rapid and patients would be mroe comfortable. When I suggested robot surgeons I refer to as mediunits over 25 years ago, a woman told me she would never want a robot to work on her body. I told her that she would most likely be unconscious by then. Mediunits would be faster and more efficient than doctors and in constant contact with a medical computer for further guidance. They won't have a great bedside manner. But at least they have and will save lives. If we can replace the telamerase molecule of the DNA with something that doesn't contribute to cellular death and can be replicated, when used in conjuction with DNA referencing and genetic manipulation, a person could conceivable live forever. Cellular replacement of defective tissue could replace cancerous organs and biosynthetic anti-bodies that are programmed to exclude toxic and diseased material plus harmful bacteria and viruses may improve our health. In my book THE MADHOUSE PROJECTS, I call the latter treatment simply the treatment. It's one device in the throat and two up the nose to prevent colds and flu. The doctor who implants my heart tells doctors in the gallery watching him that he is going to recommend that the patient eat more sugar so that the energy catalyst can work more efficiently. A nerve bypass also allows a woman who was paralyzed in a pool accident to function normally again. In Paris, a woman from the Madhouse treats coma patients by adding brain chemicals and electrical stimulation to the brain to bring the patients out of comas. A brain override device helps a person in the telecommunications area to work without needing to sleep. (You can order a copy of THE MADHOUSE PROJECTS over the Internet. Just look up Rick Badman and the book title.) Once we can determine how best to treat individuals without causing harmful side effects, doctors may be able to personallize treatment and prevent physical problems in the future. Once we can insert solid state brain implants that can work with the rest of the body and improve the brain plus allow people to interact with experiencable programs in computers better, many of our medical problems might come to an end. One time released tablet with exactly what the body needs to remain at peak efficiency might be all a person needs each day. Medical cost should go down once we can make medicine more efficient and effective. If the aging process can be reversed and cellular degradation eliminated, we could have a healthier population that lives for centuries.

Doctors don't just need access to your entire medical history, they need it in a form that makes it quickly available to them---at a glance, instead of having to shuffle through tons of data. For instance, if the figure of a human appeared on the screen, with areas of the body highlighted, or bearing icons, indicating past or current surgeries or illnesse, doctors could click on whatever was of interest, get date, diagnosis, treatment, etc. There could be a scroll across the bottom with most recent test results that proved abnormal---an icon to click to see current and past medications, reactions--an icon to click to see unusual or important family histories of disease---etc. The main thing is, at a glance, all the important data would be visible. Data on a patient could be put into a standardized information matris, able to be called up in a variety of ways, if standardized methods were adopted by labs, pharmacies, health insurers, hospitals & doctors. Also, with the ability to store so much data in small devices, people could elect to carry their own information on their person, rather than have it part of a hospitals general records. And the information, once stored on personal devices, or charts, could have identity elements removed and be used for general studies while the person remained anonymous.

Certain aspects of medical informatics could easily be solved with standard engineering methods of yesterday. For instance, sharing information that is generated from machines--X-ray, CT, MRI, laboratory test results. They are being held back primarily because these information are being overpaid by insurers. Making them accessible to other doctors would arguably lead to a loss of income. Other aspects of medical informatics that require interpretation of health care professions--clinical notes is currently held back by the huge (and unjustifiable) cost of medical IT that cannot be sustained by smaller clinics. Unfortunately, no one is making a net-based free medical record system that any doctor can use in a user friendly way. That would be GRAND! Most docs that are involved in medical informatics don't even see patients--some of the people you quoted for instance. They are in poor position to be directing these efforts since they don't use it and suffer the pains of using current software.

Healthcare is never as important as other discussed topics like water, energy, pollution, etc. Information Systems in Healthcare additionally can have a huge impact in healthcare but also outside healthcare. When in healthcare the complex nuts are cracked, that are called: semantic interoperability and privacy, healthcare can improve dramatically. Not only healthcare but any information processing system (e-Government, e-Business) might improve its flexibility and semantic interoperability capabilities at the same time considerably. What is NOT known widely is that this nut has been cracked, has been engineered and has found its way into a European standard and the first part is published as an ISO standard recently. The first commercial products are entering the market. The CEN/tc251 EN13606 EHRcom standard and the published open implementable specification via openEHR make generic semantic interoperability possible. Each healthcare provider or group of providers is allowed and capable to define what data and information they want to store, retrieve, present and exchange using tools. All this without any reprogramming by the software vendor and without data base conversions ever. This EHR standard is based on a new paradigm. This Archetype paradigm (also know as Two Level Model paradigm) is NOT based on the present notion of autonomous EHR-systems with proprietary (vendor specific) data base models and messaging. More information can be found: via www.openEHR.org and via g.freriks@e-RecordCompany.EU Gerard Freriks former convener of CEN/tc251 wg1 responsible for the EN13606