A little bit of Amber + Informatics = Jurassic Park

This weekend I had the privilege of seeing the awesome reboot of Jurassic Park, Jurassic World.  If you haven’t seen the movie, don’t worry I am not going to give any of it away.  Seeing the film, however, got me to thinking about informatics.  Why, you might ask would I think about informatics while seeing Jurassic World.  I think it has something to do with the millions of Neurons firing in my brain similar to this image borrowed from Boston Magazine.  My brain is constantly in motion, and it got me to thinking could informatics promote Michael Crichton’s original genetics nightmare?

Using many of the DNA sampling kits currently on the market, it would be possible to collect dinosaur DNA and sample it so as to represent a DNA model.  Now here is where my stretch thoughts about informatics come into play.  I today’s world informatics along with a great deal of research has helped us to isolate the specific genes that cause cancer (as shown in this image from Softpedia).

I would argue that informatics is one of the disciplines that enables our researcher and practitioner community to collect and understand the data necessary to conduct research experiments and draw conclusions that may ultimately lead to a cure for a particular type of cancer.  It is informatics that also helps pharmacists and providers understand the effectiveness and side effects that a particular drug might have a certain kind of patient.  In this new world. We are beginning to call personalized medicine it is the informaticist that provides the capabilities to help physicians, patients, and researchers to understand the data they are collecting.

The same case could be made for understanding the DNA of a dinosaur.  Using technologies we have today, we can certainly model the DNA for a particular dinosaur.  But, what about those gaps in the DNA that prove so terribly troublesome in the book and movies?   With our understanding of data informaticists can work with the researchers to understand the gaps, evaluate the type of DNA that would best fit the holes, and even hypothesize on what the Dinosaur’s disposition might be given the various mixes of DNA.  Now I am not arguing that this process is possible, and if possible should happen; my point is that it is the informaticist that helps to understand the data.

I’ve come across many HCOs who consider informaticists to be just coders.  I hope that with the points I made above folks within and outside the industry will begin to think of informaticists as professionals with significant technology and data manipulation capabilities.

Can informatics help the healthcare labor market?

If you are like me, you probably see an article every week on the need for information technology positions within the healthcare community.  As a current informatics student and a mentor to other informatics students. I can safely say that there are many people with highly developed information technology and informatics skills ready and waiting for these positions.  Would a large healthcare organization release the statistics around their open positions for those of us who are informaticists and data geeks to review?  I’d like to know how long these positions stay open, what sorts of education and certifications are required, and what are the characteristics that describe people who are hired into open informatics positions?  Many of my fellow students and folks that I interact with complain that they never hear anything from these large healthcare organizations.  Those of you who have read my previous blogs know that I am an open data advocate and I’d like to use the power of open data to try and figure out why there is such a gap in the hiring of informatics professionals.

Informatics, enterprise architecture, and hip replacements is there really a relationship?

As an enterprise architect and budding informaticist, it occurred to me the other day do the two disciplines intertwine?

There are many definitions and uses for enterprise architecture (EA).  From my perspective having worked on the first versions of the Federal Enterprise Architecture Framework, EA is a framework for describe how systems, data, and business process work together.  EA is used by many organizations to represent current day and future day representations.  EA is an excellent tool for describing the interworkings of technology within an organization.  Regardless of the framework and methodology that one uses to create and manage an EA if the EA is adopted throughout the organization it will prove tremendously powerful to the organization’s management.

So what does EA have to do with informatics?  Indiana University has an interesting definition that Informatics turns data into knowledge.  Understanding and finding data is directly related to having a valid and useful EA.

Let’s take a real example of how EA and Informatics intertwine.  According to the Journal of Bone and Joint Surgery, the number of hip replacements is expected to increase by 174% to 574,000 by the year 2030.  If one considers the many systems and knowledge required to support these surgeries, it is easy to see how EA and informatics intertwine.  From an EA perspective there are systems that support the supply chain necessary to deliver HIP replacements, there is data that is mined to determine the quality of the HIP replacements and the per unit cost of each replacement.  Furthermore, there are business processes that diagnose the need for hip replacements, place orders for the particular parts required to support the surgeries, and many processes leveraged to manage the operating rooms where the replacement parts are inserted.

Informatics is the ability to mine the data and processes described in the EA to improve the hip replacement experience.  Informatics helps hospitals control the costs of the procedures.  Informatics help physicians accurately diagnose and treat a particular patient.  Informatics helps the nursing staff to understand the types of services and needs patients with hip replacements will need before, during, and after their hospital stay.

Those of us who work with EA or Informatics tend to focus only on our particular discipline, but it is important to remember that each discipline fits together and that one can not properly exist without the other.

The cure for all our healthcare woes

As I work on my UIC knowledge management homework this weekend, it occurred to me that health data and health knowledge are the answers to all our healthcare woes.  I know it is silly to say that #knowledge and health data are the answers to our healthcare woes but they are.  To support this hypothesis let’s look at cigarette usage.

Health data leads to Knowledge that influences policy and ultimately results in improved patient outcomes.  As an example, I’d propose that the degree of taxation applied towards cigarettes has been one of the major factors in its dramatic decrease in usage.  Take this chart from the CDC, it displays the decline in cigarette use from 2011-2013.

What does this chart show us?  It shows us that cigarette smoking has decreased in most states from 2011-2013.  Now combine the fact that cigarette smoking has declined with this graphic from the BLS showing that as cigarette prices go up, consumption goes down.

I would argue that because of the research the CDC conducted on cigarette smoking that #healthcare knowledge was developed showing just how dangerous cigarette consumption is not just for the smoker but for the entire healthcare system.  Over time, policymakers began to take knowledge of the CDC knowledge and enacted policies to limit the use of cigarettes through the use of taxes.  With the theory that the taxes would dissuade smokers and fund treatment options.

Would love to hear from you

Informatics, health data, does any of it really matter

As I continue to advocate for expanded use of informatics and the data necessary to drive it I find myself does any of it really matter.  As we get ready for this week’s health data Palooza and look back the many data sets published by CMS like Open Payments.  Now while one might be apt to dismiss open payments they shouldn’t.  Open Payment is a powerful set of data.  It tells you which providers are receiving payment from which pharmaceutical companies.  Now I don’t think there is anything inherently wrong in a pharmaceutical representative taking a physician out-to-lunch to explain the latest in pharmaceutical capabilities.  Where I get concerned is when Open Payments shows the payments between the provider and the pharmaceutical company are much larger than a single lunch or two.  openpaymenI also have to ask myself is there any correlation between these payments and the prescriptions that the provider writes.  I’m encouraged to see agencies like CMS continue to publish data but would like to see the private industry follow.  Surely there is a way to share health data in such a way as not compromise privacy and protect intellectual rights?

But, back to my original question.  Yes, I think health data and informatics matter.  The challenge is to find data that is relevant and put it together to answer previously unanswered questions or to identify new questions that one hasn’t thought about.  So if you are an open data, open health data, health data, informatics, or electronic health record advocate I hope you join me in the fight to make our industry relevant and useful.

The Need For Marijuana

Today I was listening to a story on a large Pill Mill bust that had the unintended consequence of depriving patients of their pain medicine.  Law enforcement officials arrested more than 200 doctors, physicians, and patients across four states.  It got me thinking, why not use Marijuana?

What’s interesting about the piece is that we (as a nation) continue to see spikes in the use of prescription painkillers with a recognition that law enforcement can barely hold back the tide in terms of illegal use of these medications.  Even legal uses of these medications have become so difficult to obtain that I suspect many patients give up and go to the black market.  As one can see from the following chart the total number of painkiller prescriptions continues to increase.

As the number of prescriptions increases it only goes to figure that a patient’s dependence on these drugs only increases.  Unfortunately, for patients dependent on Opiate painkillers it becomes increasingly more difficult to legally obtain the medication.  As a result, patients with dependencies turn to the black market and over time migrate to Heroin because it is a cheaper (and in some cases) and a stronger high.  I don’t think it is coincidence that if you look at the chart below you can see that Heroin use has decreased as has the use of Opioids

Now I’m not suggesting that there is a direct correlation from Opiate based painkillers to Heroin but the data seems to suggest that the issue warrants further study.  So if we have an epidemic in the use of Opiate based painkillers that leads to an increase in the use of Heroin what can be done?

According to the Institute for Substance Abuse Evaluation “Many opioids are prescribed for their analgesic, or pain-relieving, properties. Morphine, codeine, and related drugs that fall within this class are sometimes referred to as narcotics. Morphine is often used before or after surgery to alleviate severe pain. Codeine is used for milder pain. Other examples of opioids that can be prescribed to alleviate pain include oxycodone (OxyContin), propoxyphene (Darvon), hydrocodone (Vicodin), hydromorphone (Dilaudid), and meperidine (Demerol). In addition to their pain-relieving properties, some opioids – for example, codeine and diphenoxylate (Lomotil) – are used to relieve coughs and diarrhea.”  Given these many uses of Opiate based painkillers it is no wonder that we are seeing increased addictions.

What if a drug such as Marijuana could help to relieve some of these conditions instead of the use of Opiate based painkillers?  This graphic from NORML presents a view of the many ailments that if used properly Marijuana could help with.  Now I’m not advocating that Marijuana is some new wonder drug or that it is the solution to our drug addiction problems, but what I am saying is that those of us working with health data and informatics need to take a hard look at Marijuana with legitimate data and studies that can help to better educate the public as to Marijuana’s benefits and impacts.

The need for cancer transparency

Just in the course of today’s media posts I saw articles that discussed using genetically modified lettuce to replace chemotherapy and another article on the importance of tracking incidents of cancer.  These articles got me to thinking about a recent paper I completed on a notional cancer transparency portal.  The Transparency Portal I envisioned in this paper provides a mechanism for cancer research and treatment centers to become more transparent in their use and publication of cancer data.  When fully implemented a Transparency Portal can enable a cancer research center or provider to publish cancer-related data in an open and accessible way. A recent AMIA panel charged with developing a national framework for the use of secondary (e.g., use of data outside of the facility) use of health data has several relevant recommendations.  The panel evaluated organizations currently engaged in publishing health data. Upon reviewing the current landscape the panel determined that organizations should be aware of and plan for the publishing of secondary health data(Safran, Bloomrosen, Hammond, Labkoff, Markel-Fox, Tang, et al., 2007). The first concept the panel identified centered around the recognition that health data is becoming widely (Safran, Bloomrosen, Hammond, Labkoff, Markel-Fox, Tang, et al., 2007). The panel found that the use of secondary health data is widespread and should addressed by any organization engaged in the health ecosystem. The panel also found that many potential users of published health data are unaware that the data even exists (Safran, Bloomrosen, Hammond, Labkoff, Markel-Fox, Tang, et al., 2007). The panel went on to recommend that organizations take care to promote properly and educate the public on the availability of this data (Safran, Bloomrosen, Hammond, Labkoff, Markel-Fox, Tang, et al., 2007). In another recommendation, the panel suggested that the access to secondary health data has become a national imperative (Safran, Bloomrosen, Hammond, Labkoff, Markel-Fox, Tanc, et al., 2007). From these recommendations, we can draw the conclusion that making our data available in the way proposed in this paper not only is beneficial to the cancer provider or researcher but also is also beneficial to our entire health ecosystem.

The Transparency Portal is necessary to help cancer researchers and providers improve their reputation and research productivity evaluations in two ways. Through a Transparency Portal the organizations will begin to publish grants, clinical trials, and (de-identified) patient surveys. This data (when published) will help improve reputations by combating the perception that the Hospital is only focused on generating revenue and is not interested in conducting research that improves the health ecosystem. There is, unfortunately, a perception in the marketplace that Hospitals engage with a pure focus on revenue at the expense of driving up costs (Relman, 2013). Through the Transparency Portal, organizations will be able to demonstrate how they spend their precious resources in support of their mission and how that mission ultimately benefits the entire health ecosystem.

If you are interested in the full version of this paper email me at asrab2001@gmail.com

I will be posting additional portions in future blog posts.

A student at the University of Illinois at Chicago

As a graduate student in the University of Illinois at Chicago’s health informatics program I thought I would start a discussion that gives you my perception on this program and insights into classes that I’ve taken.  As I publish my insights into the program I encourage you to comment and add your own insights.  As an open-data evangelist, I believe in transparency and therefore I think it is critical to share information about this program.

During the Spring 2015 semester, I completed two classes, BHIS 520 Health Information Systems Analysis and Design and BHIS 530 Topics in Health Informatics. In the days to follow I will be publishing my feelings and observations on both of these classes.