It has been well over 40 years since the vision of electronic medical records leading to greater efficiencies and quality of healthcare was articulated. It just goes to show that the problem was always much more difficult than anyone anticipated.
A passenger who had taken a Greyhound bus ride to Calgary was found to have a case of tuberculosis and may have put the passengers at risk. He is currently being treated in a hospital. Also, there was a klebsiella pneumonia infection reported of a Swedish patient who had been on holiday in Greece. Further, on February 8th, there was a report of 13 cases of Botulism (one fatal) in the Tyumen Oblast region. The source of infection was apparently a homemade omul dish, prepared from fish that was ineffectively salted. These are just three of hundreds of potential public health concerns reported worldwide through the Healthmap application. Since, I last looked at it, it has expanded its sources of information from ProMED mail and Google News to the WHO, Moreover Technologies, and Eurosurveillance. As before, all information is available through a Google map and it now includes Spanish, French, and Russian versions. The result is one of the better examples of how a decentralized army of paid and unpaid rapporteurs can bring global health awareness to our public officials and to the public without requiring ponderous, extended and often unsuccessful setting of "standards" and standard operating procedures.
Want to add more books to your library? Can't afford those compact shelving systems? Worry that the weight of books will defeat your building's structural limits and your staff's stamina? Fear no more, affordable library space is now available in SecondLife at several expanding libraries, including the consumer oriented InfoIsland. No need for stairs, no matter how many floors your library soars as your patrons can fly to any level they care to, no matter their age or physical abilities. Your holdings are safe, unaffected by the elements, available to any patron, until someone pulls the plug.
Springer now provides a choice for authors to have their publication in any Springer journal appear as an open access article. As in many other open access journals, the author is charged a fee. In this case the fee is $3000 in addition to any usually author-borne publication costs. So, are the libraries gong to pay as much to Springer as before or does the additional funding reduce costs? Springer claims that it does. Is anyone willing to bet that costs will be less than the current costs plus inflation?
Robert Darnton, the Director of the Harvard University Library, states the case for open access. He also describes a policy that that has been assembled carefully, tirelessly, and with broad consultation in the Harvard community through the leadership of Stuart Shieber and Sid Verba.
"Publish and perish" has been successfully pursued by the hundreds of thousands leading to the sustained exponential growth of the bibliome. This growth in turn has created institutional stresses in creating balanced and standardized reviews of promotion cases and therefore we should not be surprised that there are now proposals to have a promotion process that is increasingly bibliometrically driven despite a rearguard action. Will our academic rank equal our pagerank in 20 years?
This article does a very nice job of addressing the challenge of archiving electronic correspondence. Whereas I can go to L2 and see the notes of Joseph Murray as he prepared to perform the first successful transplant between homozygous twins, I know that I am not going to be able to find the correspondence describing equally important findings of the last twenty years. Why? Because we are not systematically archiving the electronic mail of our scholars. This is a classical example of where perfect is the enemy of good. There are myriad issues that have to be addressed if all such correspondence is to be stored and retrieved on demand. However, a few compromises make the task much simpler. I will review these in future entries but have no illusion, the libraries of today are almost all falling down on this job. A hundred years from now, historians will wonder why they can learn more about biomedical research, up close and personal, in the 1950's than in the archival black hole of 1990-2010.
On January 31, Harvard's Open Collections Program (OCP) launched its third online collection, Contagion: Historical Views of Diseases and Epidemics. The new, web-accessible collection is online now. The Countway's collections are heavily featured. More to come. In an era anticipating global pandemics, this collection is all too relevant.
In 1999 I had an inspiring conversation with one of my more brilliant colleagues, Dr. David Margulies. David was floating the idea of creating a commercial ecosystem whereby there was just in time bidding over the Internet for different service package for patient care. The nature of such packages would range from such well-established services as home visiting nurses but would extend to the cost of supplies for surgical procedures to entire disease management package for instance, lifetime diabetes care. In doing so David presciently was combining what would become in 3-5 years known as Web 2.0 technologies and some free market principles to argue that such an open market would create such efficiencies that would both lower health care costs and encourage standardization and improved quality of the products of health care delivery. Although the company founded around this idea, SmartAgents (with which I never had any relationship), was eventually acquired by a larger company, it is not clear to me that any of these ideas ever came to their full fruitition. From this admittedly biased perspective, it is because yet again the buyers of the product, the recipients of the product and the payers of the product were, as they have been for a long time in health care, been poorly aligned. Market efficiencies will make the most sense when patients will have transparent access to the relative costs and qualities of packages afforded to them at the time they purchase entire health care packages such as insurance so that an efficient market will have appropriate feedback mechanism in terms of the consumer of that product. However, with all the complicated details required of such a system, the sine qua non precondition will be portable transparent access to patient information under patient control so that for a given state of disclosure, a vendor of a particular health care good can efficiently and accurately bid to provide that care. Let’s be clear we are not asking patients literally out the door with their leg in a cast to put out on a medical “eBay” request for bids for their after surgical care. In directly identifying the patient and their patient controlled record as the conduit for decision-making on who has access to their information and who gets to bid on which services to their healthcare professionals (or other decision makers) we are putting the real payors in charge. And we, the patients can decided whether the payment system we adopt is one of full payment, partial payment and so on. We can decide to bid for services through collectives such as patient advocacy groups, employers or even hospitals but the decision is ours. This may seem a little too coolly rational and heartless (or naively optimistic about individual autonomy) but let’s contrast that to the current system where the patient is not a party at all to the bidding for healthcare products, they have no knowledge of whether the best such package was selected for them or the cheapest package. They have furthermore no idea to what extent they are in a long term, short term or committed relationship with these vendors or products. By revisiting the maxim “she who controls information exerts control” through the use of personally controlled records we are re-asserting or perhaps asserting for the very first time the patient’s fundamental control of the market around their services. Again, this does not mitigate the need for collective bargaining for healthcare services, nor does it remove expert decision makers from decisions regarding, which packages of health care are in the best interest of the patients. It does however provide transparency to the patient and a rational basis for them to decide whether they are getting, in their opinion, value for their money or whether should they seek such value elsewhere. This is no more (unfortunately) and no less than the cellular phone companies provide us all when they attempt to woo us to adopting one of their service plans. The much larger stakes of health care makes such transparency more, not less necessary. Given my recent experiences with my cell phone (and my mother's health insurance invoices), I do hope we end up with more transparency.
The ecosystem of rights and copyrighting biomedical publications is about to be disrupted by a very important and useful piece of legislation. To this point, this interesting webcast by Matthew Schruers is very likely to be of interest.