Say Hello to Empathetic Interfaces and Digital Humans

- reposted with permission of author


The very first trend introduced in my co-authored book, ePatient 2015: 15 Surprising Trends Changing Healthcare, was "Empathetic Interfaces."

Trend Overview: Empathetic Interfaces

Source: ePatient 2015

My co-author Rohit Bhargava and I, described this as how "artificial intelligence ... [is making] health technology go beyond the diagnostic to be more empathetic and responsive to emotional needs—in other words ... more human."

The inventive people at New Zealand's Soul Machines are taking empathetic interfaces to the next level. They have developed a cadre of 'Digital Humans' that utilize AI to engage in face-to-face conversations, spontaneously display emotion and much more. One of Soul Machine's Digital Humans is pictured below.

Soul Machine's Digital Human

According to Soul Machine, the possibilities for these virtual assistants are endless. One day they could play a significant role in treating a range of mental illnesses, including depression.

Next week, I'll take those attending future::present, my upcoming breakfast event, on a tour of the rapidly evolving and exciting world of health-focused artificial intelligence (including Digital Humans).

I'll discuss recent innovations, leading companies, investment activity and more. And, I'll be joined by Thomas Tsang, CEO of Valera Health who will discuss how AI is being put into practice today.

A great group of executives from leading health organizations, consultancies, innovation catalysts, entrepreneurs and others will be attending future::present. I hope you can join us for this live event in New York City next week. Click the button below (or here) to register.

See you there.
Click Here to Register for future::present (September 19, NYC)

Fard
Founder/President, Enspektos, LLC

NIH’s All of Us Research Issues Initial Research Protocol

August 8, 2017

by Heather Landi

| Reprints

The National Institute of Health’s All of Us Research Program, previously called the Precision Medicine Initiative, released its initial research protocol, or research plan.
The All of Us Research Program’s 61-page protocol includes information on consent forms, the ethical issues associated with the project and explanations for how participants will be able to provide secure access to their electronic health records (EHRs).

The goal of the All of Us Research Program is to gather health-related information from one million or more diverse participants to detect association between genetic and environmental exposures and a wide variety of health outcomes.

The NIH states that longitudinal tracking of health outcomes through EHRs is an important component of the program. Through a consenting process, participants will be asked to authorize linkage of their EHR information. EHR data may be sent directly by the participant’s health care providers to the DRC or sent by the participant to the program through Sync for Science.

Access to EHR data will be repeated regularly throughout the life of the program. The initial data types to be included are demographics, visits, diagnoses, procedures, medications, laboratory tests, and vital signs, but may be expanded to all parts of the EHR, including health care provider notes. The feed may include mental health data, HIV status, substance abuse and alcohol data, and genomic information stored in the EHR

Participants may need to complete and sign a separate informed consent module to authorize access to their complete EHRs.

“We will create an informatics infrastructure to clean and standardize data from disparate EHR systems across the United States; this broadly applicable system will be a key contribution of the All of Us Research Program to health informatics research efforts nationwide. For participants enrolled by their health care provider organization, the site will extract data from the participant’s EHR, format it according to the DRC’s data model (based on the Observational Medical Outcomes Partnership [OMOP] Common Data Model version 5, and transfer it to the DRC using secure protocols,” NIH stated in a press release.
And, the NIH states that although obtaining EHR data from direct volunteers presents unique challenges, early pilot studies have demonstrated feasibility of such an approach. “For example, the Sync for Science (S4S) project launched by NIH and the Office of the National Coordinator for Health IT is creating a technology that aims to make it easy and safe for people to securely share their EHR data for research. S4S has been adopted by the All of Us Research Program and initially will be enabled in a small pilot for DV participants at S4S-enabled direct volunteer sites,” the NIH states.

All of Us Research Program direct volunteer participants who have enrolled at one of these pilot sites will be able to sign into their healthcare provider’s patient portal using the S4S workflow and authorize sharing their EHR data with the program. Their health care provider’s system will provide a secure application program interface (API), which is used by the research program, rather than the provider sending out data, and transmitted to the Us of All Research program.

And, NIH notes that this is just the first version of its protocol. In future versions, NIH intends to include plans to pilot test wearable devices for real-time data collection.

Get the latest information on EHR and attend other valuable sessions at this two-day Summit providing healthcare leaders with educational content, insightful debate and dialogue on the future of healthcare and technology.

Learn More

Boost Your eHealth Knowledge. Advance Your Career. Early Bird Deadline for HI Bootcamp Booster Shot Course in 2 Weeks.

It is eHealth Design & Architecture Week! "Too many men slip out of the habit of studious reading, and yet that is essential" — William Osler Stay in the habit. Continue your learning With NIHI HI Bootcamp Booster Shot Early Bird Deadline Only 2 Weeks Away   HI Bootcamp Booster Shot September 19 & 26; October 3, 10, & 17, 2017 | 12:00-3:00 PM ET 15 - 20  CPE Hours Canada’s iconic HI Bootcamp is back! Be the first to take the new HI Bootcamp Booster Shot. Learn from the best…Professor Dominic Covvey, one of Canada’s top HI experts, and Dr. Tom Rosenal, one of Canada’s foremost authorities in clinical Informatics. Learn the new essential competencies and capabilities for today’s informatics professionals: - Analytics and Big Data.  - The Internet of Things (IoT). - Artificial intelligence. - The Cloud.  - Precision/Personalized Medicine.  - Consumer Informatics. - Devices, Sensors, Sensor Networks and data produced. - Personal Attitudes and implications in our workforce.  - Biomedical Engineering and Health Informatics. - Complexity in health care and quantization of Health Informatics - And many others.  Registration & More Information Featured eHealth Design & Architecture Education Sessions Best Practices in HIT Implementation Although health technology implementations have come a long way in the last decade, the risk of partial success and having a 'zombie' project is still high. Given the extensive investments made in health technologies and the high hopes for their effectiveness for health provider productivity and patient safety, best practices in health technology implementation are still topical. Learn about best practices in HIT implementation from a systematic review of the literature with high quality statistical analysis of the findings. The published paper has received over 4000 reads on ResearchGate, a social media site for researchers. Come learn what everyone is so excited about. Canada's Chronic Disease Surveillance Network: Architecture & Next Steps Canada's chronic disease surveillance network (www.cpcssn.ca) recently reached 1000 physicians and 1 million de-identified patients in its database. CPCSSN is revolutionizing primary care by making research easier and faster and by making it easier to apply quality improvement to patient populations. How did we get here? What makes CPCSSN sustainable? What are the impacts of primary care research? Where do we need to go next? Creating the Next Generation mHealth App: A reference Architecture mHealth apps in smartphone app stores are languishing; downloaded and abandoned because they don't solve people's problems. What is the ideal design for an mhealth app? What's working? What's not working? Why? This presentation addresses these questions and proposes a new paradigm for patient mhealth apps that could potentially solve the log-jam. Learning from Amazon: Building the Next Generation EMR Form What if electronic medical record (EMR) systems were designed like the World Wide Web? What if we could improve user experience rapidly because we could see how users were using the software? What if we could make actionable information available at the point of care instantly using Big Data techniques? What if we could quickly test whether new ideas will work and make them available into all EMRs immediately? Lowering Costs in Health Care: Architecting Health Care for Diabetes Prevention What if we could predict who would get diabetes, long before they actually got it? What if we could provide high risk patients with training, support and counselling to prevent diabetes? What if we provided diabetes prevention services to elderly patients who already have other diseases? What Diabetes Prevention Apps Should Have and Why mHealth apps are not being used. Over 45,000 mhealth apps are languishing in mobile app stores. We evaluated over 200 diabetes mobile apps found in the Apple and Google app stores against a Reference Architecture for high quality mobile apps. Surprisingly, we identified a niche where apps do work well and are popular with patients in this space. However, the vast majority of patients with diabetes are not served by these niche apps. Email Philip Grove at pgrove@nihi.ca for assistance

National Institutes of Health Informatics
Website: www.nihi.ca
Contact Us: info@nihi.ca

Reflections on a Health Hackathon

After the first Health Hackathon experience, would I do another one?

The main take away message for me was that the ideas for a pitch/solution should be driven by real needs.  The idea should come from a real world community of healthcare practitioners/patients. I just tossed out some ideas and made a pitch out of one them. It would have been easier and maybe better if I had just attended and joined an interesting team.  That way, I could get experience observing just how these events are organized. I am grateful though that I was able to work on a pitch idea and have a few people interested in sharing the work.

I learned a lot on the weekend about IBM Bluemix, the FHIR standard for medical terminology transport, the skillfulness of the programmers at the event, and the care and consideration that teams brought to their projects to help people better their health. This latter was very inspirational for me. If I ever attend another event like this, I would give more attention to this.

I was also very impressed with how the event was organized, the low registration cost, the venue (Mohawk College library) the mentoring, coaching, and judging abilities. The cool jazz musicians at the beginning of the event was, well, cool!  That all helped remove the actual stress of making a pitch to others in the competition. Every team was a winner in my books.

The Health Hackathons would make a good ethnographic research project. Probably been done before, but while Health Hackathons are still active and up and running, there is still a possibility there I think.

The criteria for judging a winning pitch are the core disciplines of eHealth - business model, patient care impact, and technological feasibility.

Hacking Health in Hamilton Ontario - Let's hear that pitch!

What compelled me to register for a weekend Health Hackathon? Anyway, I could soon be up to my ears in it.

A pubmed search on Health Hackathons...https://www.ncbi.nlm.nih.gov/pubmed/28250965 came up with a research article that shows that Hacking Health does have very useful benefits. I am intrigue and would even like to do my own research on this.

I attended a pitch workshop and learned that intellectual property on ideas is not what it appears to be. From that perspective, and in the interests of ehealth promotion:

1. Medical School ePortfolio - So you want be a Doctor eh? [app, educational]
Problem:
Getting into medical school is like a lottery. Or is it? How can students best prepare so they don't become disappointed or feel like they are gambling getting in, or getting in and realizing it is not their ideal career choice?

Solution:
This app will be for students who want to be physicians. Maybe it could even be aimed at three levels; elementary, high school, and university. It would allow students to track their interest in a career in medicine from early days. Students are also getting into medical school after high school these days at Queens University. It could have tests and quizzes, links to schools, CV prep, volunteer opportunity suggestions, how to apply, what's involved in the actual application process at very schools. The book "So you want to be Doctor eh?" by Anne Berdl is an excellent resource to model this on. Also, many universities have learning portfolios and that is also a model. Possible mentor relationships or chats or talks with professionals in the field. By tests and quizzes, it could also have an educational role to survey student empathy, compassion training, aptitude, in addition to preparation for MCAT and other formal tests.

2.Smart Forms Builder for Healthcare [ app, software]
Problem:
Hospitals were faced with a crisis in screening patients and visitors for SARS at Ontario hospitals in 2003. The paper system they had was bogging down entry to the hospital. A LAMP (Linux, Apache, MySQL, PHP) online screening system was eventually created to streamline the process. Healthcare administrators and even IT need to develop online forms quickly without programming skills as well as have access to useful data.

Solution:
There are smartform software systems like Google docs and commercial ones like Jotform, but they are not private and secure for personal health information. As well, smart forms need to be smart enough so people without programming experience can quickly develop an application. These kind of systems are evolving, but they just need something more akin to artificial intelligence to make them really smart and inexpensive to setup. API, mobile and REST applications would also be good integration components.

3. eHealth enabled browser [ browser, app, big data]
Problem:
Personal Health Records come in many different types, tethered, stand alone, and integrated. The  people who benefit most are those who need to monitor and access a lot of medical records and visits. However, tracking health, IOT, and fitness device data can be integrated into Personal Health Records to create an overall digital health snapshot. Not everyone likes to login to a portal and track their health data.

Solution:
The idea here is to integrate Watson IBM analytics, or google alpha Go search engine analytics built into a dedicated open source browser built on chrome (or chromium). While this might sound just like an app running on a smartphone, the idea is to build a Firefox, Chrome or Safari browser that is actually a dedicated health analytics and digital health single sign on personal health record browser. What you search and read in every day life is all fodder for personal health anlaytics. This is digital "google flu" writ larger for an individual. In a way, think of it is a browser add on or extension that is a personal health record data collector, storage, and dashboard, but it is actually the browser itself.

4. Universal Healthcare Observatory [Big Data app]
Problem:

The problem is that not everyone has access to free healthcare. Statistically, millions of people are rising out of poverty every year, according to the late Global Health researcher Hans Rosling. Access to free or affordable healthcare should be a basic human right.

Solution:
The purpose of the project is based on the scientific based belief of evidence based medicine that "for profit healthcare is hazardous to your health". The United Nations and even the WHO have many observatories, and this one would be similar to the European Observatory of Health Systems and Policies. It will be a big data app that pulls data and statistics from disparate sources to monitor the global healthcare systems in the world and promote any trends towards universal healthcare. It might be able to use the Trendalyzer software. The bold target would be to achieve universal access to free or affordable healthcare for everyone on the planet by 2050.

5. eHealth Garage [ infrastructure, service]
Problem:
In my neighbourhood there are two former automobile/gas stations that are now a Vietnamese restaurant and a Holistic Health Clinic. Gas stations used be found on almost every block in every neighbourhood in every city and town. Cars no longer break down because the technology is better and gas monopolies are pushing gas stations out of neighbourhoods. Needless to say, electric cars are moving in soon. Also in my neighbourhood is a legal Medical Marijuana Clinic. Why not an eHealth Garage?

Solution:
With an aging population living longer and a coming generations that might may well live easily way over 100 years of age because of advances in exponential medicine, preventive medicine and holistic health services need to be accessible with digital health services in the community. This is also a way to deconstruct medicine.The eHealth Garage could be a component of a Family Health Team but they might call it an eHealth clinic. I see the Garage being full of healthcare technology: x-ray machines, ultrasound, MRI, fitbits, resistance training gym machines, Transcranial Magnetic Stimluation (TMS) - almost any health technology that can be coupled with a digital health technology or record. DIY healthcare, though with options for professional healthcare oversight.

The myUHN Patient Portal - Infoway Award Winner

The myUHN patient portal has won a second place award from a Canada Health Infoway contest. Here is the presentation they gave:
 http://imaginenationchallenge.ca/wp-content/uploads/2017/02/myUHN-Patient-Portal.pdf

Their infographic on the uptake of the portal is very impressive by the numbers - numbers which have been suggested as viable in research on patient portals (They didn't mention concern for the security of personal health information):
 http://www.uhn.ca/corporate/News/Documents/myUHN_infographic.pdf

The pilot study is over and a full launch began January 30, 2017. It is expected that 250,000 patients will register for it in 2017! Very, very interesting that the portal is integrated into all stages of the clinical experience and by all personnel.

Based on my research on patient portals this looks to be the very promising. Sunnybrook Hospital myChart was also a great pioneer in this area and they have taken a page from their book. It also appears to be an ideal integration solution that I think would work best for a healthcare system.

But what about primary care? Is there an API for that? And why are family docs still so worried about liability or whatever for using a PHR?

Looking closer at myUHN it is very much just a portal or window on the hospital EHR, with a limited but very useful and important set of interaction tools. It is not a personal health record where one can self-report and journal one's health, as is the one developed by McMaster Family Medicine, now called KindredPHR.

If I get sick, I am going to Toronto and the UHN:
 http://www.uhn.ca/PatientsFamilies/myUHN

mbant2 clinical trial - a super duper fitbit?

I noticed on the Journal of Medical Internet Research that the mbant2 clinical trial is starting.
 http://www.researchprotocols.org/2016/3/e174/

This is an ehealth cornerstone - evaluating the effectiveness of ehealth applications. mbant2 is a University of Toronto study, where Frederick Banting appropriately enough was one of the discovers of insulin.  I almost think the fitibt could help self-manage type 2 diabetes if there was also a way to measure glucose A1c levels. Apparently Medtronic is looking into exactly that.
 https://www.medtronicdiabetes.com/blog/partnering-with-fitbit-for-type-2-diabetes/

No google contact lens yet for tears to detect blood sugar insulin. Guess they are still working on it. The email alerts I have been getting about always make it sound it is off in the future somewhere. It would be great to have pin-prickless procedures and devices. The research is very hard to make that work well.