Wednesday, March 21, 2018

I Bless The Rains Down In Africa...Again

Some of you might have noticed that I haven't posted for a while. Did you call? Did you write? Did you check to see if i was still alive?

Sorry...just the Jewish mother in me coming out. I'm sure you all knew that the hiatus was justified, and you simply decided that my next missive would be well worth the wait. And I certainly hope to rise to your expectations.

Many things have indeed been happening. Doctor Dolly is getting married in a few months, and you can imagine the turmoil joy that has brought to the Dalai household. In the midst of plans for that amazing(ly expensive) event (JUST KIDDING, DOLLY!!) I received a promotion to the Management team of RAD-AID, which has taken up a great deal of time. Fortunately, this came with a tripling of my salary from my favorite NGO...I went from $0 to $0, but the satisfaction derived from being a part of this is priceless.

And yes, I've been back in Ghana for the past week on another RAD-AID trip to Korle Bu Teaching Hospital in Accra. As I noted upon last year's expedition to Dar es Salaam, Tanzania, you just can't be in Africa without thinking of Toto's song by the same name, and I must again present both the original and a very moving chorale version:

OK, time for business.

I'm here with a a team of incredible people (and then, of course, there's me...)

Erin, with whom I traveled to Ghana last time, is head of a Radiography school in the Northeast, and plans to help out with the program here as she did two years ago.

Alice is a breast-imaging specialist from a rather well-known hospital also in the Northeast, who will work with the radiologists and surgeons (and maybe even the pathologists!) to enhance imaging and treatment of breast cancer.

Kwasi (on the right, with 4th year resident Paul) is a neuroradiologist with Ghanaian roots who will work with the IR and imaging folks here at Korle Bu.

We have been delivering lectures to staff, residents, and anyone else we can gather. I managed to hit the ground running in that regard with an introductory talk about Nuclear Medicine to the Internal Medicine Department. Which occurred at 8AM sharp the day after I arrived in Accra (at 8PM but who's counting...) Despite some computer glitches (when connected to the projector, my borrowed laptop tried to go into Picture in Picture mode or something like that), the talk seemed to be well-received and there were many good questions asked.

We were able to meet with some of the radiologists and with Dr. Awo, the Nuclear Medicine physician:

My main duty here at Korle Bu, beyond boring the staff with Nuclear Medicine lectures, is to help pave the way for a RIS to mate with the PACS. There will be many discussions in that regard as we progress, but the principals here are pleased with the way we are approaching this project.

I have been able to travel a bit, seeing Accra last Saturday and going back to Cape Coast Castle and the Kakum Canopy walk on Sunday. I'm not going to post all 300+ pics, but here are a few highlights. I have to note that wherever we went, little children tagged after me, and usually not the ladies. I'm thinking they saw the old white guy with the white beard and figured I was Santa Claus. Ho, Ho Ho! Christmas in March in Ghana! Except it turns out that there is no Santa tradition here. Oh, well....

I've got another week to go, with a trip to Kumasi and a surprise!

I should note that I don't speak even the slightest bit of Twi, the more common of over 70 dialects in this region...I tried last time, and after getting laughed at, I decided to stick to English. It IS the official language of Ghana, after all!

But for now, I bid you Maadwo, a very good evening!

Sunday, February 25, 2018

Life REALLY Imitates Art!
More on Apple's EMR

To welcome myself back after a two-month absence, I'll brag a bit about my prescience. You'll recall my April Fool's Day mock-up of an Apple EMR:

No, it wasn't real, for those who didn't realize this.

But as with "The Simpsons" predicting an unlikely candidate (some say this isn't true, but go with it),

Apple has finally come around. I alluded to this in a recent post, but it seems to be coming to pass quickly. Here's the latest, from Wired of all places...

IN LATE JANUARY, Apple previewed an iOS feature that would allow consumers to access their electronic health records on their phones. Skeptics said the move was a decade too late given a similar (and failed) effort from Google. Optimists argued that Apple was capable of translating health data into something meaningful for consumers.

But the announcement portends great things for consumers and the app developers seeking to serve them, from our perspectives as the former US chief technology officer under President Obama, and as an early adopter of the Apple service as Rush University Medical Center’s chief information officer. That’s because Apple has committed to an open API for health care records—specifically, the Argonaut Project specification of the HL7 Fast Health Interoperability Resources—so your doctor or hospital can participate with little extra effort.

This move is a game-changer for three reasons: It affirms there is one common path to open up electronic health records data for developers so they can focus on delighting consumers rather than chasing records. It encourages other platform companies to build on that path, rather than pursue proprietary systems. And it ensures that the pace of progress will accelerate as healthcare delivery systems respond to the aggregate demand of potentially millions of iPhone users around the world.

Understanding the promise of this announcement requires a bit of historical context. In the wake of the 2008 economic crisis, President Obama signed into law the Recovery and Reinvestment Act, which included more than $37 billion for investing in the adoption and use of electronic health records by doctors and hospitals. Tucked away in that program was a comparably modest $15 million investment in research and development to bring to life a vision of applications inspired by Apple’s App Store. That R&D funding contributed to the development of the open API standard that Apple now requires of providers wishing to make the feature available to their patients.

Spurred by financial incentives in the Recovery Act, the Affordable Care Act and in 2015, the bipartisan Medicare Access and CHIP Reauthorization Act, providers are implementing health IT systems that are certified to meet certain government requirements.

One such mandate is to allow patients the ability to connect any application of their choice, like Apple Health, to a portion of their records via an API. However, the government left room for the private sector to build consensus on how to achieve this requirement, which resulted in the Argonaut Project specification. Apple's decision to require that open API standard decreases the likelihood that health IT developers will adopt a proprietary system.

Better still, once a provider’s electronic health records system delivers health data in accordance with the standard, that same connection will be available to any app developer offering consumer applications, including those built for the Android ecosystem, or competing to serve the highly anticipated Amazon, JPMorgan Chase, and Berkshire Hathaway employee health joint venture. Imagine if Apple had instead introduced a proprietary system that didn't allow competitors to access data in the same manner from the participating providers.

Naysayers point out the fact that Apple is currently displaying only a sliver of a consumer’s entire electronic health record. That is true, but it's largely on account of the limited information available via the open API standard. As with all standards efforts, the FHIR API will add more content, like scheduling slots and clinical notes, over time. Some of that work will be motivated by proposed federal government voluntary framework to expand the types of data that must be shared over time by certified systems, as noted in this draft approach out for public comment.

Imagine if Apple further opens up Apple Health so it no longer serves as the destination, but a conduit for a patient's longitudinal health record to a growing marketplace of applications that can help guide consumers through decisions to better manage their health.

Thankfully, the consumer data-sharing movement—placing the longitudinal health record in the hands of the patient and the applications they trust—is taking hold, albeit quietly. In just the past few weeks, a number of health systems that were initially slow to turn on the required APIs suddenly found the motivation to meet Apple's requirement.

When we look back a decade from now to render judgment, it will be the impact Apple Health has had in changing the default setting in health information sharing—from closed to open.

Two points. First, I knew there had to be something about Obama Care that wasn't all bad. This is it. Second, don't count Google out.

Still, Apple is the master of usable GUI's, and IF they continue down this path, they will be come a major player in this space.

Told you so.