Jill taylor

What would it look like if the government took a more active role in setting standards for health IT?

Want more information on the newest iteration of the iPhone? PCWorld has put together a nice 

 that sums up the new features of the iPhone 4S that was unveiled the other day. This time around, it looks like Apple has focused on changes to the inside, and not only for the iPhone; there were evidently few visible changes to the 

Use an HTC Android phone? If the answer is yes, you’ll want to know about a 

, exposes user account information, the phone log, and system logs.

And while these pieces of tech news are interesting, there is one story in particular that caught my imagination: that of the planned purchase by India’s government of a 

 for students in higher education. What does that have to do with medicine in the US, you ask? Bear with me.

India has decided to make an across-the-board investment in technology for the expressed purpose of building an educated workforce. India is already established itself as a resource for technology companies worldwide. It would naturally like to cement and grow that status, and the government is taking steps to support that goal. The idea has evolved, the government has had to readjust its course a time or two, but ultimately it looks like they are going to get the job done.

Now, I’m not trying to make a political statement here, nor am I promoting the idea that the government should have a heavier hand in medicine than it already does. What I am saying is that India may reap a lot of benefit by centralizing this goal. Was the process painless? No. But in the end, they are supplying an entire population of students with an important tool at an extremely low cost.

The US, on the other hand, is using a patchwork approach to the national technology initiative that is meant to encourage the entrepreneurial spirit, but also will entail high cost. It can’t help but be extraordinarily expensive. In the case of EHRs, everyone is pretty much going through implementation on their own, and who knows how long it will take before we have a truly integrated medical system? Do we even know what we want that to look like, and what technology should be used to provide it?

Just for moment, imagine what it would be like if the AMA or some other respected professional group(s) stepped forward with developing standards that would define the technological footprint of a national IT system for medicine, and that was subsidized. What if the guesswork in terms of what you needed to run your practice and meet the requirements of insurance, Medicare, and Medicaid was gone? What if you had some assurance that your EHR solution wouldn’t be obsolete in five years, and that a national system under development was taking the technology you are using into account? What if you were a part of a conversation in which you could redefine the way that you worked with hospitals and your access to respected resources nationwide?

What a world that might be. Sure there would be problems. I’m just wondering if the challenges or the rewards would be what they are now.

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Standardizing Medicine's Technical Footprint 

I’m watching with interest the news that is being reported from the 

 in New York City on non-communicable diseases. Not only have chronic diseases moved into the most prominent public health threat in the US, but they are a worldwide threat as the “

.” WHO Director-General Margaret Chan, MD, MSc, appealed to both the pharmaceutical industry and food industry to curb business practices detrimental to public health. 

 as the UN attempts to tackle these problems are also being 

In the past, I’ve discussed how some pretty slick smartphone apps are being used by individuals to make positive changes to their lifestyles. And, as a high school teacher recently pointed out to me, adolescents are always on the lookout for the next great app. However, while most of these applications tend to fall into the realm of monitoring and helpful advice, some have unfortunately begun to promise treatment and cures that is reminiscent of the bottles of tonic sold in the late 1800s advertised to “purify the blood” of whatever ails.

One app making the news this week is being sold as a 

. Apparently, teens can download their purported acne cure on iTunes, and thousands did (and probably still are). And acne isn’t the only condition that smartphone apps are advertised to “cure.” I’ve seen apps that 

It doesn’t take a rocket scientist to see that claims like these can be dangerous. While the FDA mulls over what role it may eventually assume with respect to these issues, the FTC appears to be protecting consumer interests to some degree, but the bottom line is that smartphone health apps are largely unregulated — it is a case of buyer beware. And I have yet to find a website that has regularly reviews popular health apps and their claims for teens, parents, or pediatricians.

Do parents or adolescents seek your advice on health apps, and where do you get your information?

Even the high-tech world of medical smartphone apps isn't immune to false claims and quackery.

What Can Smartphone Apps Cure?

The ongoing fight between science and vaccine deniers is having an effect on public health

 is asking why immunization rates are lower for the HPV vaccine. I don’t personally have access to the article, but I rest assured that the answer is complex. However, professional organizations with a stake in healthcare might consider reacting more overtly to what our country’s elected leaders 

. I’m not sure what can be done about the state of public health when people in power continue to stoke fears and support information with little to no factual basis for the purpose of political gain.

The issues surrounding our inability to get children vaccinated are taking a real toll. 

, among the number of recent deaths reported for children of the flu, more than three quarters of the children were not vaccinated.

No one likes to see their child go through vaccinations. If the needles weren’t bad enough, the reaction from the immune system can be miserable. We can improve some of these problems with developing technologies, such as 

 and supportive treatment for side effects, but cost is increasingly a barrier. However, the predominant issue discussed is not the cost of vaccination, but of the perceived assault on parental rights that vaccination has come to represent.

How did medicine become embroiled in a culture war, and what is a pediatrician to do? Bow to the wishes of parents who won’t budge on the issue, or 

discussion regarding how to counter these types of assaults

The ongoing fight between science and vaccine deniers is having an effect on public health.

Vaccination Wars

Mobile health applications show great promise for the management of chronic illnesses like diabetes.

The development of health-related applications is an intuitive response to the growing popularity of smart phones, and the number of applications available to both clinicians and patients has 

. These apps are, of course, designed to be useful, and people download them with the expectation that they will be effective. But how effective are mobile health applications, really?

Honestly, I hadn’t thoroughly researched the topic, but I ran across an article in 

highlighting research recently published in 

. The study, which followed 163 patients from 26 primary care practices over the course of a year, found that glycated hemoglobin declined 1.9% in the treatment group using a mobile and Web-based self—management patient coaching system compared to 0.7% in the group receiving usual care (P < 0.001).

For people excited about the potential of mobile health applications for the management of chronic illnesses like diabetes, this is additional concrete evidence that they can work. Since I only have access to the abstract, I can’t comment on study limitations and what kind of compliance issues the investigators noted, and I also am assuming that the patient population was adult.

I automatically assume that adolescent compliance using a mobile health tool would be better due to a generational affinity and comfort with technology, but 

. There has been some research that has explored 

why adolescents may not engage with e-health applications

, but suffice to say that more investigation needs to be done. Information from this year’s eTELEMED conference suggests that a customized version of the e-health tool employed in the adult diabetes study, above (Diabetes Manager by 

evaluated for adolescents within the context of home health care

Are there e-health applications being piloted for adolescent use in pediatric practices? If you are aware of any, please comment here.

Jill taylor

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