Feature Articles

3D Printers: A Revolutionary Frontier for Medicine

Mission control on earth receives an urgent communication from Mars that an astronaut has fractured his shinbone. Using a handheld scanning device, the crew takes images of his damaged tibia and transmits them to earth. Orthopedic surgeons then use a 3D printer to create an exact replica of the astronaut’s leg from medical imaging files obtained before the voyage. Surgeons on earth use a robot to stabilize the bone with a metal plate on the 3D replica. The data is transmitted back to Mars, where surgical instruments, a personalized plate and screws are 3D printed. Finally, a surgical robot operates on the injured astronaut...

Halamka Says We Can and Must Improve Healthcare Management

As a physician and CIO, I’m quick to spot inefficiencies in healthcare workflow.  More importantly, as the care navigator for my family, I have extensive firsthand experience with patient facing processes. My wife’s cancer treatment, my father’s end of life care, and my own recent primary hypertension diagnosis taught me how we can do better. Last week, when my wife received a rejection in coverage letter from Harvard Pilgrim/Caremark, it highlighted the imperative we have to improve care management workflow in the US. Since completing her estrogen positive, progesterone positive, HER2 negative breast cancer treatment in 2012 (chemotherapy, surgery, radiation), she’s been maintained on depot lupron and tamoxifen to suppress estrogen...

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Why Social Media Apps Should Be in Your Disaster Kit

With floodwaters at four feet and rising, a family in Houston, Texas abandoned their possessions and scrambled to their roof during Hurricane Harvey to sit with their pets and await rescue. Unable to reach first responders through 911 and with no one visible nearby, they used their cellphones to send out a call for help through a social media application called Nextdoor. Within an hour a neighbor arrived in an empty canoe large enough to carry the family and their pets to safety. Thanks to a collaboration with Nextdoor, we learned of this and hundreds of similar rescues across Harvey’s path...

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The 'Internet of Things' Is Sending Us Back to the Middle Ages

Internet-enabled devices are so common, and so vulnerable, that hackers recently broke into a casino through its fish tank. The tank had internet-connected sensors measuring its temperature and cleanliness. The hackers got into the fish tank’s sensors and then to the computer used to control them, and from there to other parts of the casino’s network. The intruders were able to copy 10 gigabytes of data to somewhere in Finland. By gazing into this fish tank, we can see the problem with “internet of things” devices: We don’t really control them. And it’s not always clear who does – though often software designers and advertisers are involved...

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Health Care's Juicero Problem

Bad news: if you were still hoping to get one of the $400 juicers from Juicero, you may be out of luck.  Juicero announced that they were suspending sales while they seek an acquirer.  They'd already dropped the juicer's price from its initial $700 earlier this year and had hoped to find ways to drop it further, but ran out of time. I keep thinking: if they'd been a health care company, they not only might still be in business but also would probably be looking to raise their prices. Juicero once was the darling of investors. It raised $120 million from a variety of respected funding sources, including Kleiner Perkins, Alphabet and Campbell Soup. They weren't a juice company, or even an appliance company. They were a technology company! They had an Internet-of-Things product! They had an ongoing base of customers...

How WikiFundi Is Helping People in Africa Contribute to Wikipedia

In developed countries, the ability to access and edit Wikipedia easily is taken for granted, but in many African countries, where access to reliable electricity and broadband are limited, that's not the case. I recently interviewed Florence Devouard, who is working on several open source projects to help close gaps caused by poor access to online information. She is co-leader of the WikiFundi project, as well as other projects related to Wikipedia and Africa, including Wiki Loves Women, a women's information initiative, and Wiki Loves Africa, a media contest that invites the public to contribute photographs, videos, and audio to Wikipedia. All projects are part of the WikiAfrica movement...

Science Journal Examines Key Role of Open Source EHR in Ending Ebola Epidemic in Sierra Leone

The prestigious, open access, Journal of Medical Internet Research recently published a study looking at the effectiveness of OpenMRS’ use during the 2014-2016 Ebola epidemic in West Africa. The article highlights the work of a team who developed new user-interface components for OpenMRS and rapidly deployed the system in an Ebola Treatment Centre (ETC) in Sierra Leone. The team, composed of members from OpenMRS, Save the Children International, Thoughtworks, The London School of Hygiene and Tropical Medicine, Partners In Health, University of Leeds, and Columbia University. The team came together in response to an urgent request for healthIT from colleagues at Save the Children International to develop an EHR suitable for deployment in a new Ebola treatment Centre being set up in Kerry Town outside the capital, Freetown.

Innovation Needs Dumb Ideas

Over the years I've listened to many new-to-health-care entrepreneurs pitch their great new idea. They're so excited: health care is so inefficient! People are so frustrated by the system! It will be so easy to improve it! I usually end up thinking, "Oh, you poor people. You really don't know much about health care, do you?" They don't fully grasp the strange way it is bought and sold, the convoluted financing, or the layers of regulation. So I wish them well and wait to hear about their eventual failure. But now I'm thinking, maybe it is experts like me who are part of health care's problem. In Harvard Business Review, Ayse Birsel suggests that companies need to do more "reverse thinking," deliberately thinking up wrong ideas...

Report on the ONC 2017 Technical Interoperability Forum

Last week I attended with my colleague Mike Berry the ONC 2017 Technical Interoperability Forum. This meeting was convened under the 21st Century Cures Act passed by Congress in late 2016. Several hundred participants attended a series of panel presentations and discussions. The forum took place over one-and-a-half-days. The forum covered a variety of topics related to interoperability, including discussion of the business case for interoperability, semantics, national networks, and application programming interfaces (APIs). In many ways the speakers were “the usual suspects” involved in national networks, standards development, and HIE planning and implementation.

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10 Advantages of Open Source for the Enterprise

Selecting technologies means committing to solutions that will support an active, growing business over the long term, so it requires careful consideration and foresight. When an enterprise bets on the wrong horse, the result is often significantly higher development costs and reduced flexibility, both of which can stick around for the long haul. In the past decade, adoption of open source software at the enterprise level has flourished, as more businesses discover the considerable advantages open source solutions hold over their proprietary counterparts, and as the enterprise mentality around open source continues to shift. Enterprises looking to make smart use of open source software will find plenty of great reasons to do so. Here are just some of them.

FirstNet for Emergency Communications: 6 Questions Answered

The system nicknamed FirstNet was created by Congress in the Middle Class Tax Relief and Job Creation Act of 2012. Under the contract with the government, the group led by AT&T will build, operate and maintain a new nationwide communications network, providing high-speed wireless communications for public safety agencies and personnel. The network will be protected against unauthorized intrusion and strong enough to withstand disasters that might damage other communications systems. Emergency workers will be able to preempt other users’ traffic on the network, and will be able to send and receive as much data as they need to during their emergency work...

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11 Things About Health Care I'm Dying to Redesign

The folks at Ideo recently published 19 Things We're Dying to Redesign, covering a wide range of products, services, and systems, both big and small.  It's very thought-provoking, but only one of them addressed a health care topic (oddly enough, incontinence). If there is an area of our lives that badly needs redesign, it would be health care. And not redesigning it sometimes literally results in us dying. Let's start with a clean slate. I'm not as ambitious as Ideo, in terms of the breadth or number of topics, but here are 11 things about heath care that I'm dying to redesign...

Only Trump Can Go To Single-Payer

Today, I want to submit to you that only Trump can make single-payer health care happen in this country. Only a billionaire, surrounded by a cabinet of billionaires, representing a party partial to billionaires, can make that hazardous 180 degrees political turn and better the lives of the American people, and perhaps the entire world as a result. Oh, I know it’s too soon to make this observation, but note that both Mr. Nixon and Mr. Begin were deeply resented (to put it mildly) in their times, by the same type of people who find Mr. Trump distasteful today.

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Opioid Epidemic Makes EHRs Essential to Public Health

When public health is threatened by an outbreak of SARS or Zika or avian influenza, widely disseminated information becomes a crucial tool used to curtail the spread of disease. But transmittable diseases are not the lone threats to public health. Other metaphorically pathogenic events—the current opioid epidemic, for example—are more effectively managed by making sure doctors have complete information when evaluating patients and, especially, writing prescriptions.

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The Pandora's Box of Gene Editing Is Now Open

The age of gene editing is upon us. Specifically, the use of CRISPR. Amazing things are happening, proving again how clever humans are. Whether we're smart remains to be seen. For those who are unfamiliar with it, CRISPR -- more accurately, CRISPR-Cas 9 -- is a new technique for gene editing.  It has allowed faster, more precise, and less expensive gene editing.  It can already do more than you may realize. CRISPR has been much in the news lately, due to a new study published in Nature. Researchers successfully corrected a DNA mutation that causes a common heart disease that is sometimes fatal, especially for young athletes. In what is believed to be a first, the researchers repaired viable embryos. Moreover, they repaired most (72%) of the embryos, which is much better than previous efforts...