Health 2.0, Google tech updates, and Universal Health Care

Copyright Scott Shreeve, MD

I’m interested to see how the first annual Health 2.0 Conference in San Fransisco taking place this week will pan out.  Part of the conference objectives is to define exactly what Health 2.0 is!  This conference is the real deal, with a sell out attendance and reps from Google Health speaking (even after the big shakeup there 2 weeks ago).  Click here for an overview and background of the Health 2.0 concept. Or here.  Or the Health 2.0 Wiki page.

In other Health 2.0 news, the New York Times had used the term in a title of a report on Hillary Clinton’s new health care proposal:  "Unveiling Health Care 2.0, Again".

Finally, you may want to go check out Google and their new presentation product, a competitor to Powerpoint named, Presently.  Also, if you are someone who is afraid of experimental tech products, you may be happy to know that Google Reader has officially broken up with Google Labs.

Dr Google and Dr Microsoft

Here is another update on the evolving role of our our nation’s two big software powerhouses in the healthcare arena.

"By combining better Internet search tools, the vast resources of the Web and online personal health records, both companies are betting they can enable people to make smarter choices about their health habits and medical care."

Hmmm.  Enabling people to make smarter choices about healthcare sounds like a good thing.  Now, how do we figure out, as a medical community, what those smarter choices really are?  One of the biggest barriers these types of efforts will face is being able to assess performance and outcomes from various health practices and medical care.  Is physical therapy superior to surgery for back pain?  In what cases is this so?  Is all physical therapy the same, or does it vary widely, preventing an across the board recommendation as to its effectiveness?

Well, I know the answers, but how does Google or Microsoft know the answer?


How do you get your evidence?

I am employed by an academic institution with a fine health science library. I belong to several sections of the APTA as well as the AAOMPT. Through these affiliations I am able to get my hands on quite a few journals and read full text articles when I like.

I was thinking the other day, about how many allied health professionals do not have access to such a library of content. This would include those working in private practice, non-academic hospitals, rehab centers, local school systems, etc. How do these folks get their dose of evidence? How difficult is it to get access to an important new article?

There is PEDRO, and the Cochrane Database, and the APTA resources such as Open Door, but these are far reduced from what I use. They also suffer from lack of use among therapists. A scattering of journals offer free text, but usually there is a time delay or restriction with this. A service like InfoPOEMs is kind of expensive and not rehab focused even if it is useful in theory.

A colleague recently left the hospital system that I’m in and now works at a corporately owned outpatient clinic. She has no access to journals.

Barriers lead to inactivity. Inactivity leads to the failure of the principles surrounding Evidence-Based Practice. How much of a professional duty is it for health care providers to pay their own $$ for access to evidence? How much of that burden should fall on the employer?

I will assume that a majority of the Physical Therapy work force is in practice settings with limited access to rehab/ortho journals. Does this mean that the majority of the profession does not keep up with new evidence? Regardless of that being true or not, I think these barriers need to come down somehow.

Any thoughts on access to literature among Physical Therapists?

Image: Arnold Bernhard Library, Quinnipiac UniversityHamden, Connecticut

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How to Permanently Archive Feed Items

I had the opportunity to present to some faculty and students last week on the relationship between good evidence based practice and internet technology. The topic was mainly about using RSS feeds to collect information that could then be used to improve your clinical practice. i called it, Evidence at Your Fingertips: Leveraging Internet Technology to Improve Evidence-Based Practice Skills.

While the simple fact that you are reading this blog indicates you may know a bit about RSS technology, I was a little surprised that the the vast majority of the audience did not. To techies and bloggers, RSS is part of everyday life and so it was unexpected that a whole room of students and faculty did not use it, but that was the case. I hope that I was able to spread a little RSS interest through my presentation and now there’s a whole pile of new RSS fans out there.

Anyway, to continue my Evidence and Technology topic, I will offer some tips from time to time about using different internet technologies.. Of course, I am no expert on this. If you’re really interested, go check out some posts on the Lifehacker or Lifehack blogs.

My Tip of the Day: Permanently Archiving Feed Items of Interest from Google Reader.

Often I find a post that I really like, but for reasons time or energy related, I just skim the post and pass it by for later reference. Google Reader’s absence of a search component sometimes makes it difficult to find these items for later reference. I have been using a little work around and e-mail creativity to overcome this issue.

  1. E-mail the post to your self: Google Reader nicely integrates e-mail with a single click. I simply send the post item of interest to myself. It’s helpful to add a bit to the subject when sending the item to help in creating a filter in the next step. I add the letters "GR" to remind me that this e-mail is from Google Reader.
  2. Create a Filter: In your e-mail client (for me it’s Gmail,) create a filter.


The filter should include both a "to" and "from" address that is your e-mail and whatever you added into the subject field ("GR"). I choose the filter to bypass the in-box and tag it with the term "Google Reader Archive."

I can now freely search all of my saved feeds in G-mail, taking full advantage of Google’s product integration and ample e-mail storage space. Never lose a feed you like again!

By the way, if you use Firefox and Greasemonkey, you can go get the Custom Google Reader Search script.


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Google's Frantic Pace

Google has a reputation for doing things differently, such as innovative workplace design.  I was reading this piece in the New York Times about how Google continually tweaks its search engine to improve it. The man featured in the article, Amit Singhal, is the master of Google’s search ranking algorithm. For anyone who knows even a bit about Google, this guy is pretty high up.   
In the article, Mr. Singhal attributed much of Google’s success to their relatively "breakneck" pace of research in contrast to the more leisurely pace observed at universities and institutions.
“I spent the first three months saying, ‘I have an idea,’ ” he recalls. “And they’d say, ‘We’ve thought of that and it’s already in there,’ or ‘It doesn’t work.’ ”
Now, while this is the technology field we’re talking about here, I can’t help but to think about this issue in terms of healthcare research. Yeah, healing occurs over time and human research has its own time limitations; but I think we must ask ourselves, "Can we do more research in less time?" How is it that some investigators seem to have several publications per year and others once every couple years?
Perhaps it is simply a case of some researchers behaving more like Google, and others behaving more like…well, a researcher. I can imagine researchers dealing with issues of project management, technology assistance, quality, and maybe even figuring out how to exist on 4 hours of sleep.  Admittedly, I am not a researcher and am only surmising here.
Here is my own example of how research sometimes proceeds slowly:
I’m writing a case series about a group of patients at my work. In order to proceed, I need to contact our institution’s Department of Clinical Investigation. They have a series of hoops and trainings to jump through, checklists to complete, and signatures to obtain. All to perform a formal write up of treatments that have already happened. They estimate this process takes 1 month to complete.
Grrrr. I could have been finished in 1 month!

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Finding Scientific Papers for Free

Here is a fine series of posts from DigitalBio over at Science Blogs. They outline a case study and mini-investigation on how to find scientific papers for free. A very pertinent topic, as more and more journal are relenting to pressure and offering more content online. Initially planned to be a three part series, a question arose during the investigation that required a 4th part. Find out how to find scientific papers for free, and find the answer to this interesting and pertinent question:

"Do Pub Med and Pub Med Central return the same papers when you limit the Pub Med search to Free Full Text?"

Part I.

Part II.

Part III.
Bonus Question, Part IV.

I performed the same type of analysis that digitialbio did on two different search terms. I searched both "Physical Therapy" and "Manual Therapy" and then did this again limiting the search to Randomized Controlled Trials or Reviews. The graph below shows the % of each search result that was available for free (blue) and % of total literature returns that were free AND RCTs or Reviews (red).

Through my completely non-scientific, but fun analysis, it seems a greater proportion of free articles are of a high quality of evidence. It also seems that there is a slightly greater percentage of the Manual Therapy research that is freely available. Not surprising, as JMMT offers a lot of content online!

The Raw Numbers:

"Physical Therapy"

87335 -Total Results
4363 -Links to Free Full Text (4.9%)
15151 -Review, RCT
1280 -Review, RCT, free full text (8.4%)

"Manual Therapy"

28523 -Total Results
2065 -Links to Free Full Text (7.2%)
7241 -Review, RCT
775 -Review, RCT, free full text (10%)

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Move Over Swiss Ball, There's a New Desk In Town!

A new research study by James Levine describes the effects of implementing an upright, treadmill desk for office workers. The desk is designed so that workers can stand up and walk on the treadmill as they do their work. The goal of this is to increase calorie expenditure throughout the year, thus minimizing worker obesity. In the study, workers walked 35 minutes out of each hour, burning about 100 calories an hour more than usual. The Wall Street Journal Health Blog asked Dr. Levine some questions about this.

I encourage you to read some of the highly amusing comments to the WSJ blog on this topic. People are just insanely enthusiastic about it. My favorite comment was by one Marc, who suggested a Green twist to the treadmill desk as he would like to route the output back into the “grid” to save the firm on utility bills! HA! Output! A treadmill is an absolute energy hog, Marc.
I’m sure the real cost of this desk is well above the $2000 list price when you factor in energy costs, a whole new onslaught of worker overuse injuries, and the resulting high insurance premiums “the firm” would then face.
This seems like a perfect example of the media getting hold of a piece of science, overstating it, creating a furor and an instant fad. An excerpt from the interview:
“Q: These desks cost about $2,000 each. Is anyone besides you using them now?
A: Several Fortune 20 companies are involved. One has 20 units, others are being delivered. We’re turning away large companies. The level of interest is far beyond what it is possible for us to respond to. There are several thousand people doing this around the country. I get — at least every day — requests of where can I buy these?”
In James Levine’s defense, I guess his logic is solid. The treadmill project was born after he performed a previous investigation which found obese people spent 2 hours longer a day sitting compared to non-obese people. And to be honest, we should all find more ways to walk in a day.
I’m going to begin calling the companies purchasing these treadmills and offer to provide them on-site clinics to treat sore knees, shins, and feet.