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I read with great interest your post about electronic patient records.

I’d like to introduce you to MyMedicalRecords.com, which has by far the most sophisticated, user-friendly, web-based, secure approach compared with any of the other companies in the field. And it is recognized as such by some within the healthcare industry: we have tens of millions of patients at least passively in the system through our partners and revenues are expected to shoot from $550,000 last year to $27 million in 08. Yet almost nothing has been written about MMR (I’m a freelance journalist brought in to help them get some media exposure—I had written one article about MMR a couple of years ago and didn’t really understand how revolutionary it was at the time).

I’d like to send you a few things by email, snail, or fax about how we differ from the competition, our partners who have recognized the value of MMR’s unique service, our impressive management, or any other details. I could also set up an account for you to see how easy to use and useful it can be.

Sincerely,
Scott S. Smith
Director of Public Relations
MyMedicalRecords.com
10100 Santa Monica Blvd. #430
Los Angeles, CA 90067
888-808-4667 x123
ssmith@mmrmail.com

And now, for a non-commercial break ... ;-)

Thank you very much for a well-written report on 3D patient records. The project is clearly visionary in terms of information design and visualization of medical information. It also clearly has a strong connection to the real and envisioned national networks for health information, such as the US’s National Health Information Infrastructure (NHII) and the UK’s National Programme for IT (NPfIT).

We have to be realistic, however, how much of a stretch getting these systems into widely adopted practice really is. Data about electronic patient records in physicians’ offices usually peg the adoption rate at about 25% (1). In other fields, such as dentistry, it is a lot lower (1.8% [2]). In order to make the system of exchanging health information work on a routine basis, adoption rates have to become a lot higher.

A second problem is how health care providers capture data and how it is represented. SNOMED, the controlled terminology for health information used by the IBM project, is hardly in general use by physicians. In order to use a system such as that developed by IBM, the standardization and granularity with which physicians and other healthcare providers record data in patient records have to improve markedly.

A third problem is that while SNOMED contains over 300,000 medical concepts, studies have shown that its domain coverage in medical specialty and other healthcare areas is quite low. That is one of the reasons why so many “standardized terminologies” in healthcare exist. If we ever are to relinquish the Tower of Babel of medical information, existing standards have to become much more interoperable and converge to much more homogeneous development paths than is the case right now.

An issue overshadowing all of this is that we need to find out whether these systems actually improve patient care. Clearly, there is a lot of intuitive benefit to 3D applications in many areas of medicine. However, rigorous evaluation studies should find out how exactly they influence physicians’ decision-making and what their effect on patient outcomes is. More than once have IT interventions done more harm than good in medicine (3).

The good news is that researchers are focusing on 3D patient records. The bad news is that projects like these show us how far we have to go before they will actually benefit patients.

Thanks again!

Titus Schleyer, DMD, PhD
Assoc. Professor and Director, Center for Dental Informatics
School of Dental Medicine, University of Pittsburgh

P.S. [commercial break] Incidentally, we are working on a similar project in dentistry on a much smaller scale (4).

(1) Brailer DJ, Terasawa EL. Use and adoption of computer-based patient records. California Healthcare Foundation. Oakland, CA: California HealthCare Foundation; 2003.

(2) Schleyer, TK, Thyvalikakath, TP, Spallek, H, Torres-Urquidy, MH, Hernandez, P, Yuhaniak, J. Clinical Computing in General Dentistry J Am Med Inform Assoc 2006 May;13(3):344-52.

(3) Ash J, Berg M, Coiera E. Some unintended consequences of information technology in heath care: the nature of patient care information system-related errors. J Am Med Inform Assoc 2004 Mar;11(2):104-12.

(4) Schleyer, TK, Thyvalikakath, TP, Malatack, P, Marotta, M, Shah, TA, Phanichphant, P, Price, G, Hong, J. The feasibility of a three-dimensional charting interface for general dentistry. J Am Dent Assoc 2007 138: 1072-1080.

Dr. Charrette,

This is an amazing find. I posted about it very briefly in my blog on
the future of health IT, with a link to your article (http://hunscher.typepad.com/futurehit/2008/01/ieee-spectrum-v.html).

This gives me great hope for the future of evidence-based medicine.

-Dale Hunscher

-Michigan Institute for Clinical and Health Research

I enjoyed the article and am pleased to read about the significant investment by IBM.

I'm in favor of pushing enterprise applications like this down the value chain to the end user or citizen for their life record (e.g., a portfolio of records for health, finances, crimes, votes, driving, fitness, taxes, etc. covering pre-natal to post-mortem economic activity and material possessions).

The issue of standardization you raise is central to effectuating the development of a software application suite for a life portfolio. As an occasional medical patient, I would like to retain a copy of the 3D imagery, diagnosis and treatment in an extensible 3D (X3D) format, which is an ISO standard.

Having an X3D file of the medical service and products that I paid for with or without the help of my medical insurance provider(s) would allow me to review my history and share it with others as I choose using free X3D browser technologies.

I hope the 3D graphics format IBM chose is open source to facilitate platform portability and industry adoption. Moreover, I wish that IBM's strategy includes medical application development for the individual as well as the medical profession.

Thanks in advance for checking out my blog about my Leading Edge Forum Grant work on X3D for Enterprise Applications and Individuals

William O. Glascoe III, PMP
Principal, Federal Consulting Practice
Computer Sciences Corporation
wglascoe@csc.com