Bright ideas: Unboxed: carrots, sticks and digital health records

Step back from the details and what emerges is an enormous challenge in design innovation. What role should the Government? What is the right mix of top-down and bottom-up? Drive change through the system will lead to changes in technology, economic incentives and the culture of health care.

"This is a great social project, not just a technical effort," says Dr. David Blumenthal, national coordinator of the Obama administration for health information technology.

This year is when the project really takes off. In the 2009 economic recovery package, the Administration and Congress appropriated billion — the current estimate is of 27 billion dollars — on incentives to doctors and hospitals to adopt electronic records.

Now, a new Congress with Republicans trying to budget cuts could take back the money. Legislation was introduced by Representative Tom Latham, an Iowa Republican, to reclaim dollars spent stimulus — and money to accelerate the adoption of electronic health records could be a target.

Still, measures to promote the adoption of computerized health records have had bipartisan support over the years, although only the Obama administration has pushed to finance major. Most health policy analysts say it is unlikely that the legislation will be reversed.

When properly designed and used wisely, computerized accounts have proven valuable for improving care. Doctors have more complete information in the treatment of patients, while reducing the chances of medical errors and unnecessary testing.

But the stories of success to date come mainly from major health care providers, such as Kaiser Permanente, the Mayo Clinic and a handful of others. Most doctors are small practices, lack of financial and technical support, that large groups provide to their physicians. It is so little surprising that less than 30% of doctors nationwide now use digital records.

Late last year, the Administration, working with health professionals and the technology industry, establish a roadmap for what should include digital and how records should be used, for doctors to qualify for the incentive payments, typically up to $ 44,000. The program starts this year and the requirements to use the records to report and share health information increases in phases through 2015. After that, penalty kicks from Medicare and Medicaid for physicians that do not meet the rules and usage reporting.

The initial requirements to qualify for "meaningful use" are minimal, including being able to electronically collect and report basic information, such as vaccinations for children or for patients with diabetes blood glucose levels.

The long-range vision is that computerized patient data are a step toward what they call a health specialists ' learning health care system. " This means that data for diverse populations of patients can be analyzed to determine which treatments are more effective or arrive early warnings about dangerous drug interactions.

"Islands" of these learning networks already exist, notes of Charles p. Friedman, chief scientist at information technology Federal Office of public health. Data mining his patient, Kaiser, for example, was the first to identify a link between pain relief medication Vioxx and a high risk of heart failure, well before Merck pulled the drug off the market in 2004.

Yet the way to a citizen enabled on computer learning system, experts agree, promises to be long. A major obstacle is that many doctors, especially in small practices, are leery of technology which they see as unnecessarily long and difficult to use. "Doctors don't want to become employees," says Dr. Isaac Kohane, an expert on health technology at Harvard Medical School.

And complex technology — designed for large groups, small practice health — ben could increase medical errors, specialists say.

These issues, Dr. Blumenthal says, are a reason that Government standards, and perhaps also the timetable for the adoption of electronic health records, evolve and remain flexible.

The Government, he adds, is examining carefully the security and usability. Dr. Blumenthal's Office gave the Institute of medicine a grant of almost a million dollars for a yearlong study electronic health records and patient safety. And his Office is working with the National Institute of Standards and technology to develop a "usability assessment tool" that can be used to evaluate digital records offered by different companies.

Under Dr. Blumenthal, the Office has tried to build out a consensus on the criteria and technical standards, rather than issuing edicts. However, the President's Council of advisors on Science and technology, an independent group of academics and industry experts, said in a report last December that it was time for more "top-down design choices," which is called "a proper government role" and that "requires a more aggressive approach, which was taken in the early stages."

This month, the Office of health information technology has announced a move that showed his preferred approach to standard setting, one who has borrowed from the model of open source software development in an initiative called project direct Internet.

Many companies and groups contributed to Internet-based tools for Government-approved for health data exchange between institutions. Developers have written code and suggested ideas and consensus built around an approach that has been selected by the Government. The design was inspired by the Web, with its minimum specifications that leave plenty of room for innovation, says Dr. Douglas Fridsma, head of standards at the Office of health technology.

Without a lively exchange of information, the campaign to adopt electronic records really can't pay. And more is needed than standard data sharing and privacy and security protections, says Dr. Blumenthal.

Incentives must change as well. Two hospitals, a few miles away, he notes, do not now see themselves as allies, but as competitors. For a doctor or a hospital, a patient is, among other things, a financial activity — and keeping patient information is valuable.

Insurers, he suggests, will have to pay for vendors to share data or penalize them if they don't. "Exchange of information has a business goal, rather than a competitive threat, for this job," he says.

Watson gets IBM in health care (Digital Trends)

It didn't take long for demonstration of IBM the question answering system stunt Watson Jeopardy winning find some lenders: IBM announced an agreement with Nuance Communications to apply the technology Deep Question Answering of Watson in the healthcare field. The partnership of research will also address one of the main deficiencies that Watson demonstrated in Jeopardy, Watson analytical skills combined with voice recognition technology so that the system can understand what people say, rather than having to questions put to it as plain text.

"By combining our experience of Google analytics with the experience and technology from Nuance, we can transform the way healthcare professionals daily tasks, allowing them to work smarter, more efficiently," said IBM senior VP and Research Director Dr. John e. Kelly III, in a statement. "This initiative demonstrates how we intend to apply the features of Watson in new areas, such as health care with Nuance."

Columbia University Medical Center and the University of Maryland School of medicine will work on the project. Nuance and IBM hope to have direct products based on technology poised to enter the market at 18-24 months. The project will also benefit from clinical language understanding Nuance solutions to improve the understanding of Watson medical vocabulary and terminology.

Interests of the healthcare industry Watson comes apparent capacity to process information quickly available in natural language — rather than deliberately coded for computing — and make quick connections, high level between key elements of information from disparate sources. The technology could be applied to help health professionals keep up with the vast amount of clinical and scientific research is published in the healthcare field every day; looking ahead, Watson technology could be applied to some of the questions that have been long expected for so-called "strong AI" systems such as drug interactions, and diagnosis in real time.

[Image: IBM]

The Gadget can damage your health?

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When I turn off my bedroom light at night, the room is still lit up like the bridge of the Starship Enterprise. No, I'm not some sci-fi fanboy, just a gadget-happy materialist.

Overdoing the home LEDs?In one corner, I've got a desk with a PC on it. Six button lights on my two monitors glow orange. The PC power button blinks bright green. The speakers have a red light near the switch. My desktop microphone has a shockingly bright green light that casts a circle on the ceiling, as if I'm calling Batman. It's all plugged into a generic surge protector, which has a very bright red light on the toggle switch.

My wife usually leaves her work laptop, MacBook Pro, and her personal laptop, Dell Studio, charging in the bedroom. The Mac throbs with a blue-green light that brightens, then gradually dims, then brightens again like an airport beacons. Her Dell shines in small, dim light in the front. And the AC adapter has a light ring around the plug.

We also have a TV in the bedroom, and it has a cable DVR plugged into it. The DVR has a bright red light that's pointed straight at the bed. The TV and the DVR each has a smattering of other lights.

We've got two more surge protectors, each with a bright red light. Our e-books have lights that remain on when charging.

Our bedroom has a door to a bathroom, in which our electric toothbrushes flash amazingly bright green lights. Even when we close the door, you can see the seam around and under the door flash green! green! green!

Even with the room lights off, it's almost bright enough to read by the collective light produced by all of those status lights. And half of them are flashing. I'm supposed to sleep? Isn't this how they torture inmates at Guantanamo Bay?

I wrote a column in this space four years ago about how incredibly annoying all these gadgets status lights are and demanded that device makers get rid of them.

I didn't expect manufacturers to respond. And in fact, the problem is getting worse. The number of gadgets we use keeps growing, and each device seems to have more and brighter lights.

Since I wrote that column, new research has emerged that reveals how incredibly bad all of those lights can be for our health.

Lights on During Sleep Harms Health

New science has shed light on various health effects of sleeping in a room that isn't dark.

Lights at night can make you depressed and fat. An Ohio State University experiment on mice led researchers to conclude that even dim light in a room during sleep may cause depression. In a different study, Ohio State researchers found that sleeping in a dimly lighted room increases the amount of hunger experienced during the day, which can contribute to weight gain and possibly susceptibility to diabetes.

Sleeping in a room with dim lights increases a woman's chance of getting breast cancer, according to research conducted at the National Cancer Institute and National Institute of Environmental Health Sciences. The reason is that the body produces to cancer-fighting hormone called melatonin at night during sleep. But this process is interrupted if the room isn't dark.

Another study conducted at the Scheie Eye Institute at the University of Pennsylvania School of Medicine found that babies who sleep with a night light have an increased risk for developing short-sightedness, or myopia. Just 10 percent of babies who slept in the dark most nights needed glasses, compared with 34 percent who slept with night lights and 55 percent who slept with room lights on.

The bottom line is that the human body is designed to sleep in total darkness. All those gadgets lights are lighting up our bedrooms at night and damaging our health.

LED Lights are Toxic

The little lights that are built into our phones, computers and other gear are made with a semiconductor technology called the light-emitting diode (LED). These lights are advertised as "eco-friendly." But a recent study by the University of California at Irvine's Department of Population Health & Disease Prevention found that LED lights can contain hazardous substances, including lead, arsenic, nickel and more than a dozen other deadly materials.

According to a release by the university, "lead, arsenic and many additional metals discovered in the bulbs or their related parts have been linked in hundreds of studies to different cancers, neurological damage, kidney disease, hypertension, skin rashes and other illnesses."

In general, say researchers, the brighter the light, the more poisons they're likely to contain. Colored lights contain more lead than white ones. Red lights were found to contain up to eight times the amount of lead allowed by California law and about 35 times the amount allowed by federal law. That's right: Red LED lights are so toxic they're illegal.

Researchers say LED lights are generally safe unless they break, in which case they advise that you construct your own hazmat suit to deal with the toxic cocktail that spills out.

One major ongoing risk is car accidents. When cars collide, the LED lights built into the dash, as well as gadgets and computers in the car, can shatter, causing a release of toxic substances that experts say should be treated like any other hazardous materials spill. If the LED traffic lights are damaged, it's especially bad because those LEDs are so bright and scattered. Unfortunately, the risk is typically ignored, and emergency crews are routinely exposed to these hazardous materials without protection.

There's also an environmental cost. Current law ignores the risks of LED lights, which are legally disposed of in landfills. The toxic metals in the lights, especially copper, can make its way from landfills into lakes and rivers, poisoning wildlife.

And when gadgets are discarded and "recycled," they're often handled by children in filthy Chinese processing centers who have to contend not only with the toxic materials required to make computer equipment function, but also the materials in the lights, which aren't even necessary.

What Can You Do?

A single LED light on a single gadget is no big deal. But most people surround themselves with dozens of devices--all with their own lights--in their bedrooms, offices, homes and cars. These lights are incredibly annoying, damage our health and represent a toxic hazard both for people and the environment.

Worst of all: They're unnecessary! Sure, a status light may alert you to an incoming email, or tell you at a glance that something is receiving electricity. But we now know that benefits like those are vastly outweighed by the costs.

You can protect yourself to some degree by keeping as many devices as possible out of your bedroom. Put black electrical tape over the lights on those items you do keep in the bedroom.

And treat any broken LED lights with extreme caution.

Now that we know how toxic and dangerous LED lights can be, gadget makers have a responsibility to eliminate all lights that aren't absolutely necessary. They waste electricity, annoy users, wreck health and pollute the environment.

Gadget makers love lights. But getting rid of them would be the brightest thing they could do.

Mike Elgan writes about technology and tech culture. You can contact Mike and learn more about him at Elgan.com, or subscribe to his free email newsletter, Mike's List.

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