17 August 2012

Biomedical Computing on a Budget

The Numbers and Your Wallet

 - Let’s face it. How many Health Professionals are MBAs? Not even all IT Pros are MBAs! And in the current economic world, ROI (return on investment) is key.  So what is one to do? Do we pennypinch in all areas of our life? Some say no. But the majority of you reading this blog are probably feeling the “ouch” of the recession. Even big IT firms are restructuring, retrenching and recalculating all their moves in their day-to-day operations. 

 - Even a number of hospitals have suspended normal operations.  And when I say "normal" I mean feeling free and easy and generous. As a matter of fact, even malpractice insurance premiums are becoming competitive. Just a few weeks ago I learned that the small clinic practice setting has become a viable option for MDs. I have been working in a medium sized diagnostic facility for easily 10 years and I don’t regret it. We still had budget diagnostic packages being offered without sacrificing Quality of Service (QoS). ROI in the health profession is not just about big bucks, but rather, a commitment to care for those who need us. I’m not going to get into a discussion about the budget deficit and my suggestions. It’s getting downright complicated. Or so it seems. The bottom line is: where do we want to spend our hard earned cash. If we all started having to drive a Ferrari to work, then of course our overhead would shoot up. And who takes the heat? The guy next door whose wife is about to give birth and he’s out of work. 

 - It’s not just a financial crisis we have to deal with. It’s also a crisis of moral and ethical behavior. We must remember, we are called to serve. We start with that, stay with that, and live with that. No easy matter at all. The temptation to “me first” is compelling. Why? Because we’re all in the same financial boat-  more or less.  Admittedly, some have quite a fancier boat. No problem with that at all. Just don’t pass the cost to the patient. No I’m not an ordained minister. And neither am I a Navy Seal! Just your friendly neighborhood mad scientist -internist-cardiologist with a laptop. Let’s keep a good sense of humor. It’s a survival skill. So, just a word: keep focused on what really matters. And if you have happened to get lost in the professional-financial forest, try hacking your way through with some kind words and acts, and give thanks to your Creator. Not tomorrow. Today.

 - The Numbers Frenzy

To those of you who are currently working in the area of Health Statistics, well, there are some free tools available from the National Center for Health Statistics. You can visit the resources page here There is also a good epidemiologic tool know as OpenEpi  now in version 2.3.1 Check it out here.   available in English, French, Spanish and Italian. So even if you’re in the European Union, this tool may work for your needs. More free statistics software can be viewed here Since we’re dealing with budget issues, make sure to read the fine print. If you’d like an interesting free online data visualization tool check out Tableau Public available here.
 - Like I said, we’re ever confounded by the gamble of Health Technology and money. Different people have all sorts of suggestions. With the explosion of mobile computing people have asked who will pay for the development and adaption of mobile devices in the Medical arena. Businesses have done reasonably well and they’re thinking, when will it be the same in the hospital, clinic or research institute. Somebody’s going to have to pay for this. But who? Will this mean an additional increase in health expenditures? We have enough problems already. But then again, if we were going to go for the “people care” paradigm, then that means it is essential to break the boundaries and reprioritize costs for patients, health professionals as well as clinics and hospitals. And since the research has to go onward we better think of solutions ASAP! Cures have to be found and patients need our utmost attention and QoS. Healthcare can’t take a back seat behind Defense spending. Quite frankly, someone I know once told me that it paid more to blast people out of existence than to cure them. Is this what we’re coming to? I am optimistic though, that things will get better. We just have to keep focus and ride the storm while it’s still roaring. Maybe, once policy makers get their acts straight, we will progress. Will the business model work for healthcare? At any rate, each of us has a voice and we better tell government leaders to be straightforward with their service priorities instead of the self-embellishment that serves no purpose other than to anger their constituents. Those of us in the healthcare galleon should row our individual oars and steer forward and do what we do best: serve and show the world we care. Like I always say, mediocrity is a capital offense. Go and make the world a better place, regardless of your place in the grand drama of things.  And if eHealthcare is your calling, then do it with a passion. Enjoy your work and work at what you enjoy. We in the healthcare business are at a crossroads. The world is watching. Let’s keep people healthy!  Meanwhile, the medical community is pioneering new modes of healthcare delivery based on the continuous management of disease rather than expensive episodic care. Costs decline as quality and access of care improve.

 - Patient Numbers

 - As personalized Medicine grows, data capture will have to evolve too. And big numbers will be our challenge. And as we manage all those numbers well we will then see that our efforts will have paid off. Patients will be as smart as can be, and we will have to deliver top quality improvements in data analysis and consolidation. There will have to be a central body or umbrella organization that will enforce common grounds for handling information, akin to the UN/WHO ICD system. All health professionals should participate in training and supervision, and of course, as we deal with our own clients we shall be able to render care to the best of our abilities. Everybody will know the basics of coding, operating and managing the information warehouse. With the explosion of cloud technology, we will have to be tech savvy. But it’s not the tech that’s the goal: it’s the patient we care for. We need to see the big picture. I read once and I remember it well. As a painter steps back from his work to see the big picture, we will likewise need to step back once in a while and see that we are involved in a huge ecosystem where everybody is a player. And we need to play right. Self-directed education is blossoming and we need to get interested in things that we typically shrug off as “not my thing.” Take responsibility for your own education. Let’s all be mature. Like I told a resident once, “we’re not in kindergarten anymore.“ Enough  with the excuses. We have reached an inflection point between the insular ‘sick care’ non-system of the past and the collaborative, proactive, true ‘health and wellness’ system of the future. As we have come to better understand the phenotypic, genotypic, environmental, and lifestyle factors that determine our health, it has become clear that disease and wellness are inherently personal. It should be. The patient also has to learn to take responsibility for his or her education and growth. There is such a thing as patient autonomy. But rather than burden the patient with forms, and more forms, we must guide them safely along the way. Do not underestimate the patient’s capacity for self-care. Of course, at times they need a helping hand. Individualizing treatment for a given patient is a truly daunting, data-driven task. Finding a treatment based on a patient’s genes, proteins, and environment is essentially a signal-detection exercise.

 - In my previous post, I mentioned the need to not only capture the signal, but also get the sense out of it. This will ultimately require data volumes and manipulation techniques unprecedented in information science and technology.  Businesses, banks, insurance firms and even the governments are doing it. eHealthcare must tread the same path of growth. From trial and protocol design all the way to the task of prescribing, all of this may have to be coordinated in a group run. The last mile has always been the hardest: obviously multifactorial, involving structural problems with our care delivery systems, reimbursement policies, etc.  Eventually, patients want a secure network of ‘friends’ around their illness and they want their doctors to ‘like’ them. Regardless of the approach, ‘liking’ our patients—and our patients liking us in return—will be a really large Big Data problem. I dare say that there are some of us healthcare professionals who are in their comfort zones and find it hard to accept the tech issues. Actually, I think that it’s basically a fear of the unknown which can be daunting indeed. Then goes the thinking, “I did fine without it. Why bother with all that now?” My answer is ”Because it behooves us as professionals.” It’s not a threat, but rather, a challenge which we embarked on when we decided to become a doctor, a nurse, and whatever branch of medical service.

 - This is the reason why I include facts, figures, data, and number crunching methods in my discourse- this blog. Just a short while back, somebody told me that she couldn’t get her laptop to work. So I told her, “You need to do such-and-such.” She responded, “I’m not a techie.” So I responded, “You don’t need to be a techie. Just know your machine and start off with the essentials.” Know your machine and what you are doing with it, and, to it. After we overcome that inertia, everything else will come easier. We live in exciting times. Technology is a three-course dinner at the best restaurant. Let’s not get stuck at the soup phase. Let’s savor everything. Artificial intelligence, neuro-linguistic programming, and statistical, decision based systems will then come easy as pie.

 - Back to the Math Exercise

 - Jean Louis Marie Poiseuille  (22 April 1797 – 26 December 1869)
was a French physician and physiologist.   

 Poiseuille’s law.

This law is important in cardiovascular physiology. However it is  a feature in hydraulics, fluid dynamics, and electrical currents as well. So kindly take a good look at it and see the unifying characteristics of flow. It is very relevant to understanding cardiovascular pathology and eventually diagnosis and clinical investigation.

This concerns the voluminal laminar stationary flow of an incompressible uniform viscous liquid (so-called Newtonian fluid) through a cylindrical tube with constant circular cross-section. In other words, it applies to non-turbulent flow of liquids through pipes. It can be successfully applied to blood flow in capillaries and veins, to air flow in lung alveoli, for the flow through a drinking straw or through a hypodermic needle.

 - Gotthilf Heinrich Ludwig Hagen (March 3, 1797 - February 3, 1884) was a German physicist and hydraulic engineer.


In the previous post, we talked about the 

Hagen-Poiseuille’s Law.

For purposes of clarity, I'm including the formula again here.

A Formula for Vascular Resistance: Standard Fluid Dynamics

The Hagen–Poiseuille equation, a physical law that gives the pressure drop in a fluid flowing through a long cylindrical pipe. The assumptions of the equation are that the fluid is viscous and incompressible; the flow is laminar through a pipe of constant circular cross-section that is substantially longer than its diameter; and there is no acceleration of fluid in the pipe. The equation is also known as the Hagen–Poiseuille law, Poiseuille law and Poiseuille equation. Actual fluid flow is turbulent (i.e., not laminar) for velocities and pipe diameters above a threshold, leading to larger pressure drops than calculated by the Hagen–Poiseuille equation

 - Study the units used for the calculations, and  consider the reasonable limits of the variables. Remember, math is the relationship between objects, whether numbers or words. Functions are intrinsic in calculus. When you start coding, you will come across OOP (Object-Oriented Programming). So get used to this principle. As you start working with different programming languages this knowledge will come in real handy. C, C++, Java, even Python (and all the hybrids) will deal with objects, classes, data structures and algorithms.

 - Get some scratch paper and work it out. If you've got a whiteboard, you can draw out the process. If you've got the latest 10.1 tablet with pen, try doing it. It'll be fun and engaging. Can you imagine, up to 60% of a healthcare individual's time is spent on documentation. Work smart.

 - I hope you do the exercise. Next time we'll talk about viscosity and the characteristics of the flow vessels. Also, we'll be taking a view of diagnostic procedures used in evaluating these elements. PhD not required...

"See One. Do One. Teach One."

 - Take some time to check out the following resources on Big Data

2) Roel Castelein (Global) - Big Data: The Third Wave:

 - The weekend is just around the corner. Take time to step back and look at the big picture. You're part of it.

 - Stay safe!

 - Fernando Yaakov Lalana, M.D.

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