My mother often says that my handwriting is so bad I should have been a doctor. Luckily, digital systems like electronic medical records (EMRs) and computerized pharmacy ordering systems have largely taken the legibility factor out of medicine, especially when it comes to doctors’ and nurses’ notes.
Those notes—attached to millions of patient records—have the potential to do so much more than simply capture clinical observations. Within them lies a treasure trove of data about disease burden, risk factors, drug interactions and more, waiting to be mined for new insights that could dramatically impact research and care.
If the data can be extracted, that is.
The difficulty is that, to a computer, clinical notes are “unstructured” data. There are no standard entries, no numbers to be plugged into a field—just text in a box. And not every doctor or nurse uses the same words to describe the same thing.
So, how can we make the unstructured structured?
Full story »
Food insecurity is a major problem for diabetic patients at the Kay Mackensen clinic in Haiti where Julia Von Oettingen, MD (top center) serves as medical director.
In parts of the developing world, especially remote, rural areas, it’s not unusual for people with diabetes to ignore their symptoms until they’ve collapsed and need immediate care. By the time they see a doctor, their blood sugar levels might be so high as to cause diabetic ketoacidosis (DKA), where the body starts breaking down fats and proteins, turning their blood acidic and leaving them extremely dehydrated.
For many, it won’t be the first such episode. But for some, it can be the last.
Stories like this are increasingly common across large swaths of the developing world—as Diane Stafford, MD, an endocrinologist from Boston Children’s Hospital, discovered when she traveled to Kigali, Rwanda, through the Human Resources for Health program. Full story »
Above: The Hacking Pediatrics team: Judy Wang, MS; Michael Docktor, MD; Alex Pelletier, MBA; Margaret McCabe, PhD, RN, PNP; Kate Donovan, PhDc, MBA, BS (Photos: K.C. Cohen)
Michael Docktor, MD, is a pediatric gastroenterologist, director of clinical mobile solutions at Boston Children’s Hospital and a co-founder of Hacking Pediatrics.
A hackathon is most easily explained by relating it to the crowd-sourced, time-crunched challenges that we see every day in pop culture. From “Top Chef” to “The Apprentice” to “Extreme Makeover,” television is teeming with passionate individuals trying to solve a difficult task with incredibly constrained resources and time. What results is often remarkable by any standard and speaks to the power of concentrated, collaborative problem solving.
When the challenge involves children and their health, the results can be magical, as witnessed by the weekend-long Hacking Pediatrics in late October, the first event of its kind. More than 150 “hackers,” including engineers, designers, software developers, entrepreneurs and roughly 40 clinicians gathered to create ground-breaking solutions for children and their families. Full story »
Charles Dumoulin, PhD, is the director of the Imaging Research Center at Cincinnati Children’s Hospital Medical Center (CCHMC) and a professor of pediatric radiology at University of Cincinnati College of Medicine. He led the team of scientists and engineers from CCHMC’s Imaging Research Center who won the Clinical Innovation Award at Boston Children’s Hospital’s National Innovation Pediatric Summit + Awards in September.
A 4.2-lb baby girl in the new 1.5 Tesla MRI magnet, designed for use in the NICU. (Images courtesy of Cincinnati Children’s Hospital Medical Center)
Experience suggests that magnetic resonance imaging (MRI) and advanced MR techniques such as spectroscopy and diffusion imaging offer substantial benefits when diagnosing problems in premature babies. However, today’s MR systems poses significant logistical barriers to imaging these infants. We have been working to change that.
MRI provides an unparalleled ability to visualize anatomy without the hazards of ionizing radiation. Yet premature and sick babies in neonatal intensive care units (NICUs) are usually too delicate to leave the unit. The few babies who receive MRI today must be accompanied by NICU staff during transport to and from the Radiology Department. This process is often a multi-hour ordeal and reduces the staff available to care for other babies in the NICU. Moreover, infants must be imaged in an adult-sized MRI scanner Full story »
Alisa Khan, MD, is a pediatric hospitalist and health services research fellow at Boston Children’s Hospital. She and Christopher Landrigan, MD, MPH, research director of the Boston Children’s Hospital Inpatient Pediatrics Service, recently received a Community/Patient Empowerment Award at the National Pediatric Innovation Summit sponsored by the hospital.
A nightly family signout not only helps families of hospitalized children sleep better, but also empowers them to play an active role in patient safety.
Miscommunications are a root cause of more than 70 percent of sentinel events, the most serious preventable adverse events in hospitals, according to data from the Joint Commission and the Department of Defense. As Vector reported yesterday, a bundle of interventions focused on improving patient “handoffs” during clinician shift changes, piloted at Boston Children’s Hospital, resulted in a 46 percent reduction in medical errors and a 54 percent reduction in preventable adverse events. What’s now known as I-PASS is now being implemented at 10 children’s hospitals across the U.S.
While I-PASS has greatly improved patient safety and communication between medical providers, it does not currently involve the family. Yet families play a pivotal safety role, advocating for their children and monitoring their progress through acute illness. Full story »
Medical errors are a leading cause of death and injury in America, and an estimated 80 percent of serious medical errors involve some form of miscommunication, particularly during the transfer of care from one provider to the next. However, a study published this week in the Journal of the American Medical Association demonstrates that standardizing written and verbal communication during these patient “handoffs” can substantially reduce medical errors without burdening existing workflows.
The study followed 1,255 patient admissions to two separate inpatient units at Boston Children’s Hospital—half occurring before a new verbal and written handoff program was introduced (July to September 2009) and half after (from November 2009 to January 2010).
After implementation, providers spent more time communicating face-to-face in quiet areas conducive to conversation. There were fewer omissions or miscommunications about patient data during handoffs. And medical errors decreased 45.8 percent. Full story »
Chronic, unresolved inflammation can be quite harmful, right down to the cellular level. At the macro level, it has links to cancer, diabetes, heart disease and other degenerative conditions.
This is why the body keeps a tight rein on the inflammatory response and maintains a host of factors that resolve inflammation once the need for it (for instance, to clear an infection or heal an injury) has passed.
We know pretty well which factors work between cells to turn on and turn off inflammation. That knowledge has led to the development of drugs like ibuprofen, acetaminophen and naproxen, all of which temper pro-inflammatory factors.
However, when you look at the signals and signaling pathways within cells, things get more complex, especially when it comes to factors that turn off inflammation. We haven’t completely grasped the full complement of proteins that transmit these internal anti-inflammatory signals. If we did, we could potentially add new drugs to our pharmacopeia to regulate or resolve inflammation or maintain cells in a non-inflamed state, and perhaps help prevent rejection of transplanted organs and tissues.
David Briscoe, MD, and his team at Boston Children’s Hospital’s Transplant Research Program, has taken the field one step closer to grasping those internal pathways by studying a cellular protein called DEPTOR. Full story »
The Affordable Care Act (ACA)’s health insurance exchanges opened for business on Oct. 1, and, despite website glitches and non-stop political fighting, citizens across the U.S. can now comparison shop and pick an insurance plan. Time will tell how well the exchanges will work out for consumers, employers and insurers—as well as what effect they will have on pediatricians and hospitals.
According to Wendy Warring, senior vice president, network development and strategic partnerships at Boston Children’s Hospital, the exchanges may force medical professionals to face changes in patient volume, adjustments in reimbursement rates and shifts in how employers provide benefits to insurers. Right now, she says, “people are very confused about public exchanges versus state exchanges versus private exchanges,” and opinions vary on what impact these changes will have on medical professionals. Full story »
Israel Green-Hopkins, MD, is a second-year fellow in Pediatric Emergency Medicine at Boston Children’s Hospital and a fierce advocate for innovation in health information technology, with a passion for design, mobile health, remote monitoring and more. Follow him on Twitter @israel_md.
At the Hacking Pediatrics event in late October, I was fortunate to collaborate with a team interested, like I am, in patient engagement. After the initial idea-pitching phase of the hackathon, where clinicians present unsolved problems to an audience of techies and entrepreneurs, I joined a group of nearly 15 hackers who felt our desires to be similar. The prototype at left was our end result, but we had no idea then where our interest would lead.
At the beginning, in fact, our greatest challenge was determining exactly what problem we would try to solve. Full story »
Tripp Underwood contributed to this post.
Families with peanut-allergic children live in fear that their child will ingest peanuts—even minute amounts—accidentally. Now, a small pilot study published in the Journal of Allergy and Clinical Immunology offers hope.
In the year-long study, immunologist Dale Umetsu, MD, PhD, and colleagues in the Division of Allergy and Immunology at Boston Children’s Hospital were able to get some children to tolerate as many as 20 peanuts at a time. Their protocol combines a powerful anti-allergy medication with a methodical desensitization process.
While it’s not a cure, the protocol may enable children to weather trace amounts of peanuts that might lurk in baked goods or foods “manufactured in a facility that processes peanuts.” Even a small amount of peanut tolerance could be lifesaving. Full story »