It seems that a number of physicians in this health network were not keen on the new egalitarian roles presented by the hospital network. Physician roles (indeed all health provider roles) are key to any successful integration across the system. It is not sufficient to mandate integration in IPC.

In a nutshell, this article provides links to research and cases where the promise of electronic health has not been realized. It is always good to see the other side.

In retrospect, with SARS, there was chatter on discussion boards that pointed to a problem in Asia that was puzzling health care workers. While there was no name for the problem at the time, the discussion was largely about symptoms and the associated problems. Interestingly, the response to SARS required an unprecedented collaboration between public health resources around the globe — another KM challenge.

A virtual network of epidemiologists brought together public health institutions, ministries of health, and WHO Country Offices to analyze the spread of SARS and to define appropriate public health measures. (Learning from SARS: Preparing for the Next Disease Outbreak — Workshop Summary, 2004, p. 44)

So, lessons from the SARS experience now influence how we respond to global health issues in a flat, interconnected world. Here is the online version of the book referenced above:

And here is a paper on SARS and the KM opportunity for public health — From SARS to systems: developing advanced knowledge management for public health. [Stud Health Technol Inform. 2004;100:149-56.]

Back to swine flu. Can information sources be used to predict an outbreak like swine flu?

Google’s flu trends uses a number of terms, in aggregate, to spot trends in flu enquireies on their site. They even developed a version specific to the Mexico outbreak. The spike on this chart in January and February precedes the recognition by public health authorities.

Similarly, Veratect, a small company in Washington state [@Veratrect on Twitter] claims to have spotted this flu outbreak and notified a number of its corporate clients in advance of the general public health warnings. They were even accused of not reporting this information to Mexico authorities.

The Associated Press reports …

Veratect Inc., a 2-year-old company with fewer than 50 employees, combines computer algorithms with human analysts to monitor online and off-line sources for hints of disease outbreaks and civil unrest worldwide. It tracks thousands of “events” each month — an odd case of respiratory illness, or a run on over-the-counter medicines, for example — then ranks them for severity and posts them on a subscription-only Web portal for clients who want early warnings.

The idea fueling Veratect and similar companies is that blogs, online chat rooms, Twitter feeds and news media and government Web sites are full of data that public health agencies could use to respond faster to problems like outbreaks of swine flu.

Detecting public health outbreaks and even foiling terrorism has become more and more an information problem. Data scattered on the web can be turned into information and ultimately knowledge with the right tools and lenses. Knowledge pattern recognition has become one of the great challenges for today’s organizations and for society.

Addendum (May 26, 2009): Here is another related article from Wired — This article refers to Veratect and also HealthMap.

Here is the concept in a nutshell:- information, used effectively, can act to facilitate integration inside and across organizational boundaries; information binds organizations together (glue) and acts (like plumbing) as a mechanism for communications and the exchange of ideas. Communications in this case, can be transactional (e.g. EDI) or conversational (as a means of exchanging ideas and negotiating shared understanding).

Looking for an example? Consider the electronic health record (EHR) and all of the work being done in many jurisdictions to reach this holy grail. One of the opportunities that the EHR affords or provides (or, I should say, “should” provide) is the opportunity to bind the various organizations (physicians, hospitals, pharmacies, long term care facilities, etc.) that exist across the spectrum of care to coordinate and collaborate for the benefit of the patient. The EHR is not only a place where we ‘store’ information but is a vehicle for exchanging / sharing information about a patient.

Thoughts?

First, and on the cover, was a story about Ted Kennedy’s recent encounter with cancer titled “The Story Behind Kennedy’s Surgery“. Given his grave situation, Kennedy did what most of us cannot do – he convened a panel of experts from across the US (May 30th, 2008) and sought input (expertise) from the best experts he could assemble who had access to the latest research and treatments (knowledge). Here is a real life social example and application of expertise networking and expertise location. It turns out (or so the article alleges) that this approach to problems is a standard approach for the powerful Kennedy and illustrative of how he approached similar problems in the past.

Second, “Climate Experts Tussle Over Details. Public Gets Whiplash“  the author writes: “Scientists see persistent disputes as the normal stuttering journey toward improved understanding of how the world works. But many fear that the herky-jerky trajectory is distracting the public from the undisputed basics and blocking change.“. What interested me about this story was the notion that experts don’t always agree and the challenge we have as individual consumers of the knowledge-products they produce is how best to discern who to trust and what positions to adopt or follow.

Third, “Doctor and Patient, Now at Odds” deals head on with issues of trust. In the article, they point out that: “About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins study published this year in the journal Medicine. And two recent studies show that whether patients trust a doctor strongly influences whether they take their medication.“. The short story:- when we trust physicians, we are more likely to follow their advice. Trust and credibility are paramount to the determination of whether an expert’s advice will be adopted and followed.

In some ways, this snapshot on one day of major newspaper shows the ubiquitous role of experts and expertise networks in our everyday lives. I would be interested to receive stories and case studies from anyone out there that are illustrative of expertise-in-action.