Lab Soft News

Snap Google Quiz on a Tuesday Morning

Here is a snap quiz about Google for a Tuesday morning. If you get it right, take the day off and tell your boss that I said it was OK.

If you Google for the search terms Abbott and middleware, you will find that a Lab Soft News note is listed in second place on the first search page. Here is the link. Following is the question:

Why would an insignificant blog like Lab Soft News, only in existence for two months and with 50-60 visits per day, get such excellent placement in a Google search?

ANSWER:  Google juice.

Here is a definition for Google juice:

Google juice is jargon for the ability or power of a website to turn up in Google searches. A website that commonly turns up as the first or second entry in a variety of searches — especially for keywords that are not part of the site's name — can be said to have a lot of Google juice. It is frequently used by bloggers and webmasters. Google's PageRank system plays a large role in ranking "hits" for a given search. It works by counting how many times a site has been linked to and by the "quality" of those links — namely how many times the site that is linking has been linked to. In this way, sites with high Google rankings (i.e., lots of "Google juice") can offer to "share" or "give" Google juice to a less popular site. A link from a site with less Google juice can also be helpful in this regard to a lesser degree: there is less juice to give.

The blogs with the best readership have interesting new material added each day, thus attracting the attention of the spider bots of Google and other web search sites.

Active blogs = abundant Google juice. Formal static corporate web sites = little Google juice. Please do not share this tidbit with the marketing executives at Abbott Diagnostics.

Free Wi-Fi for Patients in Hospitals

Talk about great ideas. The blog Medical Connectivity Consulting reports about a hospital that is now offering Wi-Fi Internet access to its patients. Here is the link to the original report and below is the quote from the blog.

The Richardson Regional Medical Center now provides free Wi-Fi Internet access to patients and visitors throughout the hospital. What started as a WLAN to support paperless charting became a broader deployment. Today, the entire hospital is on a Wi-Fi system. The system includes waiting rooms, patient rooms and associated medical office buildings. Access is also available to clinical personnel and for business functions. The clinical and business operations are completely separate from patient access so that no one can tap into the hospital's confidential records, [CIO Ronald] Franquiz said. "We definitely have total control to make sure that our business network and hospital network are not affected at all."

A few years back, my hospital, the University of Michigan Health System, launched a marketing campaign based on the slogan: Knowledge Heals. It was emblazoned on billboards on all of the surrounding interstate highways. I believed the sentiment expressed in this slogan then and I believe it now. When they launched the ad campaign, I wonder if they had patients in mind.

I would prefer to have every patient room equipped with a PC wired to the Internet but, for now, I will settle for Wi-Fi access.  Every room should also come equipped with a list of the URLs of reliable medically-oriented web sites so that patients can browse the sites to read about their diagnoses, the drugs that are receiving, and relevant disease-oriented patient web sites so that they can join on-line discussion groups. How about access to details about controlled clinical trials?

The hospital should also purchase web access for all patients to the PDR, available on the web here. With this resource, they can review the side effects of their drugs and also see what their pills look like so that they and family members can monitor the drugs and dosages that they are receiving when the nurses say "swallow."

However, I also believe that patients should be on their own if they want to search for medical malpractice attorneys on the web.

Deadline for Reduced Registration Fee for Lab InfoTech Summit

Wednesday, February 1, is the deadline to register for the reduced earlybird fee for Lab InfoTech Summit. The conference will be held in Las Vegas at the Venetian Resort Hotel on March 1-3, 2006. If you register on or before February 1, the fee is $495.  The cost of registering after this date will be $575. You can register on-line for the conference here.

Another good reason to stay on top of this deadline, particularly if you wish to stay at the Venetian Resort Hotel, is that only 185 suites have been reserved for peak nights at the special rate of $209 per night. The hotel reservation cut-off date is February 6. Suites from this block of rooms are going fast.

Qualities of a Successful Business Blog

Here is an article that describes some of the qualities of successful business blogs. It's entitled Blogging Your Way Up the Career Ladder. Below is a cut-and-paste quotation from the article by Shahid Shah, CEO of Netspective, who has three IT blogs, including HealthCareGuy. He advises potential bloggers about how what really "sells" in a blog:

''I would be even more focused,'' he says. ''Try to have a point of view, espouse specific ideas, and give people a reason to come to your site for something they can't get elsewhere. The more opinionated you are and the more focused you can be on specific industries or topics, the better and more loyal your readership will be.''

I think Shah is right on target with this advice. The strength of many successful business blogs is focused news and edgy opinions. HIStalk is particularly good in this regard in the area of healthcare IT. This blog has managed to develop a constituency with frequent feedback from readers. It publishes breaking news tips from readers that creates a more interesting and exciting web site. A fresh and changing environment is critical to attract what Shah refers to as a loyal blog readership.

Shah is quoted further in the article to say:

If you are looking for long-term career advancement, blogging is an opportunity that can be used to your advantage. It now is common for job interviewers, customers and partners to Google your name before engaging with you personally. If your blog is found in the search results, they can get a feel about your disposition and experience regarding the subject matter of the potential engagement.

Here is where I need to part company with him. It is hard for me to view a business intelligence blog as a means for career advancement for someone with, say, a salaried healthcare IT position who is fishing for another position. Any prospective employer who Googles the candidate's name is going to be (1) nervous about whether the candidate's blog is going to rub someone the wrong in the industry and (2) wondering how much time the individual is going to spend on the blog in the future. We are talking healthcare here, not a spot in an advertising agency.

For clinically-oriented academics in healthcare, however, blogs may have some connection with career advancement in the future.  However, it is unclear exactly how this will work and whether a serious blog will yield any substantial benefits for advancement. I wouldn't bank on it for now and would recommend the standard process for now of publishing papers in recognized journals.

Workplace Drug Testing: Some Statistics

Here is a very interesting item about the percentage of positive tests among federal "safety-sensitive" workers released by Quest Diagnostics and dated 12/1/05.  Drug testing home kits were discussed in a recent post but no data was presented about drug test positivity among workers.

The number of federal “safety-sensitive workers” who tested positive for amphetamines jumped about 13% during the first six months of 2005, according to the Drug-Testing Index released  by  Quest Diagnostics. The tests show 0.35% of federal workers tested positive for amphetamines against 0.31% during the same period last year. In total, 10.2% of all positive drug tests revealed amphetamines, as opposed to 10% a year ago.

Overall, 4.3% of all workers tested positive for some sort of drug in the first six months of 2005 against 4.5 % in 2004. The percentage of workers to test positive for drugs has declined almost every year since 1988, when 13.6% of workers tested positive for drugs. Among those workers who did test positive, 54% were found to be using marijuana, as opposed to 55% a year ago, while 14.4% were found with cocaine in their systems compared with 13.8% a year ago.

Here is another reference to a similar topic dated 9/29/05:

Oregon Medical Laboratories in Eugene, the state’s largest drug-testing laboratory, reports a 30 percent increase in the first six months of this year.  Marijuana remains the most frequently detected drug, showing up in more than half of all positive tests. But methamphetamine appears to be the fastest-growing illegal drug of choice among workers.

The actual rate of positive test results that indicate drug use increased to 6.9 percent for the first half of 2005, compared with 5.3 percent during the first half of 2004, lab officials said.  The results do not include tests from employers regulated by the U.S. Department of Transportation, such as trucking firms, which have been required to randomly test workers for drugs since 1989 and have lower positive rates as a result.

By the way, there is a booming market on the web for "drug cleansers" which purportedly "cleanse" the body of residual traces of drugs of abuse.  Here is a link to a Yahoo search page listing some of the products available on the web.

How would I know if they work?

Delinking Work Processes in the Virtual Lab

A previous note addressed the virtual lab as it relates to flow cytometry.  One of the key issues presented in the discussion with regard to the virtual lab was that it enables a delinking of the technical (lab) component from the professional (interpretive) component of a test process. In the traditional model of lab testing, both components are performed within the same physical lab with the lab-based pathologist contributing the interpretation when appropriate.

Information technology (IT) destroys time and distance. The use of web applications in the lab allows an external party such as a pathologist working in his home laboratory to view real-time the preliminary results of flow cytometry for a given patient in a distant reference laboratory.  He can then direct lab personnel in the reference lab to perform additional test procedures, as required, and remotely produce the final report.  As indicated in the previous note, this allows the reference lab to solicit business from pathologists whose home laboratory does not perform flow cytometry and allows them to bill for the professional component of the test.

This delinking of the technical and professional components in reference labs by enabling real-time participation of external consultants has significant implications for the future of lab medicine consulting.  I distinguish here between the professional component of testing in flow cytometry where the expertise of the consultant is necessary to transform the raw data generated by the cytometer to create the final report and what has been referred to in a previous note as a contextualized report in which, for example, the flow cytometry results are integrated into a more comprehensive clinical interpretation for a patient.

The emergence of the virtual laboratory model opens the door for a qualified external expert (e.g., a pathologist or a clinician) to contribute the interpretive component for any test or complex set of tests.  As noted above, the consultant's expertise may be necessary to "finish" raw results or provide a broader laboratory medicine consultation billable under CPT codes 80500 and 80502. This is another example of the web "opening up" a work process and creating a more competitive environment.

Clinical Informatics Wiki Under Development

A clinical informatics wiki, Clinfowiki, is in the process of development.  Check it our here. This page provides a general outline of the contents of the Clinfowiki. Twenty articles in the area of clinical informatics are under development and help is being solicited to complete the study. Note the previous note here relating to some deficiencies in the current LIS definition in the wikipedia. Help to make sure that all of the clinical lab and pathology informatics entries in Clinfowiki are accurate and well written.

Home Testing for Drugs of Abuse

I can only describe myself as somewhat taken aback when I googled for "home health tests" and the search yielded a Yahoo page accompanied by the following index :

Test Type
Multidrug Tests (69)
Marijuana Tests (38)
Cocaine Tests (20)
HIV Tests (12)
Cholesterol Tests (10)
Alcohol Tests (9)
Hepatitis C Tests (5)
Colorectal Disease Tests (5)
Blood Sugar Tests (4)

The numbers in parentheses to the right of each category of test kits represent the number of products available by category by retail web site. I am going to do some math for you but keep in mind that I will be assessing only the array of test kits on the web and not the number of units of each sold nor the value of product sold.

Adding up the numbers in parentheses yields a denominator of 172. A numerator of 153 is obtained by adding the number of kits for multidrug testing + marijuana tests + cocaine tests + HIV tests + alcohol tests + hepatitis C tests.  Calculating a percentage for these specific tests indicates that 89% of home test kits offered on the web are designed to detect drugs of abuse or diseases often related to drug abuse.  Blood sugar testing, colorectal disease detection, and cholesterol testing account for 11% of the home kit testing market in this list using this same calculation.

Here are some possible reasons I have come up with to explain the preponderance of home test kits designed to detect drug abuse and some of the sequelae of drug abuse in this list:

• The use of home test kits for chronic diseases like heart disease or colorectal disease is lower than anticipated because the test kits available in the market are unreliable and/or better tests can be obtained (and will be paid for) in traditional healthcare settings.
• Home test kits provide privacy and confidentiality which are important when testing for drugs of abuse in order to to avoid embarrassment and legal repercussions; this explanation makes no sense for adults who surely know that have been abusing drugs but is relevant for parents testing their children for drug abuse.
• Given the high prevalence of drug abuse in the U.S. population and also the incidence of drug screening as part of some preemployment physicals, there probably is a burgeoning market for drug screening tests among casual users interested about how they test prior to applying for a job requiring such screening.

LabCorp Licenses Interpretation & Reporting System

LabCorp has licensed an interpretation and reporting system for their CYP450 genetic test results from Signature Genetics. Here is the link to the press release and here is the link to the Signature Genetics home page. Below is an excerpt from the press release:

Increasingly, physicians are using pharmacogenetic tests such as cytochrome P450 (CYP450) to determine if an individual carries genetic variants, or polymorphisms, impacting the safety or effectiveness of many commonly prescribed drugs.... Even with results from the various pharmacogenetic tests for CYP450, however, many physicians still resort to "trial and error" for prescribing and dosing drugs because the genetic information is complex and difficult to interpret. The Signature Genetics interpretation and reporting service is intended to help take the "trial and error" out of selecting the most appropriate drug and establishing the most effective dosage for a given individual....The report details which medications should work most effectively and at what dose, which treatments might cause adverse reactions and/or react with other concurrent treatments, and which types of lifestyle and nutritional changes would have the greatest impact on improving patient health.

A previous post on this blog discussing lab reporting contains a link to a PDF file of an article published in Lab Medicine. In this article, Jules Berman and myself present the concept of the web-based contextualized laboratory report, which is computer-generated and also places the test results from the report into the context or the larger frame of both the patient's medical history and the body of medical knowledge about the patient's disease process accessible via the web. The article goes on to distinguish such a contextualized report from a unique, reimbursable, and individually customized lab medicine consultation in the following way:

We want to emphasize that the contextualized report discussed here should not be confused with the option of providing individualized reimbursable laboratory medicine consultations to clinicians for complex patients. Such consultative reports will be generated on the basis of a request for consultation from the clinician to the pathologist in exactly the same way that all clinicians consult among themselves for complex cases. In contrast, the contextualized report is an automated process that can be generated at a relatively low cost that will serve to enhance the value of all laboratory reports.

The contextualized report, of which the LabCorp/Signature Genetics is one example, represents mass customization for the laboratory world, which is defined in the following way by the Wikipedia:

Mass customization, in marketing, manufacturing, and management, is the use of flexible computer-aided manufacturing systems to produce custom output. Those systems combine the low unit costs of mass production processes with the flexibility of individual customization.

So, in summary, LabCorp/Signature Genetics has announced that they are using information technology to mass customize reports for CYP450 genetic testing because the recommendations will both complex and individualized for each patient. The ability to develop and deploy technology such as this is strategic for that segment of the clinical lab industry involved with sophisticated molecular diagnostics.  It is not surprising that such an announcement comes from LabCorp. The only surprising aspect of the announcement is that LabCorp is outsourcing this strategic capability rather than retaining the intellectual property in-house.

 

Blogs as a Source of LIS Vendor Feedback

Here is a quote from Jon Phillips, courtesy of HIStalk. Phillips, who is managing director of Healthcare Growth Partners, was interviewed in greater detail by Mr. HIStalk in an earlier post:

I absolutely believe that a more vocal HIT blogging community can make a difference in the way that vendors do business. The most successful vendors stay close to their customers, not just at the highest level of the organization, but at all levels to ensure that users are able to use the systems they have. Therefore, methods whereby vendors can capture feedback outside of traditional lines of communication can be highly valuable competitive tools for ongoing product enhancements. The blogging movement is still certainly in its infancy, and I expect its influence to continue to grow.

This comment raises an  interesting question. No one would argue with the premise that LIS vendors should stay close to their customers. By "traditional lines of communication," I assume that he means the daily give-and-take between a vendor and a customer relating to system performance and system features/functions. Another traditional means of communication between vendors and their customers are user group meetings. Let's assume that such meetings are well organized and that the vendor is receptive to an ongoing dialogue with customers. 

What additional purpose could a blog like Lab Soft News serve if these two methods were already being utilized by a vendor and its customers? One possible idea would be that the blog would function as a general discussion forum about LIS features and functionalities that could then be taken back to one's own user community. Perhaps also, from time to time, some sort of voting methodology could be deployed for blog readers in order to obtain some sense of interest and need for specific ideas and features.

I hasten to add here that blogs focusing on lab and healthcare software vendors have the potential to lapse into sounding boards for malcontents, perhaps with unfounded grievances being aired against a particular vendor.  Although blog anonymity can be useful in terms to tapping into useful feedback from laboratory personnel anxious to avoid vendor retaliation, it can also be a two-edged sword.