Last year, members of the HQA together with the Centers for Medicare & Medicaid Services and the Department of Health and Human Services created a consumer-oriented hospital comparison website called Hospital Compare. Hospital Compare provides information on how well hospitals care for patients with specific medical conditions or surgical procedures, as well as results from a survey of patients about the quality of care they received during a recent hospital stay.

Yesterday, new quality data on hospital readmission rates was made available on the Hospital Compare website. The data includes hospital readmission rates for Medicare patients with heart attack, heart failure and pneumonia. This is especially relevant in today’s healthcare reform environment because the issue of hospital readmissions has been cited by policy makers and the Obama administration as a potential opportunity for improving healthcare quality and reducing unnecessary healthcare spending [2]. Indeed, a recent New England Journal of Medicine study found that almost one-fifth of Medicare beneficiaries discharged from the hospital were readmitted within 30 days; one-third were rehospitalized within 90 days [3].

Until now, hospitals have had only information on those patients who return to their own hospital, but not about patients who were readmitted to a different hospital. Using Medicare billing records from July 2005 to June 2008, the information on Hospital Compare shows how often a Medicare patient with one of these conditions returns to the same hospital or a different hospital within 30 days following their initial stay. Hospitals are placed in one of three categories based on their readmission rate in relation to a national readmission rate – “no different than the U.S. national rate”, “better than the U.S. national rate” or “worse than the U.S. national rate”. Each hospital’s readmission rate for the specific condition also can be compared to its state’s average. Additionally, each rate is shown as a single number, along with a confidence interval that indicates the range of certainty in which the hospital’s true performance falls.

The new quality data on hospital readmission rates is being added to existing information on how often hospitals take the right steps to provide care for their patients, as well as updated information on mortality rates. Available information includes statistics on a variety of quality measures such as:

• Percent of surgery patients who were given an antibiotic at the right time (within one hour before surgery) to help prevent infection
• Percent of surgery patients whose doctors ordered treatments to prevent blood clots after certain types of surgeries
• Percent of heart attack patients given aspirin at arrival
• Percent of pneumonia patients given the most appropriate initial antibiotic(s)
• Percent of heart failure patients given discharge instructions
• Percent of children who received reliever medication while hospitalized for asthma

In addition, Hospital Compare includes statistics on answers to a survey of patients’ hospital experiences, such as:

• Percent of patients who reported that their doctors “Always” communicated well
• Percent of patients who reported that staff “Always” explained about medicines before giving it to them.
• Percent of patients at each hospital who reported that YES, they were given information about what to do during their recovery at home.

You can search for hospital information in your area using either a general search or a specific medical condition or surgical procedure search. The general search provides information on Hospital Process of Care Measures, Hospital Outcome of Care Measures, and Survey of Patients’ Hospital Experiences. The specific medical condition or surgical procedure search provides information on Hospital Process of Care Measures and Hospital Outcome of Care Measures (where applicable), Survey of Patients’ Hospital Experiences, and Medicare Payment and Volume. The Hospital Compare database is updated on a quarterly basis.

Interested in how your hospital stacks up to others in the area? Find and Compare Hospitals

Are you a Twitter user? Tweet this!

References

1. Vital New Quality Data on Hospital Readmission Rates Available on Hospital Compare Website. Hospital Quality Alliance press release. 2009 July 9.
2. Health Reform’s Benefits for Middle Class Under Scrutiny. Kaiser Health News. 2009 Jun 25.
3. Jencks et al. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009 Apr 2;360(14):1418-28.
   View abstract

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This is the kind of story that gets me out of bed before I go to work in a few hours at our small medical library and to try to get the news out of what should be a fascinating development in search, Health 2.0, Science 2.0 and public discussion of patient empowerment and in neurologic science generally. I have been sent through my connections at AltSearchEngines and Next Generation Science a link to the Marketwire press release “PatientsLikeMe Launches Genetics Search Engine for ALS Patients“.

I spent many hours in the amyotrophic lateral sclerosis community of Patients Like Me in 2007 — 2008 and still visit it occasionally. It is a remarkable instance of a close-knit group of people united by the personal tragedy of either having Lou Gehrig’s Disease (ALS) or caring for and/or about someone with it. The founders of Patients Like Me (PLM), Jamie and Ben Heywood, have since created similar online patient communities for Parkinson’s Disease, Multiple Sclerosis and so on.

I briefly met Ben Heywood at a recent Health 2.0 conference. Both he and Jamie are frequent speakers at Health 2.0 and Web 2.0-related gatherings and have been the subject of books and documentaries. The documentary So Much So Fast shows the courageous struggle their brother Stephen made against the ravages of ALS. The solidarity and love his family showed in that struggle is one of the most moving films ever made and should be viewed by literally anyone in the health sciences, encompassing as it does the minutiae of confronting ever growing disability and the quest to obtain accurate medical information in the Internet Age. The Heywood brothers have accomplished remarkable things across a variety of fields, notably in prodding the research establish to fast track research in ALS and to engage in far more transparent practices. They and men like Augie Nieto are the kind of people that leave one feeling that individuals can make a difference even in the face of such frightening specters as a diagnosis of ALS.

But I do have my qualms and concerns about some of the PLM initiatives. Even when papers about it appear in the standard medical literature in PubMed, the authors of the papers are usually affiliated in some way with PLM. It would be nice if there were at least a few by neurologists who have no relationship at all to PLM that reported on advances made as a result of the data acquired from the self-reports that PLM members upload to PLM databases.

The search engine is simply called the Genetics Search Engine, although it covers only ALS and thus is likely to create some branding confusion.

The PLM blog post announcing the launch of the new search engine states: “Today, we’re announcing the launch of our Genetics Search Engine for people with ALS. Imagine finding other patients just like you, down to the genetic level. Patients in our ALS community can now do that. (For patients who don’t see their genetic mutation right now, that’s alright. They can be the first with that genetic mutation to join our community and share information about the disease.) What does sharing genetics mean for research? By capturing data on familial ALS patients’ known genetics, such as the A4V or D90A mutations in superoxide dismutase 1 (SOD1) and the P56S mutation in vesicle-associated membrane protein-associated protein B (VAPB), we can learn more about the cause and effects of every kind of ALS and better our chances of advancing research and finding new treatments. Our goal in launching the Genetics Search Engine (and other upgrades like it) is to help patients find others just like them and enhance our understanding of the phenotype of each genetic mutation (i.e., different causes of ALS have faster or slower disease progression).”

This brings up some interesting issues:

• As noted, there is the matter of branding. The wording “… other upgrades like it” suggests that this is the first of what may become a series of search engines for genetic mutations. That is an intriguing development and illustrates the genuine knack for marketing and technological innovation that has always made PLM a leader in the patient social networking space even as other such communities (such as Trusera) with much less drive to actually contribute to the medical science related to the travails of members have struggled to attract and retain users.

• The Genetics Search Engine does not appear particularly innovative or interesting vis-a-vis search technology. It seems, indeed, to be fairly unspectacular and rudimentary in that respect. But it is certainly more handsome and engaging than ALSOD: the Amyotrophic Lateral Sclerosis Online Database, which covers only SOD1 mutations and is designed for medical professionals, not patients and the general public.

• The wording “Imagine finding other patients just like you, down to the genetic level” is quite fascinating. ALS is a rare disorder and now patients can find in that small group an even smaller group and, now, so can researchers. This has all kinds of implications for organizing patients into lobbying groups for research into that particular mutation. That might actually advance research, given that the intense study of one gene or one mutation could benefit the entire ALS population. Alternatively, it could hinder advancement if a vocal group successfully wins earmarks for what turn out to be blind alleys. In any case, it is a brave new world in which people can form political, emotional and social bonds on the basis of genetic mutations. This is a good thing for public education in medical matters and public discussion of important scientific and bioethical matters.

• The development of the search engine and what becomes of the data is something that all those intrigued by the era of personalized medicine will watch with intense interest. Some argue that such data will prove of limited utility for decades and that it is cruel and deceptive to suggest to patients that hours spent mastering the arcana of genetics will improve their short-term prospects and day-to-day quality of life. Indeed, part of the marketing muddle is that the press release does not make the distinction clear between familial ALS and the sporadic type, the former being much rarer. Jamie Heywood is quoted as saying:

  Beyond the research implications of what this means today, if you’re a patient with familial ALS, you can now use this information to make better decisions about your healthcare and learn from the experiences of others like you.

  But that group is a small subset of the greater ALS patient population as a whole and the press release makes it sound like the Genetics Search Engine is a potential boon for all ALS patients. It could be, but that isn’t made clear.

But one should not complain too much given the obvious solace and genuine enjoyment members find in PLM and the impressive amount of useful information exchanged there on matters of nutrition, respiratory care, assistive technology and such, necessary in the care of patients with this illness. The fact that PLM has 3,400 members worldwide alone is impressive given that there only an estimated 30,000 people with the disease in the U.S. in any given year.

It will be interesting to see what public comment discussion is engendered by this development vis-a-vis patient education and genomics, and the ethical and health information management issues raised by patients taking an ever more intense interest in the building blocks of their very beings and expecting frontline clinicians to treat them by utilizing such data.

This not just an ALS story. This is a new era in medicine.

About the author: Hope Leman writes about Health 2.0 and the e-patient movement at Significant Science. She is also a writer for AltSearchEngines, which covers hundreds of alternative / niche search engines. Hope is a research information technologist for a health network in Oregon and is also Web administrator of the grants and scholarship listing service ScanGrants.

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Consumer health sites are all over the Web and more and more of the content they are producing is working its way into search engine results on health-related topics. Some of this material is solid enough, but much is simply banter or commiseration of one heathcare consumer to another. Knowing ahead of time about these sites can save power searchers in health matters time and prevent ill-considered clicking on what is almost certainly likely to be fluff or outright rubbish.

OrganizedWisdom is one such consumer health site and indeed if you go by its notable presence at conferences such as Health 2.0, it is a market leader in this space. It certainly excels at parlaying a bargain basement marketing gimmick, its WisdomCards, into a reputation for business savvy.

On its home page, the peel away top right corner reveals that WisdomCards are “Your guide to the best health resources” and touts “We do the Searching for you!”

Now, I don’t really get the appeal of the whole WisdomCard thing. Basically, each WisdomCard is simply a page of results organized in much the same way as you might find on MedlinePlus, say, or RightHealth.

Moreover, the “hand-crafted by experts” part doesn’t really inspire confidence. Take the WisdomCard for ALS, for instance. Clicking on “About this WisdomCard” reveals that the card was contributed by Tonya J. and reviewed by Pat. However, there is no information about who Tonya J. or Pat are. I was able to find information about the composition of the OrganizedWisdom Physician Review Team. Consisting of four medical doctors, OrganizedWisdom’s Physician Review Board is “responsible for training, educating and guiding all our Guides. In addition, we take great care in hiring people who have extensive health backgrounds, personal experience with health issues, or who may have served as caregivers, health advocates or health professionals.”

Nevertheless, given that credibility is a fairly basic component of consumer health searching on the Web, it is fairly amazing that OrganizedWisdom has received such positive coverage in the business press (the rah-rah, go team buzz it generates in such venues as the Health 2.0 conference is less surprising).

For instance, on the basics of cross-referencing OrganizedWisdom falls flat. Case in point: You can call up a WisdomCard on ALS provided that you call it ALS and not Amyotrophic Lateral Sclerosis and we are told once at the ALS WisdomCard to, “Try also: Muscular Dystrophy; Myasthenia Gravis; and …” (trails off there) but not Lou Gehrig’s Disease, which does not have a WisdomCard of its own, and not Motor Neuron Diseases, which is a topic allocated to a WisdomCard. And on that card you do at least get the last names of the contributor and the reviewer. The Motor Neuron Disease WisdomCard was contributed by Elisa Carter. According to her (self-listed?) health experience, she has spent 15 years working in the medical field as a Supervisor in a Hospital Admissions Department and has managed administrative staff for a large multi-physician office that included pediatricians, a cardiologist and an internist. The Motor Neuron Disease WisdomCard was approved by TaraS. According to her (self-listed?) health experience, “Her medical knowledge comes from years as a medical secretary and in administration for physicians’ offices specializing in internal/pulmonary medicine, orthodontics and pediatrics. She has also served as a health advocate and caregiver for people with disabilities, a role that brought her to a nuanced understanding of Web health search and online research.”

I am not against consumer health sites. Indeed, I get rather impatient with the persnickety attitude some in the medical library community take towards them. But it is unnerving to think that the “serial entrepreneurs” (as founders Steven Krein and Unity Stoakes style themselves) can generate such hype on the basis of some quite sloppy, not ready for prime time stuff as is on OrganizedWisdom. Call in a librarian, guys, to inject some order into the currently messy state of affairs in your WisdomCard world.

I decided to try to determine what qualifications guides (the term appears to cover both contributors and reviewers) must meet. The page Become a Guide outlines a three-step process to apply to become an OrganizedWisdom Guide. First you register with the site, then you fill out a Guide Application, providing as much information as possible about “any related experience, whether in paid or volunteer work, that will contribute to your success. OrganizedWisdom Guides need to be self-motivated, well organized, able to discriminate between good and bad information, and able to check their own work. And yes, spelling and attention to detail counts.” Applicants then take an open book test. At the bottom of the page is a list of reasons OrganizedWisdom rejects Guide applications:

• No relevant experience.
• Misspellings or poor grammar on application.
• Incorrect answers on Open Book Test.
• Applicant did not check “I am over 13 years old.”
• Applicant did not check “I agree to the Guide Terms of Service.”
• Applicant did not provide full name, address and telephone information which we need for payment verification.
• Applicant does not live in the United States (sorry, we can only accept U.S. applicants).

Although the results on the WisdomCards are acceptable, they are not noticeably better in terms of links or richness of multimedia content than you would find on RightHealth and certainly lack the authoritativeness of MedlinePlus. Additionally, the web site has has navigation problems. For instance, it not always clear when you are in a WisdomCard nor how to get to one, except by browsing through an alphabetical list, and even that is not reliable as there seemed to be a WisdomCard for the man Lou Gehrig but not for the disease named after him, but the biographical entry does not appear to be in the alphabetical list and so on.

All in all, much ado about very little in the case of OrganizedWisdom.

Additional health search resources are listed in the Highlight HEALTH Web Directory.

About the author: Hope Leman writes about Health 2.0 and the e-patient movement at Significant Science. She is also a writer for AltSearchEngines, which covers hundreds of alternative / niche search engines. Hope is a research information technologist for a health network in Oregon and is also Web administrator of the grants and scholarship listing service ScanGrants.

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Mednar is here and it is good. Check it out medical librarians, public library staff, academic librarians who do life science searches, busy front-line clinicians, clinical researchers, medical school faculty, power searchers generally in the health sciences and anybody, indeed, who wants quick, authoritative results in health searching. Yet another impressive achievement of the firm Deep Web Technologies, which already has a stellar record of achievement providing the underlying technology of Scitopia.org, Science.gov, WorldWideScience.org and the brand new Biznar, a free, publicly available business research site. Check that one out, too.

Why is the firm called Deep Web Technologies and what is federated search, which is its specialty? Federated search is simply the capacity to search several online resources at the same time. The Deep Web is also called “The Invisible Web” and consists of gray literature and similar hard-to find content, such as heavy duty science and medical databases that the average search engines don’t tend to provide results from. That is where Deep Web Technologies comes in. Professional societies and the big players in federally-funded science search rely on it. It delivers sleek, elegant interfaces and solid search results. I like its stuff a lot. That is why I am up at 4:23 a.m. playing with it rather than sleeping before I have to get ready for my day job at around 7 a.m. Good technology should be exciting and something that compels you to get out of bed to go seek information about subjects you care about. Therefore, scientists, medical people and people who are ill or who love someone who is driven to seek information should take a spin in Mednar and the other products of Deep Web Technologies. They are the must-have tools of today and tomorrow.

Okay, enough rhapsodizing (couldn’t help it — it is that good). Why do I like Mednar so much?

Well, as someone who works in a medical library and spends many happy hours working in the kingdom of medical search tools, PubMed, I am always interested in seeing what else is out there in health sciences search. One thing I liked right away about Mednar was how it easy it was to set up an email alert on the latest results on my subject of choice, in this case my consuming interest amyotrophic lateral sclerosis. I have been receiving daily updates of the latest research on that subject from Mednar and they are quite fascinating. Now that might some strike some as not particularly novel or exciting (think Google Alerts), but it is really surprising how few options one has in terms of current awareness of authoritative (where Google falls down) daily bulletins and it never hurts to supplement the services one can get from PubMed. The one glitch in the email alerts is that when I click on some of the options I am taken to the log-in page of a resource I may not subscribe to. But at least I get the title to work with and can use other avenues to learn more about an article I might never have learned about otherwise. And if you follow a rare disease or even a common one that is making your life miserable, you don’t want to run the risk of missing out on key developments.

In that regard, Mednar is an extremely useful complement to PubMed in that there is a lag time before the very latest articles get into PubMed. Everything is vetted to the nth degree before it enters the hallowed halls of PubMed and while that is desirable and necessary, it also prevents timely notice of interesting developments or awareness of perhaps ultimately insignificant but nonetheless interesting, thought-provoking developments. By contrast, Mednar include among its results EurekAlerts and identifies them by the institution (e.g. Brandeis University) or organization (e.g. the American Academy of Neurology) that the press release concerned is discussing so that you don’t click on something of little interest. That’s an excellent way to monitor where the centers of research activity are in certain medical conditions and an easy method of keeping up in an engaging, entertaining way on what is happening now instead of waiting for a meta-analysis to appear in PubMed two years hence. You can learn a lot from press releases. For instance, in my search through the EurekAlerts in my search on ALS I came across this result about a touching article in the Journal of Palliative Medicine, something I might not have encountered otherwise. What I want from a search engine is for it to tell me something I don’t already know or that I would not have learned about from one of its rivals. Mednar does all of that.

Additionally, Mednar provides results by author, which enables users to quickly determine who seems to be the leading authority in a given field or at least someone who has published quite a bit in it.

Mednar also is a forgiving, patient envirnoment. For instance, I tried “proteomics in nephrology” but that resulted in much extraneous stuff. I then tried just “proteomics nephrology” and got tons of useful material. That is the mark of a good search engine. If you bumble and fumble and get nothing, trying different wording improves matters. Mednar definitely is on its way to becoming an outstanding launch pad for medical subject searching and it easy to see why frugal but astute purchases of services for government scientific agencies, demanding overseers of the databases of scientific societies and university libraries turn to Deep Web Technologies for prowess in search technology. Those are not easy audiences to win over and it has consistently done that. This is the state-of-the-art stuff, folks.

I wish had the brains of its CEO, Abe Lederman. I am in jaw-dropping, stupefied awe at the general excellence of the products of his firm. Anything that saves all of us time as we hunt for relevant data amidst overwhelming amounts of information on every conceivable aspect of disease day after day catches my attention and it has been caught today by Mednar. It searches many databases that PubMed and NLM Gateway do not, let alone other commercial search engines. That alone is a public service and I fondly hope that Elsevier and Springer and the other sci-tech publishers will start to see the value in working with innovative superstars in search and enlist them to render their superb content searchable. My wallet is open to good stuff in the sciences if I can find it and Mednar helps me find it. It is up to the sci-tech publishers to decide if they want to find eager, paying consumers of their content by working with Mednar. In the meantime, Mednar is educating us all about databases that we didn’t even know existed. Edifying those of us who like to think we know everything is noble work.

About the author: Hope Leman is a writer for AltSearchEngines, which covers hundreds of alternative / niche search engines. She works in a medical library as a library technical specialist and is the web administrator of ScanGrants. Hope is a student in the Master of Library and Information Science (MLIS) program at the University of Pittsburgh.

Additional health search resources are listed in the Highlight HEALTH Web Directory.

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If Web 1.0 was about being told what the best information for you was (like the flat top 10 results on Yahoo! or Google), then Web 2.0 is about giving more control to the individual and inviting them to participate in the world of information.

Letting users start conversations or organizing information to the benefit of the end user are two outputs of the Web 2.0 evolution. So what is Web 3.0?

An article in ReadWriteWeb recently attempted to define Web 3.0, the semantic web based on personalization and recommendation. Web 3.0 may become quite adept at trying to algorithmically match you romantically, like a modern version of the 1950s board game Mystery Date, and some companies have already made significant headway in recommendation and personalization, such as Pandora and their music recommendation jukebox-like interface.

Will health ever benefit from the semantic web? Perhaps. Nothing is impossible, but it’s hard to imagine a computer will ever know how to deal with queries like:

These questions deal with the core physical nature of human beings and the nuances and language to express physical experience is so wide that Web 3.0 may never build the right bridge.

However, Web 2.0 — with intelligent interaction flow — can make answering the afore mentioned questions much easier. By categorizing the scary wilds of the web for an end user, it makes searching that much smoother.

Kosmix, the creators of RightHealth, have created a categorization technology that simplifies the web. This categorization of information is important for online health search, where the nature of queries can be intensely personal.

Asking a person concerned about his/her health to plough through homogenous search results is just plain cruel. Categorize the information, build your interaction flow around that categorization, and you’ve already helped make the mystery of a health question easier to understand. Web 2.0 puts the user or the user’s needs at the center of the product, at least when it’s done right.

Being smart about categorization and interaction flow is more than just dressing up search results. Standard search results will require a user to determine for themselves what is a trustworthy source and what is plain spam. RightHealth treats the categorization of health information much like how an editorial health site would treat their articles: insuring results are relevant, trustworthy and of value to the end user.

The user interaction associated with these valuable results is just as important, exploiting the value of Web 2.0 sensibility in order to be smarter about how health searchers interact with information to better understand their health. In Health Web 2.0, the user is just as important as the information they are trying to access. Building those bridges correctly is the way to effectively evaluate the quality of a Health 2.0 website.

About the author: Matthew Krajewski is a writer for The Kosmix RightHealth Blog, which uses information obtained through the RightHealth search engine to provide insightful posts about health-related news and issues.

Additional health search resources are listed in the Highlight HEALTH Web Directory.

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