Medical Uses of Wolfram|Alpha

There have been increasing medical uses and capabilities of WolframAlpha, and I am very interested in its potential in medical and health areas. WolframAlpha is like a type of search engine capable of finding and cross referencing relevant data from multiple sources. Unlike other types of search engines, it actually provides real answers to queries rather than only links to possible answers. It returns not only the data, but the relationships between the data. It not only searches data it computes data. Kinda like Google on steroids...

Bertalan Meskó is a medical student at the University of Debrecen, Medical School and Health Science Center. Berci writes a very nice blog at Science Roll. He will graduate from medical school this summer and he has found WolframAlpha very useful. He said "I use WolframAlpha because sometimes (if I know exactly what I want to find) it saves me plenty of time and clicks. If I want to calculate BMI, Google lists me several calculator. WolframAlpha calculates it itself."
He continued, "If I want to find information very fast about a clinical marker, Google gives me resources, WA gives me the best answer in one click. I also use it for ICD classification, as it's more easily accessible than Wikipedia; for epidemiological data and other calculations.
To sum it up, I think WA is for those who perfectly know what they want to find and want to save time and clicks. For other search queries, Google still is the best."

Developers at WolframAlpha have made improvements to the engine's capabilities and scope of knowledge, particularly in medicine and health. They have published an overview and some examples of the types of searches both patients and clinicians will find useful on the Understanding Medical Tests at their blog.

WolframAlpha is a helpful reference for understanding what the tests measure and how to interpret the results. WolframAlpha allows you to query information on a specific medical test or a panel of tests, compare tests and results for patients with specific characteristics, compute your estimated risk for heart disease, and find the diagnosis corresponding to an ICD-9 code. WolframAlpha can take into account specific patient characteristics like gender, age, smoker, non-smoker, pregnant, diabetic, obese, and underweight. WolframAlpha can give you a snapshot of available data that might help you understand how your results compare to others'.

WolframAlpha can provide a number of interesting medical statistics including body measurements, physical exercise, diseases, mortality, medical tests, and medical computations. You can see other examples of Health & Medicine uses here. For example to determine the benefits of running 20 minutes for a 28-year-old 5'11" 185lb male, then type: running 20min, 6min/mi, 28yo male, 5'11", 185lb into the search box. Results would look something like this:

If someone is interested in calculating their daily food intake, WolframAlpha can help. Here is more from Understanding Medical Tests.

We have heard from many people who are interested in learning more about calculating their daily food intake in WolframAlpha. If you have been following our posts on how to use WolframAlpha to help achieve your nutritional and wellness goals, this will be easy as apple pie. Our data curators have been busy working on over 7,000 food entities that are listed in the USDA National Nutrient Database for Standard Reference and other food databases. Currently, they’re adding additional brand-name and specialty food items. Once a food entity is placed into WolframAlpha’s nutrition bank, rules and algorithms are applied to help categorize it by typical attributes (e.g. raw, boiled), units (e.g. cups, tablespoons), and unique serving forms (e.g. slices, pieces). As a result of these categorizations, when you enter a food item such as “strawberries” into the site’s computation bar, WolframAlpha computes a breakdown of total calories, fat, cholesterol, sodium, carbohydrates, protein, and other particular nutrients based on standard serving sizes (units) and attributes.

Or, how about cholesterol information for a 45-year-old male. Type: cholesterol 45yo man into the search box. As you can see there are already many uses for health and wellness that people can use to find and calculate information on nutrition and fitness. But the thing most exciting to me is the possibilities for clinicians that have barely scratched the surface. The widespread adoption of tools like Epocrates and UpToDate show that providers are hungry for mobile, web based services. I believe that as WolframAlpha continues to expand its abilities in medicine and health we will eventually see it used for Clinical Decision Support. When that happens it could cause a pardigm shift in web enabled technologies supporting medical care.

#RAMLA - plugging health insurance gap

No @RAMLosAngeles does not mean The Rams will be playing football in LA again...

Watch this July 13, 2008 "60 Minutes: Remote Area Medical Finds It's Needed In America To Plug Health Insurance Gap" Video:


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Things have not changed much in healthcare since this report. And between August 11-18, 2009 Remote Area Medical is again bringing this incredible ministry to America, and for the first time it is in Los Angeles. "We're very happy to be here in Los Angeles,” said Stan Brock, founder of RAM. "Obviously, there's a very, very strong turnout of patients here. It's a real blessing to come out here to find people who are donating and volunteering their time."

About 1,500 people received tickets in the early morning hours allowing them to receive free healthcare. They started lining up outside the Los Angeles Forum several hours earlier. They will continue providing free medical, dental and vision care all week. Follow their work this week on Twitter at @RAMLosAngeles

Uninsured in America

The problem of the uninsured is continuing to grow. The federal government estimates that over 45 million individuals lacked health insurance coverage of any kind during 2008. Millions of American workers have lost their jobs, so the numbers of those losing their health insurance and applying for Medicaid or going naked (without health insurance) are also rising rapidly.

The report The Clock Is Ticking: More Americans Losing Health Coverage by FamiliesUSA provides the first ever state-by-state data on the number of people who may lose health coverage between the beginning of 2008 and the end of 2010. Numbers are broken down per week, per month, and per year.

The early release of Selected Estimates Based on Data From the 2008 National Health Interview Survey by the CDC gives the most recent data on health coverage available. Some highlights include:

• In 2008, 43.8 million persons of all ages (14.7%) were uninsured at the time of the interview, 55.9 million (18.7%) had been uninsured for at least part of the year prior to the interview, and 31.7 million (10.6%) had been uninsured for more than a year at the time of the interview.
  In 2008, the percentage of children under the age of 18 years who were uninsured at the time of the interview was 8.9%.
• In 2008, 60.2% of unemployed adults aged 18-64 years and 22.2% of employed adults in this age group had been uninsured for at least part of the past year. Also, 33.3% of unemployed adults aged 18-64 years and 13.4% of employed adults in this age group had been uninsured for more than a year.
• In 2008, 19.2% of persons under age 65 years with private health insurance were enrolled in a high deductible health plan (HDHP) including 5.2% who were enrolled in a consumer-directed health plan (CDHP). In addition, 18.7% were in a family with a flexible spending account (FSA) for medical expenses.
• In 2008, the percentage of persons uninsured at the time of interview among the 20 largest states ranged from 3.0% in Massachusetts to 22.9% in Texas.

I have created a map on GeoCommons trying to show the distribution of the uninsured around the country. I leave it you to draw your own conclusions how to address this crisis.

#Gov20 - Let the sunshine in

The historic swearing in of Supreme Court Justice Sotomayor is significant not only in the fact that she is the first Hispanic to serve on the Supreme Court, but also this is the first time that cameras have been allowed in the court for this ceremony. Supreme Court Chief Justice John Roberts swore Sotomayor in twice, the first in a private ceremony as stipulated in the U.S. Constitution and a second time before television cameras, friends and family, a first in Supreme Court history.

The various Justices have held differing opinions on whether camers in the courtroom are appropriate. While he was still Supreme Court justice, David Souter (who is replaced by Sonia Sotomayor) discouraged any attempts to broadcast Supreme Court proceedings. He used the "camel's nose" theory fearing that once they had even the slightest amount of access, the media would soon gain full access to Court proceedings. Justice Souter once told a House Appropriations subcommittee, “that I can tell you the day you see a camera come into our courtroom, it’s going to roll over my dead body.” Justice Sotomayor is of a different opinion.

Chief Justice Roberts has signaled that he may not oppose televised court proceedings. Roberts said during his confirmation hearings that he had an open mind about the issue of cameras in the Supreme Court, a statement that gave advocates new hope after the late Chief Justice Warren Burger's "over my dead body" opposition and his successor William Rehnquist's less vehement but still unyielding distaste for the idea.

“Justice Souter going off the court means a vocal opponent is gone,” said C-SPAN founder and CEO Brian Lamb, adding that Chief Justice John Roberts may not have wanted to press the issue with Souter there. C-SPAN has long wanted to broadcast proceedings of the court and they may some day now get their wish. “The chief justice who has his hand on the gavel can control any kind of rambunctiousness in which lawyers might want to show off. The public would benefit by seeing this isn’t ‘Judge Judy,’” Lamb said. “The process of writing opinions will never be public. All we’re asking for is the public discussion for one hour. It’s in a public forum, and there’s only 80 of those a year.”

Justice Stephen Breyer, when questioned by Rep. John Culberson (who filmed the statement himself) during a House Appropriations subcommittee hearing.“On the one hand, of course it would help people see how in some of these difficult issues we struggle with them, as do you." On the other hand, he continued, “would they know that this is 2 percent of the matter, what they’re seeing, and would they, in fact, understand that most of what we do does not involve the two people in front of us, the lawyers on either side? It involves the 300 million people who are not there physically in the courtroom.” At the Aspen Ideas Festival Justice Stephen Breyer responded to a question about televising oral arguments at the Supreme Court (see video below). He spelled out the two sides position on the issue without giving any support to either position.



I think we will see the Supreme Court televised one day. I look forward to that day...

CTO of the USA comes to Silicon Valley

Aneesh Chopra spoke to technology thought leaders on his first visit to Silicon Valley this past Tuesday evening. He was appointed by the President as the nation’s first Chief Technology Officer, with the mandate to promote technological innovation to help the country meet its most urgent priorities - from creating jobs and reducing health care costs to keeping our nation secure. Mr. Chopra spoke at the Computer History Museum in Mountain View at an event co-hosted by the Churchill Club, Center for Democracy & Technology, and TechNet.

He spoke about R&D collaboration, infrastructure, and education in the 21st Century. The USA is very advanced in technology, but our technological savvy "has not translated to global competitiveness and our public policy. It should be just as easy to get things going in government as in your personal life with things like Facebook or Twitter," said Chopra.

In one of the slides Chopra used President Obama is viewing the new Federal IT Dashboard, a new website enabling federal agencies and the general public to view details of federal information technology investments. "That's my boss," Chopra said with a chuckle.

Mr. Chopra gave a brilliant performance as you can see below. He is obviously very well qualified for this position, and I am glad that we have such capable hands at the helm with the siginificant challenges we are facing.

What #HealthReform will look like II

Cost and quality are intertwined and very important issues in any healthcare reform plan. With medical malpractice reform off the table, reducing costs will require administrative simplification and reimbursement changes. We will need to move from paying for volume to paying for quality. The implementation of a Medical Home Model can help with chronic disease management and provide better continuity of care, while also ultimately lowering costs. We should create increased incentives for health savings accounts, with a mix of public and private coverage available. Involving the patient as much as possible in healthcare decisions (and giving them a financial stake) will be an important component if reform is to be successful.


Attempts at administrative simplification (remember HIPAA) is no guarantee that costs will be lowered, but streamlining billing codes and practices can do a lot. We can save billions of dollars by cutting through the administrative red tape, according to a recent report released by the Healthcare Administrative Simplification Coalition, or HASC. Founded by the American Academy of Family Physicians, the American Health Information Management Association and the Medical Group Management Association, HASC is a partnership of organizations committed to reducing the administrative costs and complexity of health care. The report "Bringing Better Value: Recommendations to Address the Costs and Causes of Administrative Complexity in the Nation's Healthcare System," claims that about 25% of healthcare costs (approximately $2 trillion) go toward administrative functions, such as billing and payment tasks. "These wasted health care dollars could be much better spent on ensuring that all Americans have access to high-quality health care," said Douglas Henley, M.D. "If we don't work toward reducing administrative complexity in our health care system, we'll continue to waste both time and money."


The healthcare cost explosion has not been accompanied by clear and measurable quality improvements, and we are going to eventually need to change the way we pay for care. We should try to stop paying based on the number of procedures and instead pay based on results. Tying payments to outcomes not only saves money, but improves quality. Minnesota has implemented an innovative program called QCARE, for Quality Care and Rewarding Excellence. QCARE identifies quality measures, sets aggressive outcome targets for providers, makes comparable measures transparent to the public, and changes the payment system to reward quality rather than quantity. These types of innovations will be required on a national scale.


But cost reforms won’t help much if we don’t have more doctors working in the fields where we need them, such as primary care, pediatrics, and behavioral/mental health. Physician workforce enhancement programs will provide greater access, lower costs, and higher quality care. When doctors are not overloaded, stressed out and under-reimbursed thay will provide much better care.


Health information technology will also lower costs and improve quality. Most providers lack the information systems necessary to coordinate patient’s care, share necessary information, monitor compliance, and measure and improve performance. Most other industries have lowered costs and improved quality through investments in information technology, yet healthcare has been stuck. It is time to pull our healthcare system into the 21st century. Health IT helps with prevention by scanning patient records for risk factors and by recommending appropriate preventive services, such as vaccinations and screenings. Health IT can also assist in effective chronic disease management by helping to identify patients in need of tests or other services, and ensuring consistent recording of results. Patients using remote monitoring systems can transmit information directly from their homes to their providers, allowing a quick response to potential problems. I think that all of the efforts at reform are going to need to be tied to a robust national health information network.


I like the quote from President Franklin D. Roosevelt: “In regard to every problem that arises, there are counselors who say, ‘Do nothing’; other counselors who say, ‘Do everything.’ Common sense dictates an avoidance of both extremes. I say to you: ‘Do something’; and when you have done that something, if it works, do it some more; and if it does not work, then do something else.”

What #HealthReform will look like

Gazing into my crystal ball I am getting some idea of what the final healthcare reform product from Congress will be. The devil is in the details, and there are still many to be worked out, but we can see some broad areas where I feel safe making predictions. The areas of coverage, access, costs and quality will be addressed (albeit probably not comprehensively). There are different aspects of each of these areas which overlap, and a change in one area of the healthcare system will have effects throughout the system. Today I will look at coverage and access.

In the area of coverage, we will see a public option plan. Many decry this as a government take over of the healthcare system. But as Paul Krugman said, "Getting the government involved in health care wouldn’t be a radical step: the government is already deeply involved, even in private insurance." The government already covers about 100 million Americans. Medicare dominates the market, stifles competition, and sets arbitrary and unfair pricing standards. Many want a single-payer system. When I met with Senator Merkley yesterday I asked him directly did he support a single-payer system and he said, "Yes I do, but that will never happen this time around." I tend to agree. The momentum is certainly against this option, so a compromise will be the public option plan. Many believe that this is a trojan horse to eventually implement a single-payer system, and for some that is certainly the plan. Rep. Barney Frank admitted that a public option is the best strategy to move towards single-payer because they do not have the votes to pass it now. If it was all or nothing for single-payer right now, there would be no health reform passed. It would kill the deal. We will see a multi-payer universal enrollment system, much like what they have in Switzerland, Japan, the Netherlands, Ireland, and Australia.

With regards to access, by adding coverage for millions of additional patients we will seriously exacerbate the shortage of primary care physicians (family doctors, general internists, geriatricians and pediatricians). of about 50,000 which we already face. The argument that these folks already get healthcare via the emergency room does not mean that we will have adequate resources for them to find family primary care physicians to care for them. Since it takes eight to 12 years to educate and train a primary care physician we have a steep climb to fill the gap. In the Physicians' Foundation survey of 270,000 primary care physicians, virtually all of those now practicing in the U.S., revealed that 54 percent planned to retire or see fewer patients within the next few years; 60 percent said they would not recommend medicine as a career for their children; and 36 percent said Medicare does provide adequate reimbursement. We are already facing a crisis, and expanding coverage will worsen the doctor shortage.

The health reform package will attempt to address these issues by establishing primary care based medical homes to coordinate and provide comprehensive care; cutting medical school debt for doctors promising to practice in underserved regions of the country; and funding to help expand the number of medical schools, the number of medical students in existing schools and the number of training programs for primary care residencies. This will be an expensive but necessary component of any successful reform efforts.

Later I will take a look at possible reform efforts in the area of cost and quality. One thing I will say is that it is unlikely that we will see any tort reform included. The political process is going into overdrive this summer, and there is going to be extensive lobbying pressure applied. Some of the more controversial elements (threats of a single-payer system, abortion, end of life counseling for seniors) will be removed as compromise takes place to buy votes in congress. Pork filler will be added and the end result will be a bloated, bureaucratic beast that may or may not make healthcare more affordable, accessible and higher quality for everyone.