MDNews - Lower Hudson/Bronx

Contents | MAR/APR 2015 | FEATURES NEWYORK-PRESBYTERIAN/LAWRENCE HOSPITAL TAKES THE NEXT STEP TOWARD BECOMING A PREMIER CARDIOLOGY CENTER FOR THE REGION 6 The new Cardiac Catheterization Laboratory broadens access to emergent and elective cardiology services for patients across the lower Hudson Valley. MINING THE MASSES WITH MEDICAL CROWDSOURCING 22 Digital services are pooling the knowledge of physicians and others to diagnose difficult cases and respond to medication dilemmas. Experts assess the pros and cons of the expanding field of medical crowdsourcing. SPECIAL CLINICAL SECTION: MEN'S HEALTH STUDY REVEALS MISSED CHANCES FOR OSTEOPOROSIS DETECTION IN MEN 16 The number of hip fractures in older American men is expected to increase 51.8 percent by 2030, yet men typically do not undergo bone-density screening or receive appropriate medication, such as bisphosphonates, after a fall. Orthopedic surgeons are calling for increased awareness of fragility fractures among older men. CHOLESTEROL CONTROL: A WEAPON AGAINST PROSTATE CANCER RECURRENCE? 18 High cholesterol levels may contribute to prostate cancer recurrence in some men. Researchers speculate that controlling cholesterol levels in prostate cancer survivors may reduce the risk of recurrence after radical prostatectomy. MEN'S HEALTH UPDATE 19 A roundup of recent developments in men's health. Unraveling Diagnostic Dilemmas Jared Heyman watched his sister Carly's health inexplicably decline as, beginning at age 18, she developed depression, expe- rienced hormonal problems and gained 50 pounds. More than 24 physicians sought a diagnosis to explain Carly's symptoms; no medication she tried offered permanent relief. Finally, a multidisciplinary team of specialists with the National Institutes of Health's Undiagnosed Diseases Program collaborated to come up with the correct diagnosis: fragile X-associated primary ovarian insuffi ciency. A hormone replace- ment patch resolved Carly's symptoms within weeks. "While Carly was sick, I was study- ing the wisdom of crowds at a company I'd founded, and I learned a lot about harnessing that wisdom and separating the mechanisms that allow for the com- munication and collaboration it takes for crowds to solve problems," Heyman says. Mining the Masses with MEDICAL CROWDSOURCING By Thomas Crocker TWO MODELS OF CROWDSOURCING — DRAWING ON THE COLLECTIVE WISDOM OF MANY PEOPLE TO SOLVE PROBLEMS — POINT TOWARD A NEW WAY OF ADDRESSING MEDICAL CONUNDRUMS AND EXPANDING ACCESS TO EXPERTISE. "I thought, 'Crowdsourcing should be applied to medicine.'" The result was CrowdMed, an online service that allows individuals with per- plexing illnesses to submit their cases to a crowd of "Medical Detectives." These healthcare gumshoes are active or retired physicians, nurses, and other providers from a variety of medical backgrounds. They suggest possible diagnoses, which are weighted and ranked by probability and presented to patients in a report. The aver- age CrowdMed patient has been sick for eight years, seen eight physicians and spent $50,000 trying to fi nd a correct diagnosis. Patients can offer cash compensation as a way to attract more Medical Detectives to their cases. Typically, case resolution takes less than two months. "What underlies CrowdMed is a pat- ented prediction market algorithm," says Heyman, CrowdMed's Founder, CEO and product visionary. "Medical Detectives suggest diagnoses and solutions, and other Medical Detectives allocate points to the most probable diagnoses. If they allocate points correctly, they can win points toward a higher Medical Detective rating in our system [detectives start with a rating of 3; 10 is the highest], or even cash. Our system looks at point alloca- tion behavior [based on detectives' ratings and backgrounds] and uses that to assign probabilities to the most likely diagnoses." Anyone can become a Medical Detective, but accuracy of suggestions determines success and status in the system. "We believe previous performance is the best predictor of future performance," Heyman says. "We don't care if you're a physician, nurse, medical student or acupuncturist — we care about how well you perform." Monetary compensation is a signifi cant motivator for Medical Detectives but not the primary one for most, according to Heyman. Altruism, competition, education and intel- lectual stimulation are important factors, he says. The crowd has helped bring more than 50 percent of CrowdMed patients — more than 500 individuals — closer to a correct diagnosis or cure since the service launched in April 2013. CrowdMed has an obvious limitation: In-person patient examinations aren't possible, which can make physicians skepti- cal about the service's accuracy. But the groundwork laid by patients' own physicians is vital, Heyman says. "Most patients have seen several physi- cians by the time they consult CrowdMed, and we like it that way," he says. "CrowdMed doesn't replace seeing physicians; it doesn't even work very well unless patients have seen one or two physicians fi rst. CrowdMed's role is to provide a short, insightful list of suggestions that patients can discuss with their physicians." Clinician-to-crowd Applications Marc Halterman, MD, PhD, Associate Professor in the Department of Neurology at the University of Rochester and Co-Founder of Collaborative Informatics, LLC, and his colleagues have investigated a different form of medical crowdsourcing: a downloadable mobile application that allows physicians to glean information from their peers. Dr. Halterman and his team described their work with the app they created, called DocCHIRP, in papers published in 2014 in Health Informatics Journal and Journal of Hospital Medicine. used DocCHIRP crowd, members notifi cations had the option average fi rst minutes. Eighty-fi of whom were DocCHIRP's "We expected to revolve around interestingly, medication-related," "Providers wanted side effects and interesting discovery excited about with other specialists workers to ask, or therapy?' Those otherwise end provider might of the day or The follow-up and his team revealed some cation-driven potential to contribute ing, the safety based on digital security and providers' personal knowledge "Physicians but in a way that Dr. Halterman accessed their CORE + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + Contents | APRIL 2015 | 6 PAGE ON THE COVER 22 24 DEPARTMENTS LEGAL EASE 12 PRODUCT SPOTLIGHT 13 PEOPLE IN THE NEWS 14 BUSINESS OF MEDICINE 21 PRACTICE MANAGEMENT 25 FINANCE 26 CME CREDITS 28 LOCAL NEWS 30 30

• Cover