Saturday, December 30, 2017

Annual Reflections at the End of 2017

As longtime readers of this blog know, I always end each year with an annual reflection on the year past. I did this in the first year of the blog of 2009, and have done it every year since.

The life of this blog has seen a remarkable transformation of the biomedical and health informatics field, especially for those of us who had been working in it for a long time. In my case, I entered the field in 1987 when I started my NLM postdoctoral fellowship at Brigham & Women’s Hospital in Boston, MA. After spending three years in Boston, I arrived at Oregon Health & Science University (OHSU) as a newly minted Assistant Professor. I have climbed the ranks to full Professor and am the inaugural (and still only ever) Chair of the School of Medicine’s Department of Medical Informatics & Clinical Epidemiology.

During my career, I have witnessed a great deal of other change and growth in information technology. I witnessed the birth of the World Wide Web in the early 1990s (with skepticism it could really work since the bandwidth of the Internet was so slow back then). I was doing information retrieval (search) before the emergence of Google (why didn’t I come up with the idea of ranking Web page output by number of links to each page?). And I watched the rest of healthcare, especially the policy folks, “discover” the potential benefits of the electronic health record (EHR).

It could be argued that EHRs were not quite ready for prime time when new President Barack Obama unveiled the Health Information Technology for Clinical & Economic Health (HITECH) Act, with the American Recovery & Reinvestment Act (ARRA). HITECH can certainly be criticized in hindsight that the “meaningful use” program had too much emphasis on process measures and not enough on information exchange or standards and interoperability. But, as those of us glass-half-full types would note, we do have a wired healthcare system now, and the next challenge is to meet the needs of patients and their providers.

I always remember students who asked, in the early days of HITECH, whether there would be jobs once we were “done” implementing. Of course, not only is implementation of large and complex software systems never truly “done,” there is so much more to do to obtain value.

As for me personally, I still remain gratified by my career choice at the intersection of medicine and computers. My interactions with my colleagues and my students, helping and mentoring them in different ways, gives me that nice human touch that I abandoned through making the decision in 2001 to stop seeing patients.

My department at OHSU continues to thrive under my leadership and, more importantly, the dedication of faculty, staff, and students. Our research programs are still being impactful and well-funded, and the enrollment in our various educational programs remains strong.

My family also adds a critical dimension to my life, with the academic and career successes of my wife and two daughters as gratifying as my own. I did suffer a couple unfortunate losses this year, with the passing of both my mother and father. Fortunately both lived long relatively healthy lives, although my mother’s last years were compromised by dementia. I do miss them both, and am sad that they will not see the rest of my family and I going forward in life.

And of course this blog is doing well. Last year I touted reaching 400,000 page views. This past month I barreled through the half-million page views milestone, and was able to make the 500,000th view myself, as seen in the picture below.

There are still challenges ahead, both for myself and the field. But this year, and likely next year, I receive comfort not only from family, friends, and colleagues, but also the satisfaction of my work.

Thursday, December 21, 2017

Apple Watch 2, A Year On

About a year ago, I described my early experience with the Apple Watch 2. I noted that based on my priorities for a digital watch, the Apple Watch 2 had excellent hardware but some limitations with its software. A year later, the software has improved, but is still not as good as I might like.

Everyone has different needs for devices such as a digital watch, and mine mostly revolve around running. Other functions, such as telling time, viewing local weather, and accessing text messages, are secondary. My main needs for running center around access to the data. I need data from my runs to live in the cloud, and not be stuck on my phone. I want to be able to access the details of my runs from any device, and share them with friends who do not need to be logged on to the app or its Web site to view them. I also want to be able to run without having to take my phone with me, even though I sometimes do, especially when I am traveling.

I have gone through a number of running apps on my Apple Watch. The requirement to be able to run with the watch and without the iPhone made the initial choice very limited. I started with Apple’s Activity app that comes with the watch. While the app has a nice interface and can be used without being tethered to the iPhone, its inability to export data beyond the iPhone makes it a non-starter. When I upgraded my iPhone shortly after obtaining my Apple Watch 2 last year, and promptly lost all of my runs that had been stored on my old iPhone, I had no way to get them back.

Within the first few months of the Apple Watch 2 release, some of the other running app vendors released standalone versions of their apps. One of the first was RunGo. It was a decent app, although one has to explicitly save runs to the cloud as “My Routes,” as it is not done automatically. Nonetheless, RunGo has served me well in places such as Singapore, Bangkok, Honolulu, Siesta Key FL, Chicago, Philadelphia, and here in Portland (including my annual birthday 10-mile run).

More recently, I have settled on Strava, a long-time running and cycling app that by default stores exercise sessions in the cloud. The Strava Apple Watch app is not perfect. I wish the watch app displayed the cumulative distance run in hundredths of miles (instead of tenths) and the cumulative time and distance in larger size on the watch than the pace. I do like its auto-stop abilities for when I get stuck at stop lights, although get a little bit annoyed when it stops temporarily when I pull up the watch to view my distance and time. Strava too has served me well in a number of places, including Washington DC, New York City, and Abu Dhabi. All in all, I will stick with Strava for now.

Some may wonder whether I have considered upgrading to the Apple Watch 3, whose main feature is including a cellular chip so it can be accessed without being tethered to the iPhone. Given my running needs, it may seem ironic that I do not see a need to get the new watch. This is because with the exception of being out on my runs, I am just about always carrying my phone, so see no need to have the watch stand alone at other times I am not exercising.