Tech Medicine

An Open Letter from America's Physicians

2008-05-10T11:10:00.000-07:00

Sermo is an online network for physicians — currently, over 60,000 of them. (I've written about the Sermo community previously, and I've written about meeting Sermo's CEO, Dr. Daniel Palestrant.) One of the advantage of social networks like Sermo is that it allows groups to quickly formulate and vote on ideas. The physicians of Sermo — over a thousand of them — have used the network to craft "An Open Letter from America's Physicians." I recently had the pleasure of meeting Dr. Sean Khozin, who originally proposed the idea of a group letter from Sermo physicians. He and the writers did a great job. The text of the letter is below. To sign the letter, visit Sermo.

Dear Fellow Americans,

For decades the United States has led the world in healthcare. We have enjoyed the finest hospitals, medical schools, research, technology, and resources. Unfortunately, our healthcare system has lost focus to the point where patient wellbeing is placed after politics, profits, and special interests. Healthcare costs are on the rise and patients have lost their freedom of choice. These trends are hurting our economy and compromising the doctor-patient relationship. As a result, it has become difficult for physicians to deliver the best possible care.

Our heavily fragmented healthcare system has made it very difficult for you, the American public, to get the care you need. As your physicians, we want to partner with you to address the critical defects of the system as outlined below:

* You are paying a lot for healthcare and not receiving enough in return. Your insurance premiums continue to increase while your healthcare options are dwindling. Gatekeepers, insurance networks, and restrictive regulations limit your choice of doctors and your access to care.

* You have been made dependent on complicated and expensive health insurance plans. Employers are forced to take money out of your paycheck to purchase health coverage. If you lose your job, you are left with no safety net and the money you have paid for health coverage vanishes.

* The time you spend with your physician has become remarkably brief due to regulatory hurdles requiring doctors to spend more time on documentation than with you.

We believe the following factors have made our current healthcare system unsustainable:

* The insurance industry's undue authority and oppressive control over healthcare processes

* Excessive and misguided government regulation

* The practice of defensive medicine in response to a harmful and costly legal environment

We, the physicians of the United States, will no longer remain silent. We will not tolerate a healthcare system where those without medical expertise or genuine interest in our patients' health have absolute control. This letter is merely a summary of the most important problems in our current system. We believe that by partnering with the public we can start to demand real change and formulate practical solutions.

We invite you, our patients, friends, neighbors, and employers to unite with us at this important time in the history of healthcare in the United States. Together, we can guarantee our nation a healthier tomorrow.

Please talk to your doctor about this letter and visit Doctors Unite for more information.

Respectfully,

The Undersigned U.S. Physicians

Monthly Introduction to Tech Medicine

2008-04-30T18:16:00.000-07:00

Image from WikipediaWhat's this blog all about?

My goal in Tech Medicine will be to explore the intersection of medicine, new technologies, and the Internet. This is a purposefully broad topic. Several times weekly I will post focused reviews of issues interesting to health professionals and nonprofessionals alike. Posts may include examinations of medical devices, pharmaceuticals, scientific advances, internet services, and other technologies involving health care and the practice of medicine. Mirroring as it does the nature of the Internet and the sometimes surprising nature of new technologies, the content may also include topics that are wonderful, unusual, hilarious, or strange.

What are some recent posts on Tech Medicine?

Topics of recent posts have included the book I'm writing with the American College of Physicians, The Prostate Cancer InfoLink, The iStan Medical Mannequin, Why Doctors Don't Email Patients, Three Visions of the Future of Healthcare, Links of Interest, and the Second Annual DiabetesMine Design Challenge.

Who are you?

I'm trained as a nephrologist (a kidney and blood pressure specialist). For the last two years I've written Kidney Notes, a blog designed to filter and process medical news. Most recently, Kidney Notes has become a collection of links, commentary, and scraps of information -- a reference database of interesting things with the help of a popular social bookmarking service called del.icio.us. While I will continue posting to Kidney Notes, several friends have asked me to write longer posts of original content -- and this is what I will be writing on Tech Medicine. Recently, I have also written a blog on personal productivity called The Efficient MD (in association with the American College of Physicians). I'm also writing a book on physician productivity and lifehacks.

There are many topics I plan to cover, but I'm also open to suggestions, tips, and even posts by guest bloggers. Please email techmedicine@gmail.com.

Thanks for reading.

2nd Annual DiabetesMine™ Design Challenge

2008-04-30T18:06:00.000-07:00

Image via WikipediaThe folks over at MedGadget (full disclosure: I'm a proud editor there) and Amy Tenderich of DiabetesMine™ are sponsoring the 2nd Annual DiabetesMine™ Design Challenge, a "a competition designed to foster innovation in diabetes design and encourage creative new tools that will improve life with diabetes."

Here's the official announcement:

2nd Annual DiabetesMine™ Design Challenge*

* a competition designed to foster innovation in diabetes design and get the creative juices flowing around new concepts and tools to improve life with diabetes*

Two of the most enticing design concepts will win a package of prizes to help further their creative efforts: $1,000 in cash, some pro-bono professional advice from world-renowned design experts, and free access to the next Health 2.0 conference for one adult winner.

This contest is co-hosted by my friends over at Medgadget, the Internet journal of emerging medical technologies, and supported by the world-renowned design firm IDEO, with headquarters in Palo Alto, CA. The campaign is generously sponsored by Cory and Justin Oringer, two young brothers (ages 14 and 11, respectively) who have both been living with Type 1 diabetes for more than 10 years each and have already seen and personally experienced many wonderful benefits of design innovation in diabetes technology. Just a few of the innovations that have changed their lives include:

blood glucose tests that previously took 30 seconds now take only 5 seconds

5 microliter droplets of blood required have now shrunk to just .3 microliters

where we once there was finger sticking only, we can now use alternate sites (nighttime toe testing gives the boys' fingers some healing relief)

multiple injections have now given way to the option for pumping with convenient temp basals, correction calculators, and "bolus wizards"

21g lancets have slimmed down to just 30g needles, now available in "virtually painless" lancing devices like Renew and Pelikan

These devices provide the lancet needles in cartridge form, doing away with accidental needle sticks (Cory's schoolmate once poked himself with a lost lancet, creating havoc at their school)

At the same time, Cory and Justin have witnessed (and lived) the revolution in communication we fondly know as Social Media. Who ever heard of a "blog" back when they were diagnosed? User-generated content has changed lives, and driven a whole new wave of excitement about contests and challenges (think American Idol, Dancing with the Stars, Survivor, and The Apprentice).

"With a father deeply entrenched in the diabetes business, Cory and Justin inevitably wind up in the midst of numerous innovation-brainstorming conversations. They’re very excited to be involved in the DiabetesMine Design Challenge," the family writes to me.

Now for the particulars:

THE BACKGROUND

It was just about this time last year that I posted my Open Letter to Steve Jobs, calling for the gods of consumer design to help revolutionize design of diabetes devices. This spurred a ton of conversation across the blogosphere and mainstream media. In the weeks and months that followed, all sorts of individuals and organizations came forward with many compelling new prototypes, designs, and ideas.

This year, we're making it an official competition, laying down the gauntlet, as it were, to anyone passionate about diabetes and product design. Whether you're a pharma R&D pro, an independent engineer, a design student or an enterprising patient, we want to hear from you.

ELIGIBILITY

This competition is open to all individuals and organizations developing devices or supplies for people with diabetes (medications not included), or enterprising patients with unique prototype concepts. DiabetesMine™ will accept submissions in two categories: under age 18, and age 18 and older.

CONTEST TIMELINE

Submissions can be made beginning April 30, 2008, until Monday, May 26st, 2008, at 11:59 pm PST. The winners will be announced on Friday, May 30th, 2008.

PRIZES

The winners will receive a combination of rewards intended to help take their ground-breaking diabetes design concept to the next level: prize money, consulting advice, industry event exposure and media coverage.

Sponsors Cory and Justin Oringer generously offer $1,000 each in two entry categories: under age 18 and over age 18 (total prize money $2,000).

Health and wellness consultants from world-renown design firm IDEO will host a two-hour workshop to help each winner refine their concept.

Organizers of the “innovation incubator” Health 2.0 Conference have generously offered one free access ticket to their Fall conference in San Francisco, October 21-23rd, 2008, for the winner of the adult competition.

Medgadget and DiabetesMine™ will promote the winners through articles and blogs, and possibly also feature some of the coolest finalists.

COMPETITION GUIDELINES

All entries must be in the form of a movie or an animation, no more than 2 minutes long (all content in English), which will be submitted by uploading into the DiabetesMine™ channel on YouTube.

Each product or design concept must be new, i.e. introduced within the last half-year, or in development phase, possibly undergoing user testing now.

One video per product idea only, please.

The product or design concept needs to have been created in its entirety by the submitting team, i.e. it must not infringe or violate the rights of any third parties, including, but not limited to the copyrights, patents, trademarks, trade secrets, and right of publicity/privacy.

Each video submission needs to contain your brief but complete "Elevator Pitch," covering the following aspects describing your new design:

Explanation of the everyday problem(s) your concept is designed to solve – how does it help improve life for people with diabetes?

Description of the medical application of the product.

Detailed depiction of the product's look and feel, material, and dimensions. Ideally the video will include a 360-degree shot of the product or design concept.

Demonstration of the product in action and its various functions, if possible.

Each video segment must display the 2nd Annual DiabetesMine™ Design Challenge screen at the beginning and end for five seconds. (See instructions below on where to download that slide)

[for some inspiration, see tips on crafting your Elevator Pitch here. View the sample contest entry videos here. Or browse the various product pitches here.]

HOW TO SUBMIT YOUR ENTRY

1. Create your video, and add the DiabetesMine™ Design Challenge screen (downloadable HERE) to appear at the beginning and end for five seconds.

2. Give your video a short, recognizable title (ideally the product name), to make it easy for readers to vote on favorites.

3. Go to this site: http://youtube.com/group/DiabetesMineDesignIT, and click on “add a video” to upload.

4. Post a comment on this blog below providing the following information to help identify your video:

Video title

Your name and age (category you are entering)

Valid email contact info

State of residence

Your status (medical professional, start-up company, independent designer, student, etc.)

5. Note that by submitting an entry for the 2nd Annual DiabetesMine™ Design Challenge, submitters agree to these additional OFFICIAL CONTEST RULES.

THE JUDGING CRITERIA

Winners will be evaluated both popular vote and by a panel of three judges. In a sort of reverse American Idol system, reader voting will be taken into consideration, but the final determination will be made by the judges.

The judging panel will consist of one MD/Editor from Medgadget, one design expert from IDEO, and Amy Tenderich of DiabetesMine™ providing the patient perspective on user experience/desirability of the product. Entries will be judged on three-pronged criteria:

Efficiency - how does it solve a real-life problem for people living with diabetes?

Clinical Efficacy – how realistic and applicable is this product from a medical standpoint?

Aesthetics - it's the look and feel, Baby! How good is the pure design?

Remember, good design can be applied to anything, even something as "low-tech" as a special container for disposing of used glucose test strips. Let the innovation begin!

The official contest website and rules can be found at Diabetes Mine...

Thanks to Doc Gurley for Grand Rounds

2008-04-30T04:45:00.001-07:00

Thanks to Doc Gurley for Grand Rounds and for including my post on Three Visions of the Future of Healthcare.

Links of Interest

2008-04-29T18:14:00.000-07:00

Image via WikipediaThe following posts on the web recently caught my attention.

Clinical Cases and Images -- which contains a wealth of resources for technology in medicine -- posted 5 tips to stay up to date with the medical literature (click the link for a detailed discussion):

1. RSS Feeds for Journals.
2. Podcasts.
3. Persistent Searches.
4. Text-to-speech (TTS).
5. Blogs.

Struggling to Evade the Email Tsunami in the New York Times.

Paul Levy, CEO of Beth Israel Deaconess Medical Center, shares his hospital's "problem log" in Save Time; Improve Patient Care; Improve Work Life.

New study finds anticipating a laugh reduces our stress hormones.

A paper on network theory in PLoS medicine: It's the Network, Stupid: Why Everything in Medicine Is Connected.

Via Ted Eytan, MD: The “Showroom” Concept in Yogawear - applicable in health care?. Also from Dr. Eytan: Thoughts from the iPhone Developers Summit.

Via Read/WriteWeb: Health 2.0 - Apps & Trends to Watch.

The Health Sciences Library of the University of Buffalo has recently started an own Youtube channel with a variety of tutorials and answers to FAQs.

Sermo, the online network for physicians, just started a board for medical jobs:

Goodbye recruiters! On Sermo Jobs™ there are no more third parties—no recruiters, no headhunters, and no conflicts of interest. Sermo Jobs™ provides the perfect forum to connect with one another, discuss job opportunities, and network—all in real time.

Via Scientific American: Are pacemakers vulnerable to hackers?

Scientists from Harvard Medical School's Beth Israel Deaconess Medical Center in Boston, the University of Massachusetts Amherst and the University of Washington in Seattle say they were able to launch cyber strikes against and glean private patient data from an ICD's communication protocol while testing the device's safety and security.

And finally, Cats Cut Heart Attack Risk?

(Also posted on The Efficient MD.)

Three Visions of the Future of Healthcare

2008-04-26T19:44:00.000-07:00

Below are juxtaposed three visions of the future of healthcare. The first is from Microsoft, a conceptual video which echoes 2001. But the computers don't remind me of HAL. They remind me of, um, the iPhone. The video follows a pre-diabetic (presumably type 2) patient as she's out on her run, with all her physiologic data being automatically uploaded to her personal health record, which is then sent to a researcher who enrolls her in a clinical trial... For more commentary, see Dr. Bill Crounse's post on Microsoft's Health Blog. (Did you know they had a health blog?)

The second video is of Dr. Jay Parkinson -- who's in the running for medical iconclast of the year -- displaying the Myca Platform. Myca aims to be a revolutionary interface for the medical record. Here's a description from the website:

Myca is a technology platform that opens intelligent channels between patients and doctors. It supports access to a better care experience through the entire range of connections, from live video communications, video mail, chat and secure email to face-to-face office visits. It is designed to use everyday consumer technologies and be consumer-friendly.

What the Myca platform delivers:

* Video, voice and data communications across multiple platforms and channels, including mobile phones and PCs
* Practice automation through documenting and archiving of communication
* Intelligent system offers rules to validate diagnoses delivered through a compelling, easy-to-use interface
* On-line personal health records
* Secure access to each interaction for patients and doctors
* Integrated scheduling and billing
* Integration with remote monitoring devices and services
* Online prescriptions with dosage guardrails and medication interactions alerts
* Automatic medical coding for diagnostics and therapy
* Ability to add nutrition and wellness features to support preventive medicine

With a single communications and clinical information platform, Myca offers an elegant solution to the three top healthcare issues; access, high-quality medical care, and cost management.

Finally, the third video was taken at the recent EconHealth conference in New York. It features executives of many popular Health 2.0 Websites describing their vision of the future (and present) of healthcare. The Panelists include Raj Amin, CEO and co-founder, HealthiNation; Steven H. Krein, CEO and co-founder, OrganizedWisdom; Daniel Palestrant, CEO, Sermo; Dean Stephens, president & COO, Healthline. The Moderator is Michael Mason, Health Editor of the New York Times.

(Also posted on The Efficient MD.)

Why Doctors Don't Email Patients

2008-04-23T20:27:00.000-07:00

Image via WikipediaIt's no secret that I'm a strong advocate of patient physician communication by email. (See, for example, "Does Providing Email to Patients Benefit Patient-Physician Communication," "Someone Please Create Free, HIPAA-Compliant Patient-Physician Email," and the three part "Thoughts on Patient Physician Email.")

The Associated Press published a story recently with the following title: It's no LOL: Few US doctors answer e-mails from patients.

Kreuziger’s experience is shared by most Americans: They want the convenience of e-mail for non-urgent medical issues, but fewer than a third of U.S. doctors use e-mail to communicate with patients, according to recent physician surveys.

“People are able to file their taxes online, buy and sell household goods, and manage their financial accounts,” said Susannah Fox of the Pew Internet & American Life Project. “The health care industry seems to be lagging behind other industries.”

Doctors have their reasons for not hitting the reply button more often. Some worry it will increase their workload, and most physicians don’t get reimbursed for it by insurance companies. Others fear hackers could compromise patient privacy _ even though doctors who do e-mail generally do it through password-protected Web sites.

There are also concerns that patients will send urgent messages that don’t get answered promptly. And any snafu raises the specter of legal liability.

Many patients would like to use e-mail for routine matters such as asking for a prescription refill, getting lab results or scheduling a visit. Doing so, they say, would help avoid phone tag or taking time off work to come in for a minor problem.

Still, a survey conducted early last year by Manhattan Research found that only 31 percent of doctors e-mailed their patients in the first quarter of 2007...

I'm surprised that almost a third of doctors emailed their patients, frankly. I would have suspected the number would be lower.

The article goes on to say that Cigna and Aetna have piloted programs which pay doctors for making "virtual house calls" through email. This is a step in the right direction. Dr. Robert Center points out that the lack of payment has been a major barrier to more widespread adoption of patient-physician email.

As I write repeatedly, physicians are not paid for their time, they are paid by the widget. The patient visit is our version of the widget. Anything that we do to prepare for that visit, communicate between visits, review the tests induced by that visit or discuss you problem with another physician is gratis. We cannot bill for the proper use of time to improve the patient experience.

For further reading on patient-physician email, see

Email: The new frontier in physician-patient communication? and
Why you should email your patients in Modern Medicine

Healthline's Been Nominated for a Webby!

2008-04-21T13:55:00.000-07:00

Image via WikipediaHealthline.com has been nominated for a Webby award in the "health" category!

To vote for Healthline for the "People's Voice Award," simply

Log on to http://peoplesvoice.webbyawards.com/.
Register to vote (or log in if you are a returnee).
After registration, click on the Web site icon and find the Living section, under which the Health category falls.
Vote for Healthline.

Thanks!

The iStan Medical Mannequin: it Sweats, Bleeds, and Breathes.

2008-04-19T06:34:00.000-07:00

There's an appeal to learning medicine on virtual patient simulators, like Simantha, a simulator for cardiologists that I wrote about last week. You can practice dealing with emergencies and challenging patient situations that you might rarely encounter in practice. You can learn from your mistakes. You can be tested in a standardized fashion with actual clinical situations. And you can learn about pathophysiology and the effects of medications without the need for laboratory animals or actual patients.

The excellent blog, Clinical Cases and Images, brought a new patient simulation to our attention -- the "iStan" medical mannequin. iStan is a "wireless, sweating, breathing, bleeding training mannequin," according to Chris Seper of the Cleveland Plain Dealer. A video of iStan is below:

Live from ShowCASE: iStan

iStan is completely wireless. Procedures that can be performed on iStan include defibrillation, chest tube, catheterization, and needle decompression. He can also "drool, cry, and bleed out of his ears."

iStan was originally designed for use by the U.S. Army. For more information on iStan, as well as interviews with the engineers who created it, see the METI website.

Designed from the inside out, METI has created the first patient simulator truly based around a human-like skeletal structure. A revolutionary development in itself. But iStan also closely mimics the anatomical workings of the human body to a level of realism not possible with other simulators. Spine, neck, arms and hips all move with incredible life-like accuracy. And iStan is fully wireless and battery operated for amazing portability and versatility. Modeled from a unique cast of a real person, the skin of iStan truly acts, looks and feels like real human skin. Finally, iStan comes fully loaded, boasting an unsurpassed array of new, breakthrough features that will take simulation training to a new and exciting level of realism.

The Prostate Cancer InfoLink

2008-04-16T19:23:00.000-07:00

Image via WikipediaThis is a guest blog post by Dr. Arnon Krongrad, a urologist and founder and director of the Krongrad Institute for Minimally Invasive Prostate Surgery. It illustrates some of the ways physicians are utilizing the internet and online social networks such as Ning.com to educate patients about their practices.

--

“I hope you are not one of those used car salesmen turned robotic surgeon.” Rhonda said that her husband had had his prostate removed. She sounded like she regretted his decision. If so, she is not alone. A paper to be presented at a urology meeting reports that the likelihood of regret is approximately 2.5-fold higher for men having robotic prostate surgery.

I am a prostate cancer surgeon. In 1999, I introduced minimally invasive prostate cancer surgery to the United States. The surgery that Rhonda’s husband had is a form of this surgery. Given that minimally invasive prostate surgery reduces bleeding and pain, her words seem ironic. Why would a technical advancement that reduces bleeding and pain be associated with regret? There is no answer, although regret may represent a mismatch between expectations and delivery.

Rhonda’s regret comes in the context of acrimony in the public arena. Consider that 2007 saw death threats against commissioners of the Food and Drug Administration if they voted wrong on a prostate cancer vaccine. In various ways, one picks up signs that communication between the physician and prostate cancer patient communities has broken down. One feels that expectations are not being met and frustration by patients is intense, that there is a need to build bridges. The question is how.

In November 2007, the not-for-profit Prostate Cancer Mission, which I chair, held a public experiment. It conducted a seminar in which world experts on various aspects of prostate cancer addressed an audience of lay men and women. The event carried no drug company or device maker sponsorship. It succeeded brilliantly at showing that doctors and patients can enjoy each others’ company and learn from one another. When commercial bias is minimized, we can build bridges and communicate.

The question then became how to leverage the positive experience of 300 people into something broader and more sustainable. The obvious answer is the internet, which provides an unlimited potential to share information. As it stands, most of what one finds on the internet today is biased, ignorant, or shrill. It is not useful to the vast sea of men and women who need simple, relevant, and interactive information. What do do?

In 1994, the world’s first prostate cancer web site was introduced. It ran as the New Prostate Cancer InfoLink until it died a computer viral death in 2001. Uniquely, the InfoLink presented articles in simple English and offered an “Ask Arthur” section in which men and women could write in questions about their situations and get answers.

We are now introducing the New Prostate Cancer InfoLink as a modern incarnation of the original. Like the original, it will have articles in simple English that are written by some of the world’s foremost authorities on prostate cancer. It will have a blog to help you interpret the news. Uniquely, it will have an expended Ask Arthur that now brings a doctor, layman, and wife with 50 man-years of prostate cancer experience. You can get information and news and online, interactive guidance about your situation.

We are also developing a New New Prostate Cancer InfoLink social network. Modeled on Facebook, this sister site is far less structured and permits organic growth, group formation, and broadcasting of questions and answers. Here we can also bring together doctors, scientists, patients, government officials … anyone with an interest in prostate cancer. It is our hope that the Prostate Cancer InfoLink sites will let us build bridges between physician and patient communities to the benefit of both.

If you run a web site or blog, please consider providing a link to the sites. Then you too can be part of a global bridge building effort:

http://prostatecancerinfolink.net

http://www.prostatecancerinfolink.ning.com

Thanks to Dr. Wes for Grand Rounds!

2008-04-13T12:01:00.000-07:00

Thanks to Dr. Wes for Grand Rounds this week and for including my post on a bioartificial kidney.

I'm Writing a Book with the American College of Physicians

2008-04-04T12:28:00.000-07:00

The ink on the contract is drying, so I'm finally able to make this announcement: I'm writing a book with the American College of Physicians. This means that I'm humbly joining the ranks of other medical bloggers with book deals based on their blogs. (I'm aware of several, but I'd love to see a complete list.)

Writing a book was never my intention. I started The Efficient MD because I was interested in ways physicians could increase productivity and improve patient care using simple principles from books like Getting Things Done and The Successful Physician. I realized there were no websites devoted solely to lifehacks for the medical profession, so I decided to create one.

And as it turned out, the publishers at ACP Press became fans of The Efficient MD website. They felt, as I did, that this was a worthwhile topic. After several meetings, we decided to turn the ideas on that site into a book.

Some thoughts on the project:

The medical blogosphere will be prominently featured. The book will describe ways the blogosphere benefits both health care professionals and patients.
I've already spoken with several physicians and consultants with innovative ideas who will be featured in the book. If you'd like to be interviewed -- or if you'd like to offer help, feedback, stories, or ideas -- please contact me.
To make it easy for healthcare professionals to share their advice on medical practice with others, Dr. Ves Dimov -- Hospitalist at the Cleveland Clinic, Clinical Assistant Professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and writer of Clinical Cases and Images -- and I are creating The Efficient MD Wiki. Like Wikipedia, this will be a public website to which anyone can contribute. It will be devoted to clinical pearls, helpful links, general advice, and strategies for improving the practice of medicine.

More information to follow. Thanks for reading. Of course, comments and feedback are welcome.

Joshua Schwimmer, MD, FACP, FASN

About the American College of Physicians

The American College of Physicians (ACP) is a national organization of internists — physicians who specialize in the prevention, detection and treatment of illnesses in adults. ACP is the largest medical-specialty organization and second-largest physician group in the United States. Its membership of 125,000 includes internists, internal medicine subspecialists, and medical students, residents, and fellows.

(This announcement was originally posted on The Efficient MD.)

Thanks to GruntDoc for Grand Rounds

2008-04-03T04:32:00.000-07:00

Image from WikipediaGrand Rounds, this week's best posts of the medical blogosphere, is up at GruntDoc (and eveywhere else). Thanks for including my post on The Physician Success Strategies Conference.

Monthly Introduction to Tech Medicine

2008-03-31T18:25:00.000-07:00

Image from WikipediaWhat's this blog all about?

My goal in Tech Medicine will be to explore the intersection of medicine, new technologies, and the Internet. This is a purposefully broad topic. Several times weekly I will post focused reviews of issues interesting to health professionals and nonprofessionals alike. Posts may include examinations of medical devices, pharmaceuticals, scientific advances, internet services, and other technologies involving health care and the practice of medicine. Mirroring as it does the nature of the Internet and the sometimes surprising nature of new technologies, the content may also include topics that are wonderful, unusual, hilarious, or strange.

What are some recent posts on Tech Medicine?

Topics of recent posts have included Interventional Cardiologists Tested on Virtual Patients, The Physician Success Strategies Conference, Bioartificial Kidney Reduces Risk of Death from Acute Kidney Failure, iPhone Medicine Watch: Epocrates on the iPhone, Jay Parkinson, Myca, and Hello Health Watch, and Google Health Watch.

Who are you?

I'm trained as a nephrologist (a kidney and blood pressure specialist). For the last two years I've written Kidney Notes, a blog designed to filter and process medical news. Most recently, Kidney Notes has become a collection of links, commentary, and scraps of information -- a reference database of interesting things with the help of a popular social bookmarking service called del.icio.us. While I will continue posting to Kidney Notes, several friends have asked me to write longer posts of original content -- and this is what I will be writing on Tech Medicine. Recently, I have also written a blog on personal productivity called The Efficient MD (in association with the American College of Physicians).

There are many topics I plan to cover, but I'm also open to suggestions and tips. Please email them to techmedicine@gmail.com.

Interventional Cardiologists Tested on Virtual Patient Simulators

2008-03-31T10:17:00.000-07:00

Image from WikipediaCardiologists and other medical specialists are required to complete training and education "modules" by the American Board of Internal Medicine (ABIM) for renewal of their board certification. For the first time, the ABIM is allowing cardiologists to take one of these modules by performing cases on a life-sized mannequin, a virtual patient named "Simantha."

This virtual patient simulation is offered at one of six Medical Simulation Corporation’s six SimSuite education centers, located at major medical schools across the United States. The patient simulation is also offered at major cardiology conferences.

More information is available from the ABIM's web page:

During the SimSuite session, which lasts between two and three hours, diplomates will perform cases on “Simantha,” a life-size mannequin, and answer two questionnaires. The simulator also includes six monitors that show displays found in an angiographic suite, and multimedia characters representing the patient, assistants and mentors.

Information on the simulated patient includes a pre-brief patient history and procedure simulation. The pre-brief patient history displays information about the patient and lists drugs given and examinations performed prior to the procedure. Diplomates completing the cases apply their practice knowledge and judgment in a real-time fashion. The system records comprehensive performance data which can be used separately or combined to create metrics for each scenario. Feedback will be provided to the diplomate once the data is analyzed by ABIM. Proctors will provide training in the use of the simulation technology and will allow you to practice on a training case before you begin the five simulations. Once finished, you will be asked to complete two surveys, one about your experience on the simulator and one about your interventional cardiology experience.

“The Interventional Cardiology Simulations represent the first time that ABIM has applied a simulation technology tool as a means of understanding cognitive and procedural proficiency as part of the self-evaluation component of Maintenance of Certification,” said Rebecca S. Lipner, PhD, Vice President of Psychometrics and Research Analysis at ABIM. “We believe that simulation reflects many of the experiences interventional cardiologists may face in practice, and we are planning to expand the number of available cases. In addition, we continue to explore applying simulation technology to the self-assessment process in various subspecialties.”

The Physician Success Strategies Conference: What Can Doctors Learn From Consultants?

2008-03-29T11:59:00.000-07:00

Many doctors, in their daily practice, have the nagging suspicion that there must be a better way to do things.

The blog focuses on strategies and ideas that doctors can use to stay organized, increase productivity, and take better care of patients. Many of my colleagues and I have experienced our desks disappearing under a pile of papers and charts, suddenly realizing that we’re an hour and a half behind schedule in the office, or finishing our workday to discover that we still have a stack of urgent messages that need answering. And physicians, almost universally, have been forced to see more patients, more quickly, yet are reimbursed less for their efforts.

Plenty of patients have the same feeling — that there must be a better way of doing things. They feel this when they're been trapped in a waiting room for over an hour. Or when they’re unable to reach their physician on the phone. Or when they’re rushed through a 10 minute visit without expressing the real reason they came to the doctor in the first place.

Just as doctors devote their careers to caring for patients, other professionals devote their careers to improving the productivity of individuals and organizations. I’ve highlighted some of them previously — like David Allen, author of Getting Things Done, and Marshall Zaslove, author of The Successful Physician. For doctors, there’s an entire landscape of consulting organizations that offer to improve the practice of medicine. In my initial review of consulting groups for this blog, one organization that stood out is the International Council for Quality Care (ICQC). Headed by Greg Korneluk, a healthcare consultant with 30 years experience, ICQC offers an impressively thorough approach to analyzing and improving medical practices. ICQC provides detailed physician benchmarking, clinical practice redesign, staff education, and conferences on improving performance. These services are aimed at both small practices and large organizations, at practices that accept insurance as well as “concierge” or “boutique” practices.

I was curious about what consulting services like ICQC might have to offer physicians. So last week, I accepted an invitation to write about a two-day conference hosted by ICQC called “Physician Success Strategies.” And let me be frank: I usually dislike conferences. As I listen to lectures, these are the questions in my mind: “Why am I here? Is this a good use of my time? Why couldn’t I get this information from a podcast, journal, or book?” As this was the first conference of its kind that I’d attended, I was admittedly skeptical: we’re in the trenches with patients every day, shouldn’t we be able to solve our own practice problems? What can physicians actually learn from consultants?

Quite a lot, it turns out. I left the conference with a notebook filled with ideas and the sense that this was definitely time well spent.

The Physicians Success Strategies conference is held monthly at the Boca Raton Resort and Club, a vast tourist destination and meeting-place in southern Florida. The 20 person group who attended included doctors, nurse practitioners, office managers, pharmacists, and the CFO and CEOs of medical systems. They came from all over the United States. Some had attended multiple times. In the words of one physician I spoke with, “I learn new things every time I’m here.”

And these professionals have real problems with their practices. Some of the multi-provider groups were receiving more than 100 phone messages from patients per hour. And some doctors who attended saw more than 50 - 60 patients a day.

Brita Hess, the president of ICQC, highlighted the problem of information overload in an initial presentation. One of the most striking diagrams of the day — and there were many — was an animation of the flow of people, objects, and information in a typical doctor’s office. Streaks of lines representing the movement of charts, messages, and doctors obscured the screen in a tangle of intersections. Most physician’s offices, it made you realize, were organizational disasters.

Greg Korneluk, ICQC’s founder and the main speaker, asked the audience a simple question: “What’s preventing you from having a perfect day?”

As they brainstormed, Greg sketched a mindmap of the answers. “Patients think my office is a factory.” “I’m not getting my phone calls.” “Patients wait for too long.” “I have to see too many patients in too little time.” “I’m not reimbursed enough.” “I don’t have time to actually listen to patients.”

Faced with the pressure of declining reimbursement on the bottom line, many practices would sacrifice quality of care to reduce costs. ICQC advises a different and perhaps controversial approach: increase the quality of care, and the bottom line will follow. Throughout the conference, videos were played of doctors who’ve successfully followed this model of putting quality first.

ICQC advocates a 360-degree approach to analyzing and improving the quality of care, encapsulated in the mnemonic “CARES+”:

Core Service: Quality Improvement, Clinical Documentation, Patient Education, Outcomes Management, Interpersonal Impact
Access: Facilities & Technology, Records Management, Patient Flow, Time Management, Scheduling Systems
Representation: Practice Positioning, Marketing & Public Relations, Ambiance & Decor, Patient Relations, Collegial Relations
Economics: Optimal Utilization, Third Party Payments, Collections Management, Overhead Management, Financial Controls
Staff & Support: Organizational Structure, Personal Policies, Performance Reviews, Hiring & maintenance, Productive Morale
Attitude+: Pride in Profession, Taking Responsibility, Positive Expectations, Clear Vision, Action Orientation

Each of the obstacles to a “perfect day” were positioned in the CARES+ theoretical framework, and using this model, Greg Korneluk provided advice to solving problems commonly encountered in clinical practice. Some of the many strategies discussed in the two-day conference included organizing office staff into care teams, identifying and opening up bottlenecks in practice, strategies for complete documentation, optimal strategies for scheduling patients, and how to choreograph the ideal patient visit. The level of granularity was impressive. The discussion on patient interactions, for example, even included advice on how to knock, how to shake hands, and the importance of the right facial expressions.

ICQC’s ideas are widely applicable to different types of practices. Parts of the presentation were geared specifically towards “concierge” practices — where patients pay out of pocket for services and typically insurance is not accepted. But more broadly, ICQC focuses on the idea of adding value to medical practices, whether or not they fit the “concierge” model. If there are certain services that patients want — improved access to their physicians, specific procedures, or amenities — patient are willing to pay more. The final presentation outlined strategies for marketing and providing these “value-added” services to patients.

I surveyed the doctors at the concluding lunch. Their consensus was that the conference left them with a wealth of new strategies and ideas to improve their medical practices. And I agreed with them. While conferences like Physician Success Strategies are not for everyone, I believe that a majority of physicians would benefit from this kind of intensive focus on new ways of improving efficiency, productivity, and the quality of patient care.

For more information on the International Council for Quality Care, please see www.bestpractice.com and “Physician Success Secrets” by Greg Korneluk.

(This article was originally posted on The Efficient MD and is reprinted with permission.)

Bioartificial Kidney Reduces Risk of Death from Acute Kidney Failure

2008-03-25T18:10:00.001-07:00

Most patients with acute kidney failure receive hemodialysis -- a cleansing of the blood using a dialysis machine, a "man-made" kidney. However, acute kidney failure is associated with a high mortality rate, and researchers have been interested in whether the outcomes from kidney failure could be improved through the use of a "bioartificial kidney," which have the potential to more closely replicate the many functions of the human kidney.

The "renal assist device" (RAD) is a bioartificial kidney with tubules lined with actual donated human kidney cells. In an upcoming issue of the Journal of the American Society of Nephrology, Dr. H. David Humes demonstrates that the use of the RAD in patients with acute kidney failure is associated with improved mortality and recovery of renal function. While this device is still experimental, it raises the hope that outcomes from acute kidney failure can be improved with bioengineered devices like the RAD. From the press release:

"The cells are made available to carry out subtle metabolic and endocrine functions that the patient's failing kidneys can no longer perform, thereby staunching a cascading decline in the patient's health and allowing time for the patient's own organs to recover," Dr. Humes explains.

Outcomes were significantly better for AKI patients treated with the RAD. After one month, 33 percent of patients in the RAD group had died, compared to 61 percent of those treated with renal replacement therapy only. Patients who received the RAD were also more likely to be alive after six months. With adjustment for other factors, the risk of death was about 50 percent lower in the RAD group.

Patients in the RAD group also had a shorter time to return of kidney function. Overall, kidney function recovered in 53 percent of patients with RAD, compared to 28 percent without RAD. In both groups, about 20 percent of patients survived but never recovered kidney function, requiring chronic dialysis.

Although the initial results are encouraging, the benefits of RAD treatment need to be confirmed in larger studies. In addition, the researchers need to study the effects of changes in the design of the RAD, which are needed to accommodate mass production.

iPhone Medicine Watch: Epocrates on the iPhone

2008-03-23T11:09:00.000-07:00

"I'd like to get an iPhone, but..."

In the hospital, when I use my iPhone, I hear this all the time. What are the two biggest reasons doctors give for not switching to the iPhone? 1) They don't want to change their carrier to AT&T and 2) The iPhone can't run Epocrates or other third party software.

Most physicians have used Epocrates, which is a popular drug reference database accessible through PDAs and the internet. Back when I owned a Treo 650, I used Epocrates all the time. When I switched to the iPhone, I missed having immediate access to the Epocrates database -- though the inconvenience of having to access Epocrates through the internet was minor.

This month, the biggest complaint about the iPhone -- that it can't run third party software -- has been answered with the release of the iPhone SDK (software development kit). And to the surprise of many physicians, Epocrates was one of the first products to be showcased.

Health care professionals who are iPhone users -- or plan to purchase one -- are waiting until June, when the application store for third party iPhone software will go live. Realistically, however, our enthusiasm should be tempered by the understanding that third party software like Epocrates has already been available for the Treo and for Windows Mobile. Seen this way, iPhone users are only getting now what they should have received all along.

On the other hand, the iPhone is a unique platform. The part of the Epocrates video (shown above) that received the most enthusiastic response was the demonstration of the pill finder, which takes advantage of the iPhone's interface to identify and display medications based on their shape and color. In a handheld device, this feature is truly novel. The potential for a flood of new medical applications which take full advantage of the iPhone's strengths are what's really exciting for physicians. Will that be enough to make the iPhone the doctor's PDA of choice? We'll see.

(Also posted on The Efficient MD.)

Thanks to Polite Dissent for Grand Rounds

2008-03-19T04:47:00.000-07:00

Thanks to polite dissent for including my post on Healthline's new drug search tool for Grand Rounds.

Jay Parkinson, Myca, and Hello Hello Health Watch

2008-03-18T19:59:00.001-07:00

I previously wrote about Dr. Jay Parkinson on Tech Medicine. He runs an innovative practice, primarily for the uninsured, involving housecalls and the integral use of email and instant messaging to facilitate communication with patients.

In association with Myca, Dr. Parkinson is launching a project called hello health:

Yesterday, we at Myca, announced hello health at the Health 2.0 conference in San Diego. hello health is the consumer brand of healthcare delivery powered by the Myca platform. It’s Geek Squad with doctors and a Netflix-priced monthly membership subscription fee — it is a branded healthcare “experience” that mixes “concierge service for all,” with house/office calls and web visits via email, IM, video chat, and text messaging. It’s Fed Ex, Apple, Whole Foods, Amazon, Toyota, Fresh Direct, and Geek Squad all applied to healthcare delivery.

Specifically, the Myca platform provides the following services:

* Video, voice and data communications across multiple platforms and channels, including mobile phones and PCs
* Practice automation through documenting and archiving of communication
* Intelligent system offers rules to validate diagnoses delivered through a compelling, easy-to-use interface
* On-line personal health records
* Secure access to each interaction for patients and doctors
* Integrated scheduling and billing
* Integration with remote monitoring devices and services
* Online prescriptions with dosage guardrails and medication interactions alerts
* Automatic medical coding for diagnostics and therapy
* Ability to add nutrition and wellness features to support preventive medicine

Here's a video of Dr. Parkinson and a demonstration of Myca's interface.

Further coverage of hello health will follow.

Also posted on The Efficient MD.

Google Health Watch

2008-03-17T19:53:00.000-07:00

For those of you following Google's entrance into the business of Electronic Health Records (EHRs), here's a roundup of recent developments and insights.

Marissa Mayer, the VP at Google in charge of the project, discussed Google Health on the Official Google Blog and provided screenshots:

Google Health aims to solve an urgent need that dovetails with our overall mission of organizing patient information and making it accessible and useful. Through our health offering, our users will be empowered to collect, store, and manage their own medical records online.

Eric Schmidt, CEO of Google, gave the keynote at the Healthcare Information and Management Systems Society Annual Conference.

Matthew Holt of The Health Care Blog analyzed the concern that EHRs like Google Health aren't covered by the HIPAA privacy law, and decided that the benefits of EHRs outweigh the privacy risks.

The AMA provided its take on Google Health. (Registration required.)

The New York Times Bits Blog claimed that "the company’s new medical records system is largely about advertising, especially ads by drug companies."

A Google spokesman said, however, that the company may well put ads on future versions of the service. But it doesn’t even need to. Presumably parts of Google Health, like most everything Google does, will have a box that can be used to begin a Web search. The search results pages, of course, will have Google’s standard ads.

What won’t be standard, most likely, is the revenue that comes from those ads. Health is among the most lucrative categories of advertising, in part because there is no better way for drug companies to reach prospects than when they are searching for or reading about certain conditions.

And Graham Walker at over!my!med!body! pointed out the problems with the fundamental PHR idea that patients should control the content of their own medical records.

Have an interesting link about Google Health? Email me at techmedicine@gmail.com.

(Also posted on The Efficient MD.)

Monthly Introduction to Tech Medicine

2008-02-29T19:44:00.000-08:00

What's this blog all about?

My goal in Tech Medicine will be to explore the intersection of medicine, new technologies, and the Internet. This is a purposefully broad topic. Several times weekly I will post focused reviews of issues interesting to health professionals and nonprofessionals alike. Posts may include examinations of medical devices, pharmaceuticals, scientific advances, internet services, and other technologies involving health care and the practice of medicine. Mirroring as it does the nature of the Internet and the sometimes surprising nature of new technologies, the content may also include topics that are wonderful, unusual, hilarious, or strange.

What are some recent posts on Tech Medicine?

Topics of recent posts have included my interview about Google Book Search, interesting links and followups, Healthline's new drug search tool, a study on patient-physician email, the National Library of Medicine's Drug Search Portal, a better pillbox from MIT, Heath Ledger's drug interactions, Google Book Search and medical education, and rounding on surgical patients by robots.

Who are you?

I'm trained as a nephrologist (a kidney and blood pressure specialist). For the last two years I've written Kidney Notes, a blog designed to filter and process medical news. Most recently, Kidney Notes has become a collection of links, commentary, and scraps of information -- a reference database of interesting things with the help of a popular social bookmarking service called del.icio.us. While I will continue posting to Kidney Notes, several friends have asked me to write longer posts of original content -- and this is what I will be writing on Tech Medicine. (Recently, I have also written a blog on personal productivity called The Efficient MD.)

There are many topics I plan to cover, but I'm also open to suggestions and tips. Please email them to techmedicine@gmail.com.

My Interview With Google Discussing Google Book Search

2008-02-28T21:11:00.000-08:00

Google interviewed me a few weeks ago about Google Book Search -- why it's innovative and how doctors can use it. The 2 minute video is posted on The Efficient MD.

Followups and Links of Interest

2008-02-25T20:05:00.000-08:00

A few things that caught my eye these last few weeks:

OR-Live offers live and archived webcasts of more than 600 surgical procedures.

From the NEJM:

This spring the U.S. Supreme Court in Baze v. Rees1 will rule on the constitutionality of the three-drug regimen currently used for lethal injection in most state executions. The Eighth Amendment to the U.S. Constitution prohibits punishment that is "cruel and unusual." The central question before the Court in Baze is whether the use of sodium thiopental, pancuronium bromide, and potassium chloride violates that constitutional prohibition.

The Marpac 980 Sound Screen & SleepMate Sound Conditioner. Highly recommended.

I previously asked if there were any free, HIPAA-complaint patient-physician email systems available. As far as I can tell, there's only one, and the site is named iMedicor. It also offers CME, a dictation service, and a system that allows secure communication between physicians. A review will follow.

Alcohol hand rubs alone are not enough to curb hospital infections.

Depressed and burned out residents make 6.2 times as many errors.

Jay Parkinson is awarded quote of the week: "Today’s doctors are like feral children found living in their own little communication wilderness."

And the unlikely saga of a medical checklist has a happy ending -- ""The Office for Human Research Protections (OHRP) – part of the U.S. Department of Health and Human Services – has concluded that Michigan hospitals can continue implementing a checklist to reduce the rate of catheter-related infections in intensive care unit settings (ICUs) without falling under regulations governing human subjects research."

(Also posted on The Efficient MD.)

Tech Medicine

An Open Letter from America's Physicians

Monthly Introduction to Tech Medicine

2nd Annual DiabetesMine™ Design Challenge

Thanks to Doc Gurley for Grand Rounds

Links of Interest

Three Visions of the Future of Healthcare

Why Doctors Don't Email Patients

Healthline's Been Nominated for a Webby!

The iStan Medical Mannequin: it Sweats, Bleeds, and Breathes.

The Prostate Cancer InfoLink

Thanks to Dr. Wes for Grand Rounds!

I'm Writing a Book with the American College of Physicians

Thanks to GruntDoc for Grand Rounds

Monthly Introduction to Tech Medicine

Interventional Cardiologists Tested on Virtual Patient Simulators

The Physician Success Strategies Conference: What Can Doctors Learn From Consultants?

Bioartificial Kidney Reduces Risk of Death from Acute Kidney Failure

iPhone Medicine Watch: Epocrates on the iPhone

Thanks to Polite Dissent for Grand Rounds

Jay Parkinson, Myca, and Hello Hello Health Watch

Google Health Watch

Monthly Introduction to Tech Medicine

My Interview With Google Discussing Google Book Search

More Tech Medicine Links

Followups and Links of Interest