An Ozzie in Boston

Medical Post now up at Elder Tech Blog

If you've been wondering why I haven't done any medical posts for while, that's because I'm going to start doing them at my other blog, The Elder Care Tech Blog. Go on over and have a looksee! 

Hope you like it. I'll start to do all my medical tech blogging there.

Medical Software – Intel Health Guide Premiered Today

Thanks to MedGadget

So I had already wrote about Medical Devices from the Connected Health Seminar, and asked if any company had thought about the end user.

Intel Health did. They have just about absolutely nailed what people are looking for in a telemonitoring device. It was premiered today, in Santa Clara, and will be undergoing trials in California and maybe Tennessee. More info can be found on the Wall Street Journal, Medgadget, and the Intel Health Site, while the video of the premiere can be found at http://www.visualwebcaster.com/event.asp?id=52863.  (Unsure if I’m allowed to put this up, so let me know if I need to take this down). You can see it in action between 18:00 and 30:00, with some great insights into why Intel did what they did.

They spent over 2 years talking to experts in the field about what they want, co-operated with The Mayo Clinic to create educational material, and had anthropologists and technologists work together to create this product.

First up the amazingly great things:

• Holy heck! This system is actually readable by elderly people! Large fonts, colors that don’t disappear when people go color-blind. (using mostly blues – no yellows or reds.)
• A Touch screen! Great! People don’t need to know which button does what, they just need to touch what they want! It works for the IPhone, it’ll work for this.
• The patient gets feedback on their surveys and the measurements that they take. People want to know if they are doing well, and want to be told what they can do if they are not doing so well.
• The “teachable moment” content! If a patient answers a survey in a way that could be a problem, automatically a video will appear (after the patient asks for it) and tells them things they can do. This automatic teaching can reinforce teaching that our nurses do.
• It’s easy to use! I have a hard enough time trying to get nurses to want to use technology, let alone get them to want others to use it. If it’s something the nurses like, then it’ll be easier to get the patients to like it.

Second, the good things:

• The home office system is all in IE, which is great, as it can hopefully be put into other website systems. Will have to ask about this.
• The web cam visits. This makes getting in touch with acute patients very quick and very easy. The web cam interface is extremely easy.
• You can change surveys, add your own educational material (!) and create web cam visits using the IE home office back end, which looks very user friendly.
• This system will make it much easier for our nurses to schedule their days.

Finally, things that could get better:

• Making the system only use broadband is great for the future, but unfortunate for the present. With over 30 of the 351 municipalities ( June 2007, from http://www.mtpc.org/broadband/data0807.pdf)  without a Broadband ISP and many more either in underserved municipalities, the areas where the web cam visits could do the most good are also the ones that you can’t use the system in. This is not really a fault of the system (and another POTS version will be released in January next year) but it is unfortunate, and is most likely the reason we won’t be using it. Another reason is the 2^nd bad point.
• Most people over the age of 60 simply don’t want or need a broadband connection. How many people have parents or grandparents that use the internet? I don’t think the company I work for will be able to persuade people to get broadband for a telemonitoring system.
• The web cam visit phone ring. Ugh. I hope the user can change it. First time I heard it, I thought it was an error beep.

Well, I’ve hit a page, so I think I’ve gushed over the new Phillips Intel Health Guide enough. I’m really looking forward to hearing about the pilot projects this is going through, and the pricing of the system. I’m hoping the POTS version has just as much functionality as the Broadband system. I can understand if the web cam visits are not in the POTS system, but if a voice call visit was in the system, that would still be amazing.

Medical Software – The Netherlands tackles EHRs

This post is a response to the HIMSS article: "Electronic Health Records: A Global Perspective". Since this article is quite large, I’ll try going through it one country at a time. Last week was Germany, which you can see at Medical Software - How Germany tackles EHRs. This week I’m looking at the Netherlands.

 

Like most countries, The Netherlands population is getting older, their bad capacity is getting smaller and their GPs (or PCPs) are beginning to get overrun with patients. Right now there are 5 GPs for every 10,000 patients. Ouch. So they believe a EHR will fix some of those problems.

 

The way the Dutch are handling the roll out of their EHRs is rather different to the German system. Instead of giving each citizen a card that can be used to link that citizen to their ID and data in the EHR databases around Germany, the Dutch are using a “Federated System” which means that while there is one major database, practices will have their own local databases as well.

 

This makes sense, as many General Practitioner Practices already have their own Information Systems and some practices have EHR as well. The problem is that when these systems were created, they were created to make administration or billing patients easier, and this may not have created systems that could be useful to the patient.

 

The two main changes for individual records that will be implemented by the Netherland’s National EHR system are:

 

• A patient summary from the GP that can be accessed at any time (Deputising Practitioner Record, aka “Waarneemdossier voor Huisartsen” or “WDH” ); and
• A patient prescription history (Electronic Medication Record aka “Elektronisch Medicatie Dossier” or “EMD”)

 

(As a side note, that last one is probably a good idea, as I just found out this week that 90% of our clients from our transition program need a medication change, as there are mishaps.)

 

The system still includes cards though. Providers need to sign up to a system card called a (“UZI-card”) which is PKI-based, and this card enables access control in the system depending on the role assigned to the healthcare provider with the UZI-card.

 

The system doesn’t need cards for patients, as they are identified by the national Civil Service Number. Since a patient’s information is stored locally at its source, data exchanges between the central EHR system and the source have to be collected through a central “Act Reference Registry” based on the HL7v3 information model.

 

Overall, it sounds like quite a good model, but the main problem is, will people use it? In 2007 there have been some pilots of the system, which provided some compelling outcomes (Saving 6.75 million Euros in Medical prescription errors is no mean feat!) but since there are no financial incentives or clear business case for implementing HER adoption, many GPs are not considering it. When their next steps are implemented (such as their e-prescribing system) maybe then GPs will begin to see a clear business case.

Connected Health Symposium Recap

So the conference ended yesterday, and I've had a night to sleep on the event and think about it.

 What do I think about it? I'm still not sure.

On one hand, there is some absolutely amazing technology coming out, on the other hand, DID ANYONE THINK ABOUT THE END USER?

We've got home telemonitoring systems that can do amazing things, but the hardware they want to station in the home looks like black and decker hardware. Ugly as.

There was a machine that could intelligently give out medication based on time of day, which is pretty neat, except for the fact that it was the size of a multifunction printer. Who would want that in their home?

Finally, we have the idea of using webcams to transmit data. A great idea, and one that is great for hospitals, which are using the idea already. But when it comes to installing something like that in the home, it's nigh on impossible to do for a decent price. One company was selling a video telephone, which was amazing. But for 1500? I've got Skype. I'd rather teach my gran how to use a computer and skype rather than spend 1500 to do a single thing.

And then you have everyone saying "we need our software systems to work together" then when you ask about a way it could work together, people say no because "that's where their profit is".

But finally, the last booth I checked out was definately the best. The new Intel health telemonitoring system blew my mind away. I'll do a post later on what the Intel system could mean for tele health.

Cheers,
Nathan

P.S. Seeing the Connectiva group all make hardware and software work together with different companies was awe-inspiring.

Medical Tech - Connected Health Symposium Coming Up, My Own Project Ideas.

The Connected Health Symposium is coming up next week, which I’m really excited about.

 

The The Center for Connected health  is a program run by the Partners HealthCare, founded by Brigham and Women’s and MGH, that aims to create deliver quality patient care outside of the traditional medical setting, so this conference will have a wealth of information on telemonitoring. I'll be reporting on this next week.

 

Meanwhile, I’ve had a few ideas for projects I could try taking on in my own spare time, as winter is coming up soon, and going outside is almost the same as performing a vasectomy.

 

Current ideas for projects are:

 

• Creating a website that uses an apple IPhone web toolset for creating notes for myself - this could then be ported to work.
• Creating some kind of Facebook application. Maybe a board game. Maybe some sort of 'ring' game. That would be cool.
• Creating some sort of side scrolling game. With games like braid, love and world of goo coming out, it would be fun to try some stuff out.
• Some medical application on a website using an IPhone web toolkit.

 

None of these are really medical, which is a shame. Haven't had a real flash of inspiration on the medical side. There's plenty of medical stuff for me to do on the work side, so maybe something will come up soon. Anyone got something they wish they could do on a IPhone?

Medical News – 13th Oct to 16th – Or who wants to win $10 million?

Wall Street Journal

 

Build a Better Health Care System, Win $10 Million

 

So, who wants to win it? The X PRIZE Foundation is offering 10 million to the best health care system. The most promising ideas will be tested in several states. Right now, the targets are not set, and people have no idea what sort of ideas could come up Brad Fluegel, Well Point’s CSO says “Some of them [the ideas] could be technology changes in terms of providing better information to patients. It could be incentives for providers, or incentive for patients to take better care of themselves.”

 

Pfizer Goes Generic

 

Heck, makes sense to me. Elderly people are more likely to buy generic than brand name, to stretch their dollar further, and the market is set to balloon to $520 billion in 2011 from $270 billion now.

 

Disco Saves Lives!

 

Yes! I always knew the Bee Gees were awesome, but know they are super awesome. Turns out, if you perform CPR in time to this:

 

 

 

Gotta dig that jacket on one sleeve action.

 

You will likely deliver the 100 chest compressions per minute recommended for CPR.

 

Fierce Healthcare

 

The EMR information quest

 

Interesting piece about the MGMA conference coming up in San Diego and how PCP’s may think about how they choose a EMR IT solution. The MGMA have a paper on “Best practices for building an HER cost model” which you can find on their website at www.mgma.com.

 

Medical identity theft information still scarce

 

Another article, this time on how hard is it to collect data on identity theft from practices. There’s a bunch of anecdotal evidence, but no one knows how big a problem this is. Some practices are beginning to use biometrics to secure data, which is costly but robust.

 

Medgadget

 

Vibration Response Imaging (VRI) Shows Promise In Assessing Postoperative Lung Function

 

An Israeli firm called Deep Breeze has released pulmonary imaging technology, so now doctors can evaluate lung function without invasive surgery. And it’s already FDA approved!

 

The Healthcare Blog

 

Microsoft Healthvault: Coke, Pepsi or Intel Inside

 

Interesting interview with Keith Toussaint from Microsoft about the Microsoft Health Vault.

 

And that’s a page. I’m out.

 

Keep stayin’ alive.

Medical Software - How Germany tackles EHRs.

This post is a response to the HIMSS article: "Electronic Health Records: A Global Perspective". Since this article is quite large, I’ll try going through it one country at a time. This week is Germany.

 

It seems that the country with a healthcare system that is the most similar to the USA's system is Germany, except Germany has no governmental subsidies.

 

One major similarity between the German system and the American system is the way clinicians are rewarded. Basically, the more complex a condition, medication or procedure is, the more a clinician will be paid. I've heard of clinicians trumping up a diagnosis so they get paid more.

Which then leads me to the next major similarity, none of Germany's current health IT systems support either disease prevention or "assisted ambient living" and their government system is used only to facilitate administration. Oh, by the way, that’s what the company I work for does; check it out here at www.dovetailhealth.com.

 

Oh yeah, one last similarity: the top major issue for Germany is "The aging of the population and its related shifts in income vs. Health-cost."

 

Kinds odd that the government can see that acute disease management for the aged is going to be a problem in the future, but current paying models cause doctors to keep the patient in hospital causing a burden on the health care system, don't you think?

 

Anyway, Germany’s new “Elektonische Gesundheitskate” or Electronic Health Card, is what is currently being tested as a EHR platform. People carry around a card with their an ID number that links to their medical details on a centralized database. As internet connections all throughout Germany are between 1 to 6 MB, a centralized system under a Service Oriented structure is fine. The basic coding for conditions in this system is HL7, which is fast becoming what the world uses.

 

In general, GP (or PCP, for yanks) buy-in has not been achieved, as they need to enter their own card and PIN number before each patient entry, and since this is a primarily admin focused system, they don’t see any see real benefit over a paper and pen approach. Hopefully in future they tie the use of the system into a pay for performance model like the US is starting to try and adopt. This could make buy-in easier, as people in general tend to go where money is easy to get.

 

If you are interested in detailed designs of Germany’s EMR, check out www.gematik.de. And look for the EPA.

Medical Software Update: 5th to 9th of October

The Health Care Blog

 

This site has been gung-ho on EMR this week.

 

Reader mail: Pitfalls of EMR implementation

 

Great post from a technologist that’s been trying to implement EMRs for the past five years and what can go wrong. Good points on “technology being 90% percent people” and how you can make people fit a paper form.

 

EMR implementation -- a saving grace or year of hell?

 

Some great comments on this page about EMR experiences. It just shows how hard it is to move people from one system to another. Glad that our company are making our own, and I’m here to fix it if things go wrong.

 

Reader mail: EMR advice from an IT insider

 

Interesting points, especially the “I’m making enough money as is, and I don’t see a need to make any changes” view that some physicians have, along with the family practice viewpoint.

 

Google Health: Is It Good For You?

 

A very good interview with Google Health’s Missy Krassner. Good to see they use the CCR standard, and they are looking to focus on Diabetes, which is one of the biggest chronic illnesses facing America.

 

Healthcare IT News

 

Mass. IT vendor, Partners Healthcare employees indicted on alleged kickbacks

 

No sooner than weeks after we hear about companies having to declare when they make donations to healthcare companies over $50 that Partners Healthcare has been caught in a IT bribery scheme. Future Tech in Mass has been providing bribes to employees at Partners Healthcare to sure contracts.

 

FierceHealthIT

 

CIO status rising as health IT projects become central

 

With the entire United States of America pushing for EMR adoption, including President Bush (always trying so hard to seem important now, bless his heart “wink”) it seems the CIO is getting to be a much more important job, where the CIO needs to be a highly effective communicator who works wells with stakeholders across the hospital.

 

Medgadget

 

HAL, The One That Walks, Goes on Sale

 

That. Is. Badass.

 

Oh hell yes, I can get my very own mecha-suit. Well not yet, but it could happen soon. Cyberdyne in Japan has created a Hybrid Assistive Limb, which can help people with lower body diabilties to walk. Or guys that want to pretend like they are cyborgs. Now make that 500 feet tall, and let me take on Godzilla. That would be AWESOME.

 

Healthline

 

Epocrates for the iPhone: A Survey

 

Survey sayyyyyysssss……. Yes. 61% of physicians use it daily. And 93% believe that clinical reference such as Epocrates should be used.

 

Duh. That’s how tech is done right. I should take notes.

 

 

And that’s enough for today.

Medical software - teaching elderly how to use technology

Technology is a scary thing. You click some where with this thing called a "mouse" and something happens. You try clicking somewhere else and something different happens. How does this work? And how do you know where to click, and what these things do?

 

Strange thing for a tech guy to write about, but think about it, this is the mind set that the elderly could have. As I said before, we have people call us when the machine we give them makes noise or blinks. These people freak out, like they may have done something wrong and broken their software. They don't want to cause trouble.

 

Here’s the thing, they shouldn't feel like they did cause trouble. They should have been taught how the technology they have been given will help them and how to use it in the first place.

 

In this instance, the technology is a simple push button system that asks questions you can respond with yes or no to. When the system has questions for you, it flashes on and off and beeps.

 

That's the part that scares the client. How do you get around this?

 

Let me remind you of the three points that needed to be addressed in last weeks medical software post “The Age Old Problem – Baby Boomers”:

 

“The next big thing that needs to occur with using technology to help the elderly is that the people introducing the technology need to A) be very comfortable with using it B) be able to explain what the technology does in an easy to understand way and C) reassure that the technology is there for to care for the elder.”

 

When you are introducing the system to the client, show this happening to the client and have them do a test question and answer before you leave. This takes care of point B in my previous medical software post. You need to show a client EVERYTHING that the technology can do for that client, and let the client try it out for themselves, while you are there.

 

But before you do that, you need to reassure the patient that this system is useful to the client, and list the benefits of using it to them. This is part C of my previous medical software post. If you can't explain WHY you are making the client use the system, then they shouldn't be using it. It is that simple. When people know the system is good for them, they are more likely to use it.

 

Which leaves me with point A - making sure the person introducing the software to a client is comfortable with it. This one point impacts everything else, and is the only one that tech guys can do anything about.

 

You won't be the one going out and introducing the system, it'll be either a salesperson or someone else. In our case it's a nurse. So your ability to train other people to use the system is the most important step of all. Basically you need to run through the two other points I talked about above, and do it perfectly, because you are selling the idea of "software can help people" to them. If they don't buy it, neither will your clients.

 

So, when teaching the elderly how to use software:

 

• Make it as simple as you can, and keep in mind ailments the elderly could have that could impair their abilities.
• Go through everything a system does, and do it in great detail.
• Sell the system, and why it will make the client's life easier.

 

Hope that helps. Let me know if you have anything you want to add.

The Age Old Problem - Baby Boomers

While everyone on wall street is crying about the mess they got themselves into, there's a bigger, closer to your home problem on the horizion which, with enough foresight, can be avoided.

This problem could mean you are turned out from an emergency ward when you need treatment for a life threatening disease, you might not get medication you need for a chronic illness, and (like what is happening in america already) you might not even get access to a doctor for 2 years!

So what is this problem? Baby boomers.

The baby boomer generation has been the most influencial generation of the last century. They were the hippys in the 60's, the disco of the 70's, and the greedy business person of the 80's. And they will not be denied.

The population is getting older, and this means that medicine and healthcare needs to get more efficient.

The problem lies in the way things have become more efficient in the past 20 years. By and large, things have become more efficient through technology. Which scares most people currently over 70.

Our clients are scared and bewildered by the machines we give them to track their body measurements. We could do so much more to help them with the machines we have, but we tried it once and they hated it.

So software developers need to ensure that any software or hardware that people need to use for their health is extremely usable. I'm talking about being easier to use than Apples stuff, as people seem to have trouble using things as simple as the browser on an Iphone. We also need to take the needs of the elderly into account when developing. For instance, when people start to go blind, yellow is the first color that people are unable to see. Which is bad for us, as the hardware we use to monitor our patients uses yellow as its background color.

The next big thing that needs to occur with using technology to help the elderly is that the people introducing the technology need to A) be very comfortable with using it B) be able to explain what the technology does in an easy to understand way and C) reassure that the technology is there for to care for the elder.

How do you do that? That's a problem I'll be tackling in my medical software post next week.