healthcare technology

NEW RESEARCH SHOWS DECEPTION MAY NOT BE NECESSARY FOR THE PLACEBO EFFECT

 

Daniel Jacobs believes in the placebo effect, the well-documented but not well-understood phenomenon in which sick patients sometimes feel the same healing effects from swallowing a sugar pill that...

 

That’s the basis of his startup, Placebo Effect, which is raising $50,000 through the crowdfunding site Indiegogo to build his prototype into an iPhone app that he says can harness the placebo effect in order to help people make positive changes in their lives, such as feeling happier or quitting smoking.

 

The app offers a variety of "placebos," including images of a pill, a magic wand, a communion wafer, and other options. "Placebo pills are actually chosen often. About 12 percent of people in our testing choose pills," he said. "The reason for that probably is that in our society, we feel that pills work really well."

 

He’s done limited testing with good results, he said, and plans to do more. So far, 39 people self-reported an average of 31 percent increase in the effect they were trying to create in their lives, for example joy, energy, physical healing, or love, after one use. Seven users reported no change, and one person reported a negative change and did not complete the trial.

Jacobs’ idea may sound a bit bogus, especially since it is widely believed that the placebo effect only works if the patient believes he or she is taking a real treatment. This perceived need for deception is part of the reason doctors don’t prescribe placebos, despite the fact that they can occasionally work as well as FDA-approved treatments for some conditions.

 

 

 

We've seen a few interesting apps built specifically for Google's new headset but, to our knowledge MedRef for Glass is the first that recognize people's faces.

 

The basic functions aren't anything terribly ground breaking: you can create and search patient files, and even add voice or photo notes. What makes Lance Nanek'screation unique is its support for facial recognition. A user can snap a picture of a subject and upload it to the cloud, where it will search patient records for a match using the Betaface API.

 

All of this can be done, relatively hands-free leaving a doctors well-trained mitts available to perform other necessary medical duties. There's still a lot of work to do, and Nanek hopes that with more powerful hardware the facial recognition feature could be left running constantly, removing the need to snap and upload photos. In the meantime, if you're one of the lucky few to have an Explorer edition of Google Glass you can install the package at the source link. Otherwise, you'll have to make do with the demo video after the break.

  

I can envision apps helping patients and families manage a medical care plan.

 

if I were asked “Why should a clinician prescribe an app?” I would answer as follows:

 

Because it’s likely to help the patient reach his or her most important health goals, and is a good fit within an over-arching medical management plan.

 

In other words, if the goal is to provide sensible medical assistance to patients and families, the use of an app should be likely to:

 

Help a patient work towards the most important medical goals.This means clinician and patient should’ve discussed goals overall, and prioritized which issues are most important for the time being. Since I take care of complex older patients, prioritizing issues is really a must, and then we can set certain goals for the issues we’ve decided to focus on.Be likely to provide benefit or otherwise be clinically useful.This doesn’t mean we always need peer-reviewed studies demonstrating that use of this particular app provided a health benefit.

 

But there should be some reason to believe using an app will be clinically useful.This could be because the app facilitates collection of data needed to revise the treatment plan, i.e. documents pain, incontinence, sleep patterns, as-needed medication use, etc.Or it could be that the app digitally guides patients through an intervention previously found to be beneficial, such as a home exercise plan.

 

As with the prescription of a drug, recommending an app should include guidance as to what benefit the patient can expect, as well as a plan for ensuring that the app is delivering benefit as expected.Be a good, feasible fit within an overall management plan.Just as I don’t prescribe a medication in isolation, without considering the patient’s other medical conditions and other prescriptions, I wouldn’t recommend an app in isolation.I find that most patients and families have only so much bandwidth available for daily healthcare management tasks.

 

So in considering an app I’d also try to be mindful of how many other apps have been recommended, and I’d try to work out an overall plan that was going to be manageable for the patient. After all, there is only so much futzingwith devices that one can do in a given day.

What is person-centred eHealth?

 

Does the wording imply that ehealth in general is not person-centred. Well. To elaborate these questions further, I need to make some assumption and define what I mean by person-centred care and eHealth. 

 

Ehealth is according to  Eysenbach et al (2001) ” an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology”.

EHealth is not a technical solutions per se, it is also a state of mind and attitude about how we want to communicate and in that sense it could be a good tool in providing support for PCC. 

The core in my exposition is grounded on the definition of PCC found within GPCC. I have already discussed this in my previous blogs, and will for the matter of simplicity call it gPCC (Gothenburg person-centred care approach). The most central aspect in gPCC is the mutual acceptance that a person always is intradependent of the other person. At the core of the definition is the concept of partnership.

The juridical meaning of the word is that two persons reach an written or verbal agreement (contract) to perform certain commitments. Within the gPCC approach, this agreement would be manifested by a health and care plan that is agreed upon by all involved stakeholders.  So partnership needs at least two people that agree upon a certain approach in order to reach a certain outcomes.

Mobile health applications represent the next stage of patient empowerment. 30 years ago, patients received information and procedures from their physicians, often without instruction. Now, the smartphone physical empowers patients to identify, understand, and manage their own health on a completely new level. This offers critical implications for the future of medicine:

 

1. Patient Engagement: It’s probable that the physical act of regularly checking blood pressure or measuring blood sugar levels can make a patient more conscious about their health. It’s also hopeful that such self-tracking can inspire self-education and positive behavior change. This is difficult to measure experimentally (have you ever noticed that the most avid quantified self-ers are the fittest and healthiest people?) but it offers reason to be optimistic about mHealth.

 

2. Remote Care: A critical challenge of hospital readmissions is that, once the patient walks out the door, it’s no easy endeavor to reconnect with them. If physicians could remotely monitor patients, it’s possible they could identify early signs of a complication and intervene. As a readmissions researcher, I’ve spoken with patients who waited for three weeks of not being able to eat before returning to the hospital 30 pounds lighter. The smartphone physical could have flagged that—and someday, it will.

 

3. The Doctor’s Role: This is the big question, and it’s a loaded one. How will physicians interpret and process the information overload that follows such complete self-quantification? How will electronic health records and/or personal health records adapt to meaningfully consolidate, analyze, and present all this data? How does the patient’s ability to self-educate, self-diagnose, and (perhaps eventually) self-treat change the purpose and significance of the doctor-patient relationship? At Millennial Medicine, Dr. Eric Topol presented these mHealth innovations and said, “With this, why would you want to go to the hospital?” Good question — Will patients still want, or need, to interact with their doctors?

 

These are ambitious goals, but with the advances I’ve seen in this video as well as other seminal achievements made in mHealth and digital medicine recently, I’m optimistic that they are all entirely doable. I’m also conscious of how often I’ve used the word “possible” in this reflection and how scarcely I’ve said “proven.” It simply speaks to the fact that we’re faced with inspiring technical capabilities that offer tremendous hope; the challenge now falls to tomorrow’s physicians and scholars to innovate, research, and troubleshoot to bring these ambitions to realization.

 

 

As doctors and scientists continue to make huge leaps in terms of genome sequencing and scanning devices, everything about your medical treatment is going to change.

 

As a child, you could always count on it, even after--especially after--you struck out playing T-ball, forgot your only line in the grade school play, and came home with chalk in your nose because you took the schoolyard dare. No matter what, your mom would hug you and tell you that you were special. Turns out, she was right.

 

Each of us is special and unique among the roughly 7 billion humans on this planet. We are the walking, talking instantiation of the 3 billion instances of four nucleotides (abbreviated GATC) that constitute our unique genome’s DNA. Equally important, the interplay of that DNA with the environment and our individual lifestyles determines our susceptibility and predisposition to diseases.

 

Suppose you’re now middle aged and chest pains send you to a physician. You can’t change your genetic profile; it’s your parents most basic and lasting gift. However, that fondness for double bacon cheeseburgers and butter pecan ice cream, and an exercise regime that is all-too-frequently limited to wistful looks at the running shoes in your closet, both have consequences. That’s why your mother also warned you to eat your vegetables and wash your hands, not that you listened.

Nearly three-quarters of physicians in the United States are using their smartphones at work, according to a March 2013 survey conducted by ad agency WPP’s Kantar Media.

 

The survey of more than 3,000 physicians representing 21 specialties found that 74 percent said they were using their smartphones for professional purposes. The 2012 study found that about 68 percent of physicians were using their smartphones at work and 64 percent were in 2011.

About 38 percent of those physicians surveyed said they use both their smartphone and tablet for their jobs, too.

 

Kantar found that 43 percent of all physicians surveyed reported that they look up reference drug data on their smartphones, which marks a 13 percent increase over last year’s survey results. The survey also found that 39 percent of all physicians surveyed said they use their smartphones to find and perform clinical calculations, which marked a 4 percent increase over last year.

 

Finally, about 31 percent of all physicians said they made prescribing decisions from their smartphones, up from about 21 percent last year.

 

Manhattan Research recently announced results from its annual survey of trends in physician technology adoption: It found 72 percent of physicians in the US now have tablets — that’s up from about 30 percent of physicians toting tablets in 2011.

 

 

The Motley Fool - Apple's impact on health care has been nothing short of revolutionary. Here's why.

 

Apple didn't necessarily intend to revolutionize health care, but that's exactly what happened. Health care has changed dramatically since Steve Jobs first stood in front of an audience to introduce first the iPhone then later the iPad. Much of that change can be directly attributed to Apple.

Apples and doctors

It used to be said that an apple a day keeps the doctor away. That could still be applicable, but the opposite is true for doctors and Apple. Physicians love their iPhones and iPads.

 

A study by Manhattan Research in 2011 found that 75% of physicians owned at least one Apple product. Vitera Healthcare's 2012 survey of health-care professionals backed up this high number. The company's study found that 60% of respondents used an iPhone and 45% owned an iPad.

 

The real revolution, though, has come from how physicians and other health-care professionals are using Apple's devices. Mobile applications opened the door for clinicians to instantly access a world of medical information at the point of care.

iPatients

Apple perhaps unwittingly opened new horizons for patients also. By April 2012, the company's App Store included more than 13,600 health-related applications.

 

A peek at some of the current top-selling apps shows how much Apple's technology has empowered patients. One application allows individuals to monitor their sleep cycles. Another provides a detailed guide to help expectant mothers through their pregnancies.

Smart cards will allow each one of us to carry around our own health care information in our wallet or purse.

 

The smart card has been around for a few decades and is in wide use in Germany, France, Taiwan and several other countries.  Biometrics and other security measures have been developed to comply with patient privacy regulations.  The VA  is using asmart card system successfully.  Other health smart card companies have begun to compete for this potentially large market.

 

There are state wide and even nation wide efforts to have registries for advance directives and POLST forms in order to make them available on an emergent basis.  But we are a mobile society. Individual state registries become redundant, expensive, and hard to maintain.  Oregon has the most advanced state registry but that is just one state.  Smart cards will allow each one of us to carry around our own health care information in our wallet or purse.  Privacy can be protected with use of a thumbprint.  Secure readers can be portable.

 

A range of diseases and conditions, from asthma to liver disease, could be diagnosed and monitored quickly and painlessly just by breathing, using gas sensing technology developed by a Cambridge spin-out.

 

The highly sensitive, low-power, low-cost infrared emitter developed by Cambridge CMOS Sensors (CCMOSS) is capable of identifying more than 35 biomarkers present in exhaled breath in concentrations as low as one part per million, and is being developed for use as a non-invasive medical testing device and other applications.

 

In addition to nitrogen, oxygen and carbon dioxide, we exhale thousands of chemical compounds with every breath: elevated acetone levels in the breath can indicate poorly-controlled diabetes, asthmatics will exhale higher than normal levels of nitric oxide, and glucose is a sign of kidney failure.

Digital health may be garnering all the glory for its promise to transform health care, but take a closer look and you’ll find a promising next wave of health care investments.

 

With a proliferation of mobile apps and data being generated at a dizzying pace, few investments have yet to fulfill their financial promise. The real money will be made when companies build services around these applications, make the data actionable, and connect all this inbound patient data to the physical health care system.

 

Expect companies that find new, creative ways of connecting data to patients, determine what to do with the data when it’s generated, and figure out ways to creatively (and profitably) engage the health care system, to attract the attention of VCs and entrepreneurs alike. Here are three areas worth watching

Smart Sensors

 

Software Systems for Data Analysis

 

New Service Models for Patients

 

Everything that can be done digitally and virtually will be done digitally and virtually. This will dramatically improve access to and efficiency of the traditional health care system. Call centers will be staffed not just by the traditional nurse, but also by physicians, pharmacists and other professionals who can provide a higher level of care.

 

Tool makes it easy to search for health providers who are active in the Medicare prescription drug program.

 

 What’s the purpose of Prescriber Checkup?

A. We’ve made it easy to search for doctors and other health providers who are active in Medicare’s prescription drug program, called Part D. You can find out how many prescriptions each wrote and which drugs were prescribed. You can compare your doctor with others in his or her specialty and state. And you can check out the drugs you are taking or any that your doctor recommends.

 

Is this new information?

Until now, the identities of doctors and which drugs they prescribed in Medicare Part D have not been public. ProPublica obtained the data under the Freedom of Information Act and investigated prescribing patterns. We are making the data available to help consumers stay informed.

How can today's mobile technology make a difference? Put simply, by giving staff the right information and tools to do their job, in any place, at any time.

 

Of course, many staff are already ‘mobile workers’, moving between wards and outpatient clinics on different sites or treating patients at home or in GP surgeries. Yet current approaches to mobile working are often highly inefficient. What health boards need to do is to ‘mobilise’ each healthcare professional's entire job, using the latest generation of mobile solutions. These overcome issues of limited and clumsy web-based access to existing back-office systems by providing native smartphone and tablet apps that draw together the information and tools staff need to support them as they work.

 

No unnecessary visits ‘back to base’

 

If we look at the typical working day of a community nurse, we can see how it will change when mobile technology is used to mobilise their entire job.

Using traditional IT solutions, a community nurse will typically begin their day by travelling to their ‘base’ at a hospital health centre for a team meeting and to plan their day's schedule. Then they need to make sure they have gathered all the patient records and other documents they will need during the day, before finally heading out for their first visit.

 

With the latest generation of mobile solutions to support them, the nurse does not need to travel to the office. They can simply log on to an app on their smartphone from home and get access to all the information they need for the day's visits, from lists of appointments and tasks to comprehensive electronic patient records, including results, photographs and x-rays. They have saved both time and the cost of an unnecessary journey in to the office thanks to a smartphone app.

 

Patient records at your fingertips

 

Maybe it's the nurse’s first visit to this patient. Traditionally, they will dig out a map, wrestle with a personal Satellite Navigation, or have to stop and ask for directions. The smartphone app shows the location of the next visit and works out the best route for all visits for the day reducing carbon footprint and maximising travel time.

 

Then, while they are with the patient, they will need to keep a record of any care given, chart any readings and note any other changes in the patient's condition. With the traditional approach, they would have two options: they might take notes on paper, which would need to be entered into the records later, taking more of their time away from patient care – and probably requiring another trip to their ‘base’. Or they might boot up their laptop and key in the data there and then, a process that healthcare professionals report often puts a barrier between them and patients.

 

With an app-based solution, however, our nurses can capture all the information they need with a few taps on their smartphone's touchscreen, whilst still talking naturally with patients and their carers. They can even snap a photograph of the current state of a wound for example that can be immediately added to the patient record.

 

With the right mobile technology, they also do not have to worry about whether or not they have a signal, or about driving around until they find one: they can enter the data while they are still with the patient, even if they do not have a signal, confident the information will be synched automatically when their smartphone next connects. There is certainly no need to return to the office at midday or the end of the day to update records and complete paperwork. Even their mileage, expenses or requests for supplies can be entered through the app.

 

Double-amputee Jason Koger used to fly hundreds of miles to visit a clinician when he wanted to adjust the grips on his bionic hands.

 

Now, he’s got an app.

 

Koger came to Philadelphia this week to demonstrate the i-limb ultra revolution, a prosthetic developed by the British firm Touch Bionics. Using a stylus and an iPhone, Koger can choose any of 24 grip patterns that best suit his needs.

 

The previous version of Koger’s myoelectric device required programming by a prosthetist, meaning Koger had to fly to Advanced Arm Dynamics in Dallas. The prosthetist would work with Koger to pick a few grip patterns — such as pinching, pointing or shaking hands — to program into the i-limb.

 

Yet sometimes Koger would get home and realize they weren't the ones he needed. Now, the latest i-limb comes with iPhone or iPad app that allows Koger to reprogram his hand with the touch of a stylus. On Thursday, he demonstrated by gripping an orange, a baseball and a can of soda.

 The i-limb allows fingers and thumbs move independently to conform around certain objects, said Ryan Spill, a prosthetist for Advanced Arm Dynamics' new office in Philadelphia, who is working with Koger. The thumb is also motorized, not passive, as in previous prostheses.

For a new generation of patients, could the laptop — or even cellphone — replace the stereotypical shrink’s couch? A crop of new startups wants to take psychotherapy into the 21st century.

 

About one in five Americans will experience a mental health challenge during their lifetime, according to the Substance Abuse and Mental Health Association. But experts say that 60 percent of them will never seek help. The lack of available care, inconvenience and cost are all barriers to access, but so is the fear of prejudice and discrimination from friends, family and even employers.

 

“Stigma and shame is a huge factor – maybe the most important one,” said Oren Frank, founder of mental health startup Talktala. “People who have been to regular therapy are less ashamed of it, but people who are newcomers are paralyzed by fear.”

 

Online options enable people to receive therapy on their own turf and terms, without needing to update others on their whereabouts – and they offer the benefit of anonymity.

The Jawbone UP fitness tracker is a lot more useful now that Jawbone has opened the API to third-party developers. One of the most exciting companies tapping into the UP platform is online automation tool, IFTTT. In the article below, I will talk a little bit about connecting your UP to IFTTT and then list some of my favorite recipes.

 

IFTTT is an automation tool that allows you to setup tasks that happen at a certain time or in response to a certain event. It uses a trigger event ("If this happens") to initiate an action ("then do that"). Within the IFTTT framework, you create what are called recipes to select the trigger event and its resulting action. For example, you can create a recipe that uses a date/time trigger to send you an email at the same time each day.

 

 

Some FTTT recipes for the UP.

See the big picture of how you sleep. Track your Zzz's with a spreadsheet!

If I get more than X hours of sleep, set my mood to 'energized' in my Jawbone UP feed

Share Foursquare gym check-ins to your Jawbone UP feed

Log my UP meals and their nutritional content into a Google spreadsheet

Send your spouse a friendly email when you get below 7 hours of sleep

Tweet when I walk more than 10,000 steps

Remind me if I don't work out for 3 days

If I get less than 5 hours of sleep, put on a pot o' coffee with WeMo

#sunshine brings better #mood

Tag an Instagram photo with #UP to share it with your team

There are now 110 recipes on IFTTT for the UP and this number is climbing. If you have an UP, let us know in the comments if you use it with IFTTT.

 

 

1. The integration must take into account each user’s day-to-day life and workflow, including patients, providers, IT staff, and additional caregivers. Some users will need access to a greater depth of information, while for others design and usability will be paramount.

 

2. The design should be interoperable and support the integration of multiple MITs into a single EHR. In particular, developers should make sure to eliminate redundancies between the systems, where app users and EHR users might enter the same data into different fields.

 

3. Multiple environments have to be secure, but their security can’t keep them from interacting with each other. Stakeholders WellDoc interviewed reported problems with competing firewalls in implementing the integration.

 

4. Both halves of the integration, but especially the patient-facing app, should work natively on as many mobile devices as possible. Patients are most likely to use a system that allows them to continue using their device.

 

5. The mobile health offering is subject to a limitation already standard for EHR apps: it must be able to run even when network connectivity is sparse or intermittent, as is sometimes the case in large hospital complexes.

 

6. It’s crucial to have a support team in place familiar with the technology  to help acquaint users with it.

 

7. Make sure the two systems adhere to common standards. Not only data interchange standards like HL7, but also making sure that measurements in both systems use the same units. If lab-collected blood glucose data in the EHR and patient-collected blood glucose data have the same unit, but one is potentially more accurate, the integrated system should easily identify and distinguish the two.

 

8. The team working on an integration should be ready for a more complex process than anticipated. A clear vision, good communication, and a steering committee are important for anyone attempting to integrate a mobile heath offering and an EHR.

Manufacturers are still not putting security first when designing implantable medical devices

 

A few million people probably first thought about the security of pacemakers and other implantable medical devices last December when watching the TV show “Homeland.” The character of Nick Brody contributes to an electronic attack on the pacemaker of the U.S. vice president. The pacemaker is made to fail once the attackers get some key security information from Brody.

 

Certainly, ever since the first pacemaker implants of the 1960s, biomedical engineers have made remarkable strides with implantable medical devices. IMDs, as they’re called, are delivering painkillers and insulin at proper rates; they’re measuring our vital signs and reporting them to doctors and nurses; and, of course, they’re still making sure our hearts beat as steadily as metronomes.

 

But these devices are essentially embedded computers, and with computers come questions of hardware and software security.

 

Is there are doctor in the car? It’s highly unlikely, but with the advent of digital health applications and monitoring systems, the day of the diagnostic dashboard doctor may not be too far off.

 

Ford’s SYNC voice-activated technology embodied in its latest Fiesta is in the vanguard of these developments. SYNC allows drivers to access their smartphone applications on the move using voice control – the apps are displayed on a dashboard screen.

 

A growing number of those apps are to do with health. Last year, medical and healthcare was the third fastest-growing application category, with more than 17,000 available and, according to a Frost and Sullivan report, the market is expected to be worth $392 million (£243.4 million) by 2015, with more than 500 million users.

 

The first commercial SYNC health application went live early last year, via the Apple Store, with an air-pollution, asthma-alert and pollen-alert apps.

An electronic patch can analyse complex brainwaves and listen in on a fetus's heart MIND reading can be as simple as slapping a sticker on your forehead.

 

An "electronic tattoo" containing flexible electronic circuits can now record some complex brain activity as accurately as an EEG. The tattoo could also provide a cheap way to monitor a developing fetus. The first electronic tattoo appeared in 2011, when Todd Coleman at the University of California, San Diego, and colleagues designed a transparent patch containing electronic circuits as thin as a human hairMovie Camera.

 

Applied to skin like a temporary tattoo, these could be used to monitor electrophysiological signals associated with the heart and muscles, as well as rudimentary brain activity. To improve its usefulness, Coleman's group has now optimised the placement of the electrodes to pick up more complex brainwaves.

 

They have demonstrated this by monitoring so-called P300 signals in the forebrain. These appear when you pay attention to a stimulus. The team showed volunteers a series of images and asked them to keep track of how many times a certain object appeared. Whenever volunteers noticed the object, the tattoo registered a blip in the P300 signal. The tattoo was as good as conventional EEG at telling whether a person was looking at the target image or another stimulus, the team told a recent Cognitive Neuroscience Society meeting in San Francisco.

 

The team is now modifying the tattoo to transmit data wirelessly to a smartphone, Coleman says. Eventually, he hopes the device could identify other complex patterns of brain activity, such as those that might be used to control a prosthetic limb.

Consumer health IT can dramatically impact patient care by facilitating such vital functions as medication management, remote patient monitoring, and tighter communication between patients and their care providers. The guide is particularly timely because in the next few years, health care providers will focus as never before on electronic linkages with their patients. Many hospitals and health systems have patient portals on the Internet, with access to rudimentary health record information, and perhaps the ability to e-mail physicians. Some offer mobile versions of those portals. But providers have so far been under no outside pressure to get patients to use those resources.

 

Patient-oriented health IT is officially on the national agenda through the federal “meaningful use” program, which gives billions in cash incentives to providers for using IT to improve care (and in 2015 is scheduled to start penalizing holdouts by reducing their Medicare payments). The most recent set of criteria for meaningful use, to be phased in starting in 2014, requires an active effort to link patients into the information loop. Not only do providers have to make patients’ information available to them online, they also have to show that at least 5% of the patients have accessed that information in a given year. That percentage is likely to increase with the next round of meaningful use requirements.