These are the slides from my talk at the 4th Annual Putting Patients First Conference in Mumbai.
If god were to manifest the world using technology, he would first create something like social media. Conceptually provide technology with the ability to understand the thoughts of a population
SocMed leaves behind the old model of 1-to-1 communication – “talking to someone over the phone” Enables one-to-many communication (via blogs or microblogging) or many-to-many communication (discussion forums, social walls). Now anyone can setup an online community site/portal to represent a small or big offline community.
Further, anyone can setup an online site related to a treatment, a disease, a doctor, a drug , a concept or anything and see it grow into a popular site which in effect is simply the manifestation of a community which exists/ed but which no one ever knew of.
Deep in the back offices of Silicon Valley startups and stalwarts, you won’t commonly encounter phrases like "automotive IT" or "plastic injection molding IT" – yet all through the healthcare industry, such vague-almost-to-the-point-of-confusing terms pepper the conversation.
The most egregious example, indeed, is "health IT". Is health IT just an EHR or even the market brimming with so many electronic health records systems and modules? No. Realistically, health IT comprises any number of the technologies, whether it’s low-cost practice management services in the cloud or big, iron-bound database management systems that huge health networks plunk down tens of millions of dollars to acquire and run themselves.
Every day we talk about health IT almost as if it is one single simple solution, rather than all the technologies taken together that a hospital needs to survive, if not thrive.
A fundamental question about any (Clinical Decision Support System) CDS is just how good is it, i.e. does it get the right answer for generic and specific patients? If it doesn’t this may be the result of one or more issues such as flawed information having been used to build the system, flawed programming, or the patient being outside of an often undefined or ill defined population when for another population the CDS does actually provide the right answer
A common CDS disclaimer is that it is always up to the practitioner to second guess the CDS as necessary, or in other words, the CDS is not actually supposed to be relied upon. Depending on the complexity of the underlying theory and data, the practitioner may or may not in reality have the ability to do this, or they may not have a more rational basis for doing so than “I don’t think that is right”. Such a conclusion would put the practitioner outside of what might be considered a practice guideline. On the other hand if a CDS is easy to second guess, then it might not be very valuable in the first place.
In this context comes the recent controversy over the new cholesterol and statin on line “risk calculator”. As first reported in the New York Times, it was determined that an online risk calculator overestimated patient specific risk by an average of 100% (100 here is not a typo). If action were based on this erroneous calculator, statin therapy would be substantially over-prescribed. In this regard the Times cites a statement from the organizations that published the guidelines that will continue to be a CDS classic: patients and doctors should discuss treatment options rather than blindly follow a calculator. Or, in other words, it is not to be relied on.
Apparently the problem with the risk calculator is at least in part that the risk data on which it was based was decades old and therefore did not apply to the current US population which in at least some ways has actually gotten healthier. In addition the mathematical model used was one of linearly increasing risk which has not been demonstrated to be correct. Thus the flaws in the calculator were a result of the inappropriateness and lack of justification of the knowledge bases used to build it. Despite these fundamental issues, no plans to remove or revise the calculator were identified.
This risk calculator was not imbedded within an EHR, and it requires manual input of multiple patient parameters. And of course there are additional potentially relevant patient parameters that are not part of the calculation. However something like this certainly could be part of an EHR either by direct integration, or by pointing the EHR user to it and perhaps automatically using relevant patient information that might already be in the EHR.
Toilets have been toileting for hundreds of years without the slightest bit of disruption, minus the phasing out of the bidet. As such, the elimination industry is ripe for an app or gadget to make it more ergonomically friendly.
The Wellbeing Toilet, won a contest for potty design in the U.K. Could this be the thing that changes bowel movements forever?
Let’s review the facts: the toilet is “a hybrid,” rather than “a true squat toilet,” Fast Co. Exist reports:
“… you step up on the toilet, and as you bring your legs up, you lean into the correct angle. It’s similar to hybrids such as the Anglo-Indian toilet still used in India (and inside ancient Russian trains), which allow for both sitting and squatting, depending on preference.”
Mmkay. It also analyzes your pee, so it can tell you if you need to be checked for diabetes or kidney disease, nutritional defects or (shudder) pregnancy. Is this the apparatus that will take a dump on Big Toilet once and for all? Guess we’ll have to sit tight on that.
So we’ve all heard the varied stories on these; some people love these things and other think they are not much different from a classic old-style blood pressure device. We wanted to write up a few thoughts on where the value of these things lies. And if you are hypertensive, pre-hypertensive of just want to be proactive about your health/genetic predisposition then read on. It’s not just a price comparison, that would be an apples-and-oranges comparison. In this case, apples and giraffes because they are that different!
There’s a lot of value in a smart blood pressure monitor and it’s not really but is beyond the single measurement, it’s about the long term trend collection.
Here are some real life points to illustrate the point.
1) The value is in the long-term trend data… your own or a family member’s
2) Reducing inaccuracies by relying on doctors’ offices or one off measurements.
Hands-free devices like Google Glass can be really transformative when the hands they free are those of a surgeon. And leading hospitals, including Stanford and the University of California at San Francisco, are beginning to use Glass in the operating room.
In October, UCSF’s Pierre Theodore, a cardiothoracic surgeon, became the first doctor in the United States to obtain Institutional Review Board approval to use the device to assist him during surgery. Theodore pre-loads onto Glass the scans of images of the patient taken just before surgery and consults them during the operation.
“To be able to have those X-rays directly in your field without having to leave the operating room or to log on to another system elsewhere, or to turn yourself away from the patient in order to divert your attention, is very helpful in terms of maintaining your attention where it should be, which is on the patient 100 percent of the time,” said Theodore.
A Stanford-affiliated startup calledVitalMedicals is developing a system that would automate doctors’ access to patient images and medical records using Glass by syncing them automatically via Wi-Fi. VitalMedicals’ debut app, VitalStream, sends live vital signsand alarms to the operating surgeon’s Glass device during conscious sedation. It gets the vital signs from its integration with the ViSi mobile vital sign monitor
VitalMedicals is working on a second app, SurgStream, which displays the pre-surgical images and streams live fluoroscopy, ultrasound and endoscopy videoto Glass or a tablet.
The projects, which emerged from Google’s early outreach to developers to create apps for Glass, are still in their earliest stages and still have time to iron out the bugs. And with many doctors interested in applications for the wearable interface, Glass is likely to spread quickly when they do.
At the Society for Neuroscience meeting earlier this month in San Diego, California, Science sat down with Geoffrey Ling, deputy director of the Defense Sciences Office at the Defense Advanced Research Projects Agency (DARPA), to discuss the agency’s plans for the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, a neuroscience research effort put forth by President Barack Obama earlier this year.
So far, DARPA has released two calls for grant applications, with at least one more likely:
The first, calledSUBNETS (Systems-Based Neurotechnology for Emerging Therapies), asks researchers to develop novel, wireless devices, such as deep brain stimulators, that can cure neurological disorders such as posttraumatic stress (PTS), major depression, and chronic pain.
The second,RAM (Restoring Active Memory), calls for a separate wireless device that repairs brain damage and restores memory loss.
For decades, drug development was mostly a game of trial and error, with brute-force candidate screens throwing up millions more duds than winners. Researchers are now using computers to get a head start. By analysing the chemical structure of a drug, they can see if it is likely to bind to, or ‘dock’ with, a biological target such as a protein. Such algorithms are particularly useful for finding potentially toxic side effects that may come from unintended dockings to structurally similar, but untargeted, proteins.
Last week, researchers presented a computational effort that assesses billions of potential dockings on the basis of drug and protein information held in public databases. The result, a website called Drugable (drugable.com) that is backed by the US National Library of Medicine (NLM), is still in testing, but it will eventually be available for free, allowing researchers to predict how and where a compound might work in the body, purely on the basis of chemical structure
Television viewers could soon taste the food produced by celebrity chefs on cookery programmes thanks to new technology that recreates taste electronically
A team from the National University of Singapore says it has developed a "digital taste simulator." Called the Digital Taste Interface, the device has silver electrodes that deliver current and heat to the tongue -- tricking your taste buds into thinking they've just encountered something tasty.
It uses electrodes to stimulate the taste buds on the tongue to reproduce salt, sweet, sour and bitter sensations.
The Digital State Interface also uses subtle changes in temperature to alter the taste experience.
The researchers hope that the system could eventually be used to allow television viewers to experience tastes while they are watching their favourite programmes.
Dr Nimesha Ranasinghe, an engineer at the National University of Singapore, said it could also be used in computer games or to allow people to share meals over the internet.
His team are also working on a digital lollipop that can produce all the sweet enjoyment of a real piece of confectionery but without the harm to teeth or risk of putting on weight.
He said: “Digital taste is a technology for digitally simulating the sensation of taste.
"It uses two methods - electrical stimulation and thermal stimulation to stimulate the tip of the human tongue non-invasively in order to produce primary taste sensations such as salty, sour, sweet, bitter.
"By manipulating the magnitude of current, frequency, and temperature - both heating and cooling - thus far salty, sour, and bitter sensations have been successfully generated.
"Simulating food is one of the future directions of this technology."
New tools for analyzing genes are allowing doctors to personalize treatment for some lung cancer patients.
Imagine your doctor being able to scan your DNA from a biopsy and pinpoint the medicine that will work best for you. This type of high-tech approach is a clinical reality for advanced lung cancer at The Ohio State Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).
The technology, known as next generation "multiplex" gene sequencing, analyzes 50-plus genes in DNA extracted from a tumor biopsy for particular genetic mutations.
Previous technology required pathologists to analyze one mutation per tube in a sequencing reaction, but next-generation genome sequencing assesses more than 2,500 mutations in a single reaction.
Knowing which mutations are present in lung tumors can help doctors tailor a patient's treatment to the unique genetic features present in his or her cancer cells.
The knowledge can also help in the development of new drugs that target previously unrecognized gene mutations in lung tumors. I often compare these genes to the gas pedal in a car — when activated, these genes make the cancer grow. By breaking the linkage between the gas pedal and the motor (or interfering with these "driver" mutations) with specific targeted drugs, doctors can stop this growth and often make the cancer shrink.
That's especially important in lung cancer because the majority of patients with this disease are diagnosed in the later stages, meaning it's important to start effective therapies quickly.
For example, a patient could be given a standard chemotherapy and expect a 25- to 30- percent response rate/shrinkage of a tumor. But if the treatment team knows that a patient has a mutation in a gene called EGFR, we can offer him or her a pill (erlotinib and afatinib are approved for this use in the United States), which has a 75-percent response rate and fewer side effects.
Gene sequencing is now considered the standard of care for stage-4 lung cancer patients at The OSUCCC – James and a handful of other centers across the United States — and several clinical trials evaluating molecular targeted therapies for patients with stage-3 lung cancers will soon start at The OSUCCC – James.
Lung cancer remains the number one cause of cancer death in the United States, and in the world, among both men and women. More than 200,000 cases are diagnosed annually in the United States. Each year during the month of November, physicians and others observe lung cancer awareness month, which sheds light on this terrible disease.
New health-care smartphone apps for doctors and patients help with everything from diagnostics and monitoring to revealing who isn't washing their hands.
Mobile apps for smartphones and tablets are changing the way doctors and patients approach health care. Many are designed for the doctors themselves, ranging from handy databases about drugs and diseases to sophisticated monitors that read a person's blood pressure, glucose levels or asthma symptoms. Others are for the patients—at their doctor's recommendation—to gather diagnostic data, for example, or simply to help coordinate care, giving patients an easy way to keep track of their conditions and treatments.
Doctors say many of the apps are useful time savers, and have the potential to make health care more efficient by speeding diagnosis, improving patient monitoring and reducing unnecessary visits to a physician or hospital. Still, the field has a way to go, doctors add, particularly when it comes to making good use of all the patient data being generated.
Here are some of the apps doctors are talking about most. Some are free; others cost several hundred dollars for a year's subscription. Those that combine an app and a wireless monitor cost from $80 to $200.
EPOCRATES One of the oldest and most established medical apps, Epocrates gives doctors basic information about drugs, the right dosing for adults and children, and warnings about harmful interactions. It has replaced many a copy of the Physician's Desk Reference.
UPTODATE This app provides reference material doctors can consult when making treatment decisions. David Bates, an internist at Brigham and Women's Hospital in Boston, says he has used it recently to look up treatment approaches for patients who have failed to respond to existing hypertension therapies, and for information on the drug combinations needed to treat a bacterial infection called H. pylori.
ISABEL Every doctor needs help reaching diagnoses. Here, doctors enter symptoms, and the app lists possible diagnoses as well as medications that could cause the symptoms.
ALIVECOR This portable heart monitor and app—one of the programs that opened Dr. Topol's eyes—runs on a patient's smartphone to produce electrocardiograms. Patients place their fingers over the monitor's sensors, which wirelessly communicate with the phone to produce the EKG.
RESOLUTIONMD Doctors can look at X-rays and other images on a smartphone or tablet when they use this app. Some doctors say the app is handy for viewing images as soon as they're available, no matter where the doctor happens to be.
ISCRUB This infection-control app collects and rapidly displays data on whether hospital staff are being scrupulous about washing their hands. Most hospitals have unofficial observers of whether doctors, nurses and other staff are following hand-hygiene guidelines. Many are not.
BREAST CANCER DIAGNOSIS GUIDE Using this app, breast-cancer patients enter and track details of their disease and treatment, from the size of the tumor to the presence or absence of estrogen receptors.
CLINICAM Increasingly, doctors are using their phones to take photos of a patient's condition—such as a rash or wound—and to upload the images to the patient's electronic medical record. One problem: That could violate health-care privacy laws if the doctor leaves the photo on his or her personal phone.
Researchers uncover new ties between genetics and skin cancer by mining patients’ medical records.
Usually, studying the relationship between DNA and disease involves comparing the genomes of thousands of people with a disorder to the genomes of thousands of people who don’t. These studies can be expensive and may take years, requiring researchers to identify patients, enroll them in the study, and collect the genomic data.
A more cost-effective and speedier alternative is to mine the growing pool of genetic data in electronic medical records as reported by researchers in Nature Biotechnology.
These records chronicle a patient’s health care history, which can include physician’s notes, lab test results, and the billing codes hospitals submit to health insurance companies to receive payments.
The idea behind the new method for genetic discover is to be able to “reuse” the data in these records for medical discoveries, says Joshua Denny, a physician-scientist at Vanderbilt University School of Medicine.
To identify previously unknown relationships between disease and DNA variants, Denny and colleagues grouped around 15,000 billing codes from medical records into 1,600 disease categories. Then, the researchers looked for associations between disease categories and DNA data available in each record.
Their biggest new findings all involved skin diseases (just a coincidence, says Josh Denny, the lead author): non melanoma skin cancer and two forms of skin growths called keratosis, one of which is pre-cancerous. The team was able to validate the connection between these conditions and their associated gene variants in other patient data.
You’re one of a kind. Wouldn’t it be nice if treatments and preventive care could be designed just for you, matched to your unique set of genes?
The story of personalized medicine begins with the unique set of genes you inherited from your parents. Genes are stretches of DNA that serve as a sort of instruction manual telling your body how to make the proteins and perform the other tasks that your body needs. These genetic instructions are written in varying patterns of only 4 different chemical “letters,” or bases.
The same genes often differ slightly between people. Bases may be switched, missing, or added here and there. Most of these variations have no effect on your health. But some can create unusual proteins that might boost your risk for certain diseases. Some variants can affect how well a medicine works in your body. Or they might cause a medicine to have different side effects in you than in someone else.
The study of how genes affect the way medicines work in your body is called pharmacogenomics.
“If doctors know your genes, they can predict drug response and incorporate this information into the medical decisions they make,” says Dr. Rochelle Long, a pharmacogenomics expert at NIH.
It’s becoming more common for doctors to test for gene variants before prescribing certain drugs. For example, children with leukemia might get the TPMT gene test to help doctors choose the right dosage of medicine to prevent toxic side effects. Some HIV-infected patients are severely allergic to treatment drugs, and genetic tests can help identify who can safely take the medicines.
“By screening to know who shouldn’t get certain drugs, we can prevent life-threatening side effects,” Long says.
Pharmacogenomics is also being used for cancer treatment. Some breast cancer drugs only work in women with particular genetic variations. If testing shows patients with advanced melanoma (skin cancer) have certain variants, 2 new approved drugs can treat them.
Get to know your target market and their mobile behaviors As you’re contemplating creating a mobile health application for your patients, it’s important to really take the time to get to know your audience. At the most basic level, your target audience may consist of patients with a particular condition. For example, your healthcare business may be in the process of creating a mobile application that facilitates health management for diabetes patients.
The best mobile health strategies are backed by strong market research campaigns. Here's how you can use market research to develop effective mHealth initiatives for your patients.
Although nanomedicine is a promising area of research, scientists have been unable to figure out a way to deliver drugs using nanoparticles other than by injection, which is both distasteful and inconvenient for patients. Now, a team of researchers from MIT and Brigham and Women's Hospital (BWH) have developed a new nanoparticle that can be absorbed through the digestive tract, allowing patients to take a pill instead of receiving injections.
"If you were a patient and you had a choice, there's just no question," Professor Robert Langer, of MIT's Koch Institute for Integrative Cancer Research, stated in a press release. “Patients would always prefer drugs they can take orally.”
Ultrafine particles, or nanoparticles, are between one and 100 nanometers in size. What makes nanoparticles so interesting to scientists, particularly in the field of medicine, is the fact that the physics underlying nanoparticles means that their properties are different from the properties of the bulk material. Additionally, size and surface characteristics of nanoparticles can be manipulated. Yet, nanoparticles have not yet been available as a pill because, despite their tiny size, they are unable to penetrate the intestinal lining. This is no simple feat as the lining is made of a layer of epithelial cells that join together forming impenetrable barriers known as tight junctions.
With the increasing burden of chronic diseases, analyzing and understanding trajectories of care is essential for efficient planning and fair allocation of resources: authors Nicolas Jay, Gilles Nuemi, Maryse Gadreau and Catherine Quantin propose an approach based on mining claim data to support the exploration of trajectories of care.
A clustering of trajectories of care for breast cancer was performed with Formal Concept Analysis. We exported Data from the French national casemix system, covering all inpatient admissions in the country. Patients admitted for breast cancer surgery in 2009 were selected and their trajectory of care was recomposed with all hospitalizations occuring within one year after surgery. The main diagnoses of hospitalizations were used to produce morbidity profiles. Cumulative hospital costs were computed for each profile.
Formal Concept Analysis can be applied on claim data to produce an automatic classification of care trajectories. This flexible approach takes advantages of routinely collected data and can be used to setup cost-of-illness studies.
Microsoft Excel is like the swiss army knife for health analytics. It's a familiar and effective tool for surfacing and using almost any type of data from any sources. Learn how health organizations are using Excel as part of their overall BI strategy.
If leveraged correctly, the quantified self-movement could provide valuable patient insights as well as reduce long-term costs for healthcare brands.
But before talking about the benefits to brands, we must first understand their importance to the consumer. After all, it’s the customer (or in this case, patient), that should always come first. These products don’t just monitor activity or measure how long you’re at the gym. They allow users to connect their actions with the effect of those actions. Quantified self products engage the wearer with their lifestyle goals, stress levels and current healthcare regimens. This unprecedented awareness of one’s actions can provide insights into behaviors that are negatively affecting health.
To get a better sense of this feedback loop between measurement and behavior change lets look at a few examples of quantified self products.
Lift is the generalist of quantified self applications. It focuses on a simple cornerstone of wellness: Building habits. Lift uses beautiful visual reinforcement, social support and iterative progress to enable constructive habit building. The feedback loop goes beyond physical health to make overall behavior change fun and engaging.
The emWave2 approaches behavior change from a more scientific perspective. The portable device measures your pulse and transmits this information to a desktop graphic or in the form of a light array on the device.By monitoring physiology and providing immediate feedback in addition to providing a tool to act on that feedback, the emWave2 provides more focused insight into behaviors
Much like Lift, Mango is about reinforcing positive behaviors. However, it’s focused on one goal: Healthcare compliance. Mango was created to keep patients on track with their medication. Whether it’s a prescription for anxiety or a regimen of vitamins, Mango offers reminders, warnings of dangerous interactions and a gamified system to encourage adherence.
The popularity of these tools is a sign of a more engaged healthcare consumer, and that was only a small sampling of the apps and products available. Today’s consumer wants to know how their healthcare is connected to their everyday actions. They want simple tools to gather, understand and act on those connections. Assuming this, we can imagine two positive results for hospitals, medical professionals, pharmaceutical companies and other brands within the healthcare field.
A more engaged consumer means more insight into consumer behavior
Encouraging the use of quantified self tools will more actively engage consumers with their habits and actions. Instead of vague understandings about compliance with medication or how much exercise a consumer is getting, these tools offer incentives to monitor, measure and share this information. If the consumer is more engaged with their health through simple, entertaining tools, insights can be gathered and brands can use these insights to create strategies to shape their services around a consumer’s unique needs.
Engaged consumers lower painful costs for the system
One of the most exciting potentials in quantified self technology is that healthcare consumers will gain a clearer view of their overall health. This can empower them to predict potential emergencies before they happen. Fewer emergencies put less strain on a taxed system. Even a small amount of patients avoiding one catastrophic incident – costing hundreds of thousands of dollars – can add up quickly. Putting knowledge into the hands of consumers enables more consistent, dependable consumer relationships without painful spikes in the cost of insurance, hospital staff and distribution channels.
Taste Over IP (Taste/IP) is a new methodology (framework) for integrating the sensation of taste with the existing digital communication domain.
Taste/IP has three core modules: the transmitter, form of communication, and receiver. The transmitter is an AndroidTM mobile application, where the sender formulates a taste message to send. At present, we are conducting research on transferring basic taste sensations known as sour, salty, bitter, and sweet.
Then, for communication, we present a new extensible markup language (XML) format, the TasteXML (TXML) to specify the format of taste messages. TasteXML is a Remote Procedure Calling protocol that works over the Internet. TasteXML messages are set of encrypted requests and responses. The body of both request and response are in XML format. As the receiver (actuator), we use the Digital Taste Interface, a novel method for stimulating taste sensations on human.
We believe, in the future, this technology may use to implement digital taste sharing platforms and social networking services.
Google Helpouts is a new video service by Google that connects individuals seeking help with experts via real time online video. Healthcare providers are using the platform to connect with Patients. Helpouts is built on top of Google’s Hangouts platform and is HIPAA compliant.
Google says it was created to provide “real help from real people in real time.” People who offer help through the service are calledproviders and can be businesses as well as individuals. Providers must pass a screening process in order to qualify as Helpouts providers.
Once approved, providers create and maintain listings that explain their offerings, qualifications, prices and schedules. Payments are made through Google Wallet and pricing is based either per minute, per session, or free. While Google charges 20% of the fees, health-related providers are not yet being charged. Helpouts Providers can be rated at the end of a session by the user.
An understanding of Online Profile Management for Oncologists, with an Indian perspective.
Covers Digitally Aware Patients and Social Networks, The Need for Online Profile Management, an understanding of Local Reputation vs Global Reputation, Tips for How to do it while avoiding the traps and describing techniques for Maximizing Online Exposure for Oncologists
Researchers at Los Alamos National Laboratory are investigating the complex relationships between the spread of the HIV virus in a population (epidemiology) and the actual, rapid evolution of the virus (phylogenetics) within each patient's body.
We have developed novel ways of estimating epidemics dynamics such as who infected whom, and the true population incidence of infection versus mere diagnoses dates," said Thomas Leitner, principal investigator. "Obviously, knowledge about these things is important for public health monitoring, decision making and intervention campaigns, and further to forensic investigations."
The team models the uninfected population using traditional differential equations on the computer; this is done for computational speed, because an agent-based component is much more demanding. Once a person is infected, he/she becomes an "agent" in computer modeling terms, and the model starts following their behavior individually, as well as the viral HIV evolution within the person.
The doctor isn’t in, but he can still see you now.
Remote presence robots are allowing physicians to “beam” themselves into hospitals to diagnose patients and offer medical advice during emergencies.
A growing number of hospitals in California and other states are using telepresence robots to expand access to medical specialists, especially in rural areas where there’s a shortage of doctors.
These mobile video-conferencing machines move on wheels and typically stand about 5 feet, with a large screen that projects a doctor’s face. They feature cameras, microphones and speakers that allow physicians and patients to see and talk to each other.
“Regardless of where the patient is located, we can be at their bedside in several minutes,” said Dr. Alan Shatzel, medical director of the Mercy Telehealth Network. “Literally, we compress time and space with this technology. No longer does distance affect a person’s ability to access the best care possible.”