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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
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.
First, check your pulse, then, open this app.
If it were that easy, we could all be stars of the Japanese TV drama as referenced in the Code Blue series. However, real life codes are usually all too hectic and stress inducing especially for the new graduating medical class that just started their intern year. Here, imedicalapps.com is reviewing the top iPhone “code” apps available on the market.
We should mention the obvious caveat — you should know how to handle code blue / ACLS scenarios without having to use an app or even without having to use the commonly used pamphlets people carry with them.
That said — these apps can often times help you control the adrenaline that is flooding your veins in these high acuity settings.Medirate
Conclusion: Simple, effective
Price: Free on iPhone app store
Rating: 4 Stars ( User Interface: 4, Multimedia: 4, Price: 5, Real World Applicability: 4)
Conclusion: Do not download
Rating: 0.5 Stars ( User Interface: 1, Multimedia: 1, Price: 0, Real World Applicability: 0)
Conclusion: A great app in the making but it has not been updated since 2011. As an “orphaned” app it is useless. While I was excited about the previous medical app, it is now dead and unless we find a functional option, so will our patient!
The Code Runner Lite
Conclusion: Great app with two main features: 1) Protocol is that helps with prompts but does not allow editing and 2) thorough differential section for PEA protocol. This app is another orphaned app, so I recommend only the lite version and limit use to the differentials section for early learning (as those have not changed much with time).
Rating: 4 Stars ( User Interface: 4, Multimedia: 3, Price: 4, Real World Applicability: 4) The ability to work through a differential of Pulseless Electrical Activity makes The Code Runner Lite a good backup option for new interns, but with the timer for epinephrine at every four minutes and the app orphaned since 2010, users are still limited in their ability to run a full code without running into limitations of the medical apps. Unless we find a workable app soon, we are going to have to call an end to it.
Conclusion: Sometimes you need to keep to the basics.
Rating: 4 Stars ( User Interface: 4, Multimedia: 2, Price: 5, Real World Applicability: 4) At least we now have good CPR going, we now have the luxury of time to keep searching.
Conclusion: Still PDF format for code protocols, but it has a nice quizzes for learning.
Rating: 3 Stars ( User Interface: 4, Multimedia: 2, Price: 5, Real World Applicability: 2) Although still limited to PDF style format for the code protocols, this application does have the added features of including a timer, code quiz, and rhythm quiz. It still suffers from lack of medical input in its creation.
Conclusion: The style is great for editing but it does not offer the user much information, only a template that can be edited. This, however, is actually a plus in my mind.
Recommendations: Add easily accessible resources like The Code Runner Lite has offered
Price: $ 2.99
Rating: 4.5 Stars ( User Interface: 4, Multimedia: 5, Price: 4, Real World Applicability: 4)
Full Code Pro
Conclusion: Simple and effective
Recommendations: Add either audible or vibrating reminders as it is easy to miss the timers if you are not actively looking at the screen.
Price: $ 2.99
Rating: 4 Stars ( User Interface: 4, Multimedia: 3, Price: 4, Real World Applicability: 5)
Much of the chatter around electronic health records (EHRs) revolves around efficiency and cost cutting in clinical practice. There is even a bit of discussion about the use of EHRS to improve population health. But is there more benefit to be found in individual patient health?
Perhaps the greatest potential of the EHR, (and the concept applied to a broader application, the EMR) lies in the role it can play in predicting clinical outcomes around a range of diseases and conditions.
This application is still very much in its fledgling stage, but here are just a few examples of how data analytics, when applied to EHRs in mindful ways, can bring about positive changes in patient health.
One of the most recent examples we saw came out of UC Davis. Researchers there found that, by compiling and analyzing routine information — blood pressure, respiratory rate, temperature, and white blood cell count — as pulled from EHRs, they were able to predict early stages of sepsis, a condition that is a leading cause of hospitalization and death in the U.S. It took them only three measures — lactate level, blood pressure, and respiratory rate — to calculate the likelihood that a patient would die from the condition.
Progressing Kidney Disease
Data from EHRs has also played a key role in predicting the need for dialysis after a patient with chronic kidney disease progresses into kidney failure.
The Journal Of The American Medical Association in 2011 studied patients who were referred to nephrologists between April 1, 2001, and December 31, 2008, in an effort to develop and validate predictive models for the progression of chronic kidney disease.
According to the study, “Our models use laboratory data that are obtained routinely in patients with CKD and could be easily integrated into a laboratory information system or a clinic EHR.” It also notes that emerging literature suggests that the methods lead to “improved patient outcomes with individualized risk prediction and with advances in information technology that allow for easy implementation of risk prediction models as components of EHRs.”
All data for the study where pulled from nephrology clinic EHRs.
EHRs have also been used to improve cardiovascular risk prediction. A study (available from the National Institutes Of Health), analyzed whether internal EHR data (using flexible, adaptive statistical methods) could improve clinical risk prediction. The study used the fact that EHRs have been extensively implemented in the VA system as an opportunity for exploration.
It found that, “despite the EHR lacking some risk factors and its imperfect data quality, health care systems may be able to substantially improve risk prediction for their patients by using internally developed EHR-derived models and flexible statistical methodology.”
Another prevalent health issue in the U.S., hypertension, has seen researchers apply predictive analytics using EHR data to gain more insight into the disease. This study, from the Journal Of Informatics In Health And Biomedicine, sought to identify transition points at which hypertension is brought in, as well as pushed out of, control, through the use of EHR data.
The study of 1294 patients with hypertension (who were enrolled in a chronic disease management program at the Vanderbilt University Medical Center) found that accurate prediction of transition points from a control status could be achieved
Janssen Research and Development, a Johnson & Johnson pharmaceutical company, is looking into 3D printing living tissue for drug research, according to a document filed with the SEC Thursday. The company will partner with Organovo, an expert in bioprinting.
Organovo has 3D-printed everything from blood vessels to thyroid tissue, and has long-term plans to print entire organs. Later this year it will begin offering liver tissue to drug companies for testing the toxicity of drugs — its first commercial product.
Janssen is more interested in using 3D-printed tissue to discover drugs. By exposing many different 3D-printed cells to many different early-stage drugs, it can determine which are the most effective. Janssen and Organovo did not disclose further details about the agreement.
“Researchers who develop new therapies for patients are too often hampered by animal models and traditional cell culture models that are poor predictors of drug efficacy and toxicity in human beings,” Organovo CEO Keith Murphy said in a January release. “Our 3D printer creates living human tissues that more closely reproduce in vivo human tissues.”
QNX OS for Medical 1.1 is important because it has been built to comply with the International Electrotechnical Commission (IEC) 62304 medical device standard.
This is significant because the same standard is accepted in both the United States and the European Union. The fact that the OS has been certified for IEC 62304 saves medical device manufacturers a lot of time and money, because they do not have to recertify that part of their product design. QNZ has done the hazard and risk analysis, and has security features built into the OS. The system also supports graphic displays, touch screen input, and video capture.
QNX also understands the problems of mobile computing technology, so the company is in a good position to support a wide variety of medical monitoring and diagnostic devices.
The perioperative environment is commonly acknowledged as one of the hospital’s most complex.
This condensed and complex environment is precisely why complete command and control of the OR is imperative – and why mobile technology is an optimal path for helping achieve it.
In particular, mobility offers three distinct advantages that support command and control and help ensure all parties have the information they need to keep workflow and patient flow moving:
1. A near real-time, patient-centric OR perspective
During this highly compressed episode of care, a patient is treated by a team of clinicians who are often from different departments. In addition, supporting staff such as surgical scrubs and radiology play an important part in efficient patient movement. Having a single, shared view of patient milestones – for instance, when prophylactic antibiotics are administered, anesthesia is induced and the incision is made, or surgery is complete and the patient is on his way to PACU – allows the entire care team to know exactly what is happening which supports the delivery of more coordinated care. Giving everyone this same view on a mobile device can further synchronize care among disparate care providers.
As a result, the patient is more likely to move efficiently between care events, and clinicians are less likely to miss specific timing for milestones such as medication administration.
2. A comprehensive OR view supports better decisions with fewer interruptions
A patient-centric view enables the OR team to keep one patient on the most efficient, highest quality care path. Sometimes, however, this path requires an adjustment that can impact the entire OR.
The NHS is starting to test a sticking-plaster-sized patient-monitoring patch.
Placed on the chest, it wirelessly transmits data on heart rate, breathing and body-temperature while the patient is free to move around.
Independent experts say the system, developed in Britain, could ease pressure on wards and has the potential to monitor patients in their own home.
But the Royal College of Nursing says there is no substitute for having enough staff.
Routine checks for vital signs - including temperature, blood pressure and heart rate - are a key part of care and safety in hospitals.
Typically they may be carried out every four hours, depending on the patient's condition.
But patients can deteriorate between checks, putting them at risk.
A hospital in Brighton run by the private healthcare firm Spire has been testing the battery-powered patch, which updates information on some of the vital signs every couple of minutes.
The wireless device, developed by the Oxford-based firm Sensium Healthcare, then issues an alert if the readings fall outside pre-set levels, indicating a potential problem.
The patch is placed on the chest just above the heart when the patient is admitted. There are no cables to any monitors. Instead, readings are recorded and transmitted to a box in each room that works like a wi-fi router, passing on data to the hospital IT system.
As tech giants like Apple, Google and Samsung compete over dominance in the healthcare market, with their latest platforms and apps, the question remains will any or all of these innovations truly tap into the greater realm of consumer health? Aside from the buzz now emanating from consumers’ pockets, is there a real signal being sent out here about how to change healthcare, or will these latest consumer-concentric technologies add nothing more than noise?
Welltok's Scott Rotermund explains that what we really need from Google Fit and HealthKit is an integrated approach that not only collects data, but also meshes with the current healthcare ecosystem.
What lessons learned from the disappointments associated with the consumer use of FitBit and others tell us about behavior change?
We’ve learned two things:
1. A cool gadget is not enough – The novelty will wear off along with the use of the wearable. In my experience, most people lose interest in their tracking device after a month – they learn their sleep patterns, know average steps, etc. To maintain usage, we’ve tied tracking devices to challenges, participatory incentives and personalized action plans with defined goals.
2. Relying on the consumers to take action – With the startling statistics associated to preventable diseases like obesity and diabetes, it’s safe to say that we cannot expect consumers to take action on their own. These big tech giants are treating health activities as they would consumer electronics – the same rules don’t apply. To move beyond early adopters, they need to tie into programs that provide personalized guidance on how to use the trackers and the resulting data, and align those defined actions with the right incentives to get people moving.
The Food and Drug Administration (FDA), which regulates everything from heart monitors to horse vaccines, will soon have its hands full with consumer health apps and devices.
The vast majority of the health apps you’ll find in Apple’s or Google’s app stores are harmless, like step counters and heart beat monitors. They’re non-clinical, non-actionable, and informational or motivational in nature.
But the next wave of biometric devices and apps might go further, measuring things like real-time blood pressure, blood glucose, and oxygen levels.
More clinical apps
The FDA is charged with keeping watch on the safety and efficacy of consumer health products. Lately, that includes more clinical apps as well as devices you might buy at the drugstore, like a home glucose testing kit.
“It’s these apps that the FDA says it will regulate,” David Bates of Brigham and Women’s Hospital and Physicians Organization told VentureBeat in June. These apps will have to go through the full 510(k) process,” he said.
Dr. Bates chaired a group to advise the FDA on how to review health apps for approval, and on how the FDA should advise developers.
“It was intended to help them think through the risk factors involved with these products and then give guidance on how to stay within the guidelines,” he said.
“The device makers were asking from some guidance from The FDA on what types of things would be accepted and what wouldn’t,” Bates said.
Bates believes the FDA wants to use a light regulatory touch when looking at new medical devices. “The FDA definitely wants innovation to continue in clinical devices,” he said. “In general the FDA knows that the vast majority of apps are just informational.”
The FDA’s final guidance focuses on a small subset of mobile apps that present a greater risk to patients if they do not work as intended.
Health apps go mainstream
The big software companies (Apple, Google, and Samsung) have brought attention to, and lent credibility to, apps and devices that do more than count steps. These companies are building large cloud platforms designed to collect health data from all sorts of health apps and devices.
As I see it, mobile-savvy physicians have half-a-dozen distinct advantages over their office-bound brethren:
Mobile physicians can provide better care. I follow my patients everywhere, from my office to the hospital and their homes. In fact, I’ve made more that 10,000 house calls since 1984. Many of my patients have diabetes-related disabilities, so it’s not unusual that trips across town to my office would be next to impossible for them. But I know that I can often keep a patient out of the hospital by providing timely care. That simple fact alone - that I can better serve my patients - keeps me going to their homes as needed.
Mobile health requires less equipment. I started making house calls long before I started using technology. Today’s devices and software are catching up with the way I practice. I now carry only two instruments as I move from location to location: a stethoscope and an iPad.
Mobile physicians can stay connected. Being mobile means I can pull up information I need anytime through a secure Internet connection. Log-in is almost instantaneous with the iPad and I can switch easily from screen to screen, so I can stay focused on the patient. Because I’m always connected, I can take care of many tasks right away - before, during or after seeing a patient. At the end of the day, I’m not chained to the office. I can take my device home with me and finish the day’s “paperwork” after spending time with my family.
Mobile health improves continuity of care. Traditionally, care falters anytime a patient goes from one stage of care to the next. Mobile health is closing some of those gaps. I recently visited a patient with bedsores, for instance. In the past, I would have written a paragraph describing the wound. With the iPad, I can take a picture of the wound, send it to my team and tell them what I did to treat it and how I want them to follow up. They don’t have to interpret my words; they can see the wound for themselves.
Mobile technologies speed workflow. The system I use from Greenway Health enables me to complete and manage most tasks on the iPad. Dictating notes through Siri saves me hours of manual documentation. I still need to use the office computer to integrate unstructured data into the patient’s record, but each release provides more mobile functionality. I fully expect that someday I will be able to do everything from a single portable device.
Mobile physicians are poised for interoperability. My practice in Brooklyn is a completely integrated electronic practice. Within my office, we maintain a complete record of every patient, no matter where that patient was seen. We attested to Stage 1 meaningful use in 2011 and - thanks to all of our work to integrate knowledge across our practice - I’m confident we’re ready for the subsequent stages of meaningful use. Most importantly, our records are more complete, we have access to important details about our patients, and that helps us deliver better care.
ProTransport-1, a Northern California based medical transport provider has announced a software partnership with CrowdOptic, maker of mobile and wearable broadcasting solutions to deploy the CrowdOptic Google Glass broadcasting solution in its ambulances and mobile medicine units.
ProTransport-1 will use CrowdOptic’s software solution that will allow paramedics and nurses to broadcast through Google Glass a live view of complex cases from the ambulance to medical teams at the receiving hospital during transport. According to the press release, the companies aim to “improve documentation and expand medical consultative opportunities for patients en route.
“CrowdOptic’s see-what-I-see technology allows paramedics and nurses on our ambulances to broadcast the live view of complex cases to medical teams at the hospital”, said Glenn Leland, Chief Strategy Officer for ProTransport-1.
Additionally, ProTransport-1 envisions multiple opportunities to utilize CrowdOptic’s software particularly in the mobile medical setting by enabling a two-way educational forum between a patient in their home and providers. “We additionally envision a variety of dispatch, navigation, documentation and operational processes will migrate to CrowdOptic and Google Glass over time” said Glenn Leland, Chief Strategy Officer for ProTransport-1.
For breast cancer patients, the era of personalized medicine may be just around the corner, thanks to recent advances by USC Stem Cell researcher Min Yu and scientists at Massachusetts General Hospital and Harvard Medical School.
In a July 11 study in Science, Yu and hercolleagues report how they isolated breastcancer cells circulating through the blood streams of six patients. Some of these deadly cancer cells are the "seeds" of metastasis, which travel to and establish secondary tumors in vital organs such as the bone, lungs, liver and brain.
Yu and her colleagues managed to expand this small number of cancer cells in the laboratory over a period of more than six months, enabling the identification of new mutations and the evaluation of drug susceptibility.
If perfected, this technique could eventually allow doctors to do the same: use cancer cells isolated from patients' blood to monitor the progression of their diseases, pre-test drugs and personalize treatment plans accordingly.
Big data offers breakthrough possibilities for new research and discoveries, better patient care, and greater efficiency in health and health care, as detailed in the July issue of Health Affairs. As with any new tool or technique, there is a learning curve.
Here are some guidelines to help take full advantage of big data's potential:
Acquire the “right” data for the project, even if it might be difficult to obtain.
Many organizations – both inside and outside of health care – tend to stick with the data that’s easily accessible and that they’re comfortable with, even if it provides only a partial picture and doesn’t successfully unlock the value big data analytics may offer. But we have found that when organizations develop a “weighted data wish list” and allocate their resources towards acquiring high-impact data sources as well as easy-to-acquire sources, they discover greater returns on their big data investment.
Ensure that initial pilots have wide applicability.
Health organizations will get the most from big data when everyone sees the value and participates. Too often, though, initial analytics projects may be so self-contained that it is hard to see how any of the results might apply elsewhere in the organization.
Before using new data, make sure you know its provenance (where it came from) and its lineage (what’s been done to it).
Often in the excitement of big data, decision-makers and project staff forget this basic advice. They are often in a hurry to immediately start data mining efforts to search for unknown patterns and anomalies. We’ve seen many cases where such new data wasn’t properly scrutinized – and where supposed patterns and anomalies later turned out to be irrelevant or grossly misleading.
Don’t start with a solution; introduce a problem and consult with a data scientist.
Unlike conventional analytics platforms, big data platforms can easily allow subject-matter experts direct access to the data, without the need for database administrators or others to serve as intermediaries in making queries. This provides health researchers with an unprecedented ability to explore the data – to pursue promising leads, search for patterns and follow hunches, all in real time. We have found, however, that many organizations don’t take advantage of this capability.
Health organizations often build a big data platform, but fail to take full advantage of it. They continue to use the small-data approaches they’re accustomed to, or they rush headlong into big data, forgetting best practices in analytics.
It’s important to aim for initial pilots with wide applicability, a clear understanding of where one’s data comes from, and an approach that starts with a problem, not a solution. Perhaps the hardest task is finding the right balance.
more at http://healthaffairs.org/blog/2014/07/14/lessons-learned-bringing-big-data-analytics-to-health-care/
When an imaging run generates 1 terabyte of data, analysis becomes the problem
Today's neuroscientists have some magnificent tools at their disposal. They can, for example, examine the entire brain of a live zebrafish larva and record the activation patterns of nearly all of its 100,000 neurons in a process that takes only 1.5 seconds.
The only problem: One such imaging run yields about 1 terabyte of data, making analysis the real bottleneck as researchers seek to understand the brain.
To address this issue, scientists at Janelia Farm Research Campus have come up with a set of analytical tools designed for neuroscience and built on a distributed computing platform called Apache Spark. In their paper in Nature Methods, they demonstrate their system's capabilities by making sense of several enormous data sets. (The image above shows the whole-brain neural activity of a zebrafish larva when it was exposed to a moving visual stimulus; the different colors indicate which neurons activated in response to a movement to the left or right.)
The researchers argue that the Apache Spark platform offers an improvement over a more popular distributed computing model known as Hadoop MapReduce, which was originally based on Google's search engine technology.
The researchers have made their library of analytic tools, which they call Thunder, available to the neuroscience community at large. With U.S. government money pouring into neuroscience research for the new BRAIN Initiative, which emphasizes recording from the brain in unprecedented detail, this computing advance comes just in the nick of time.
Your smartphone is not only your best friend, it's also become your personal trainer, coach, medical lab and maybe even your doctor.
"Digital health" has become a key focus for the technology industry, from modest startups' focus on apps to the biggest companies in the sector seeking to find ways to address key issues of health and wellness.
Apps that measure heart rate, blood pressure, glucose and other bodily functions are multiplying, while Google, Apple and Samsung have launched platforms that make it easier to integrate medical and health services.
"We've gotten to a point where with sensors either in the phone or wearables gather information that we couldn't do in the past without going to a medical center," says Gerry Purdy, analyst at Compass Intelligence.
"You can do the heart rate, mobile EKGs (electrocardiograms). Costs are coming down, and these sensors are becoming more socially acceptable."
The consultancy Rock Health estimates 143 digital health companies raised $2.3 billion in the first six months of 2014, already topping last year's amount.
Recent studies suggest that people who use connected devices to monitor health and fitness often do a better job of managing and preventing health problems.
A study led by the Center for Connected Health found that people who use mobile devices did a better job of lowering dangerous blood pressure and blood sugar levels.
A separate study published in the July 2014 issue of Health Affairs found that data collected by devices is not only useful for patients but can help doctors find better treatments.
"When linked to the rest of the available electronic data, patient-generated health data completes the big data picture of real people's needs, life beyond the health care system," said Amy Abernethy, a Duke University professor of medicine lead author of the study.
Some firms have even more ambitious plans for health technology.
Google, for example, is developing a connecting contract lens which can help monitor diabetics and has set up a new company called Calico to focus on health and well-being, hinting at cooperation with rivals such as Apple. And IBM is using its Watson supercomputer for medical purposes including finding the right cancer treatment.
Called Baseline Study, Google's project will gather anonymous genetic and molecular information to create a full picture of what a healthy human is.
The early-stage project is run by Andrew Conrad, a 50-year-old molecular biologist who pioneered cheap, high-volume tests for HIV in blood-plasma donations.
Dr. Conrad joined Google X—thecompany's research arm—in March 2013, and he has built a team of about 70-to-100 experts from fields including physiology, biochemistry, optics, imaging and molecular biology.
Other mass medical and genomics studies exist. But Baseline will amass a much larger and broader set of new data. The hope is that this will help researchers detect killers such as heart disease and cancer far earlier, pushing medicine more toward prevention rather than the treatment of illness.
"With any complex system, the notion has always been there to proactively address problems," Dr. Conrad said. "That's not revolutionary. We are just asking the question: If we really wanted to be proactive, what would we need to know? You need to know what the fixed, well-running thing should look like."
The project won't be restricted to specific diseases, and it will collect hundreds of different samples using a wide variety of new diagnostic tools. Then Google will use its massive computing power to find patterns, or "biomarkers," buried in the information. The hope is that these biomarkers can be used by medical researchers to detect any disease a lot earlier.
The study may, for instance, reveal a biomarker that helps some people break down fatty foods efficiently, helping them live a long time without high cholesterol and heart disease. Others may lack this trait and succumb to early heart attacks. Once Baseline has identified the biomarker, researchers could check if other people lack it and help them modify their behavior or develop a new treatment to help them break down fatty foods better, Dr. Conrad said.
Google has already built one of the world's largest networks of computers and data centers to serve online-search results quickly and run other data-hungry services like the video website YouTube. This computing muscle can now be used to store and crunch medical information and let other researchers access it more easily.
Duke University Medicine is using geographical information to turn electronic health records (EHRs) into population health predictors. By integrating its EHR data with its geographic information system, Duke can enable clinicians to predict patients' diagnoses.
According to Health Data Management, Sohayla Pruitt was hired by Duke to run this project; “I thought, wow, if we could automate some of this, pre select some of the data, preprocess a lot and then sort of wait for an event to happen, we could pass it through our models, let them plow through thousands of geospatial variables and [let the system] tell us the actual statistical significance,” Pruitt says. “Then, once you know how geography is influencing events and what they have in common, you can project that to other places where you should be paying attention because they have similar probability.”
iHealth Beat explains that the system works by using an automated geocoding system to verify addresses with a U.S. Postal Service database. These addresses are then passed through a commercial mapping database to geocode them. Finally, the system imports all U.S. Census Bureau data with a block group ID. This results in an assessment of socioeconomic indicators for each group of patients.
“When we visually map a population and a health issue, we want to give an understanding about why something is happening in a neighborhood,” says Pruitt. “Are there certain socioeconomic factors that are contributing? Do they not have access to certain things? Do they have too much access to certain things like fast food restaurants?”
Duke is working to develop a proof of concept and algorithms that would map locations and patients. They are also working on a system to track food-borne illnesses.
Mike Dittenber had always wanted to go skydiving. There was only one problem: “At my heaviest I clocked in around 330 pounds,” says Dittenber, a technical writer from Michigan. “That’s above the weight restriction for a tandem jump.” During a doctor’s visit last spring, he got some more bad news. “I had delayed getting a physical for a while, but eventually I had to. Turned out I was borderline diabetic and right on the cusp of hypertension.” His doctor warned him that if he didn’t get his weight under control quickly he would need to begin taking medication. “It was a wake-up call.”
Dittenber had previously tried Weight Watchers, which worked for a time, but didn’t last for long. This time he decided to take matters into his own hands withMyFitnessPal, a mobile app that helps users track their calorie intake and exercise. The app became a gateway to a universe of digital health products. “I ended up buying a Fitbit, because that pairs with MyFitnessPal,” he says. “Turns out I don’t hate running. I don’t love it, but I can take it.” He added the Runkeeper app to log his distance and purchased a Garmin Forerunner 220 to help him maintain the right pace. Since he began using the tracking his health data in June of 2013, Dittenber has lost 110 pounds.
Using a smartphone as the central hub for tracking, analyzing, and motivating exercise has become a phenomenon. MyFitnessPal, which now claims over 65 million registered users, is one of the most popular digital health apps. But its success is part of a much broader trend. Venture funding for startups in the sector reaching $2.3 billion in the first half of 2014, more than was invested in all of 2013. More importantly, three of the biggest players in tech — Apple, Google, and Samsung — have all thrown their weight behind platform plays aiming to aggregate and simplify the universe of devices and apps available to consumers.
“We could be at a real tipping point,” says Harry Wang, an analyst who leads health and mobile research for Park Associates. “Fitness devices and apps have been a fast-growing but still relatively niche market. These new ecosystems, if they gain traction, could finally push the industry into the mainstream.” Success isn’t guaranteed, but Wang says it makes sense for the fragmented digital health industry to rally behind powerful companies. Apple's Healthkit and Google Fit can help reach a broader audience and forge partnerships with the traditional health care industry that would be hard for startups to accomplish alone. “It would be a transformation, with a lot of big winners, and losers as well.”Hardware gets the squeeze
For many years the digital health industry has been driven by wearable devices like the Fitbit, Nike’s Fuelband, and Jawbone’s Up. But if the titans of the smartphone industry succeed in creating a dominant platform for health and fitness data, this business could be in trouble. "A lot of the basic functions we have seen in fitness wearables — tracking your steps, taking your heart rate — those functions will become basic features on a smartphone or smartwatch," says Wang.Software’s turn to shine
While some big hardware players may get squeezed by the rise of mainstream smartphone platforms for digital health, app developers stand to make huge gains. "Devices like Fitbit and Jawbone have been essential to driving the industry forward, but they never got above 2 or 3 percent penetration with the general population," says Malay Gandhi, a managing partner at the venture capital firm Rock Health. "With smartphones as the central device powering this ecosystem, software companies will suddenly have access to tens of millions of new customers."
Gandhi believes this change will broaden the demographics in the digital health market. "Right now most of the people using this stuff are early adopter types, techies who are into the quantified lifestyle, or younger people who want to optimize their athletic performance." With just your smartphone as the baseline, he sees a chance to get older and less tech savvy people involved. "Your average consumer isn’t going to learn about pairing a wristband or managing a dozen different apps. But he or she might use the software that comes standard on their iPhone."
Here are three lessons we can learn from Chopped:
More doesn’t necessarily mean better, the details are what matter. Any chef can tell you that one can cook a delicious spread, but over/under season the dish, and he or she will be doing the walk of shame. Those of us in health IT also know the importance of applying a discerning eye to data. We have seen the dangers of things such as note bloat and copy forward, and we need ensure that those who are accessing the health data are able to immediately find what they need. Just as you shouldn’t have to eat an entire bowl of spaghetti to find a meatball, you shouldn’t have to manually parse through a patient’s entire medical record to find a glucose level from last week.
Presentation is everything. My wife says, and she is always right, “you eat with your eyes first.” A good chef knows the importance of combining and arranging the ingredients of a dish in a way that is appetizing to the foodie. The same goes for personal health data. We can be tracking every heartbeat and measuring every level in our body, however, if it is not organized and presented in a meaningful way, it will not be accepted by physicians or health consumers.
Vision needs to become reality. Chefs who do not thoroughly think through the elements of their recipes often find themselves out of time or presenting a dish that differs from what they had envisioned. Similarly, while it is great to imagine the future of health IT, what we need right now are well-thought out, logical, and achievable solutions that transform even the most challenging ingredients into a delicacy (Remember the monkey brains served during the dinner scene in Indiana Jones and the Temple of Doom?).
It's been tough to identify the problems that only turn up after medicines are on the market. An experimental project is now combing through data to get earlier, more accurate warnings.
No one likes it when a new drug in people's medicine cabinets turns out to have problems — just remember the Vioxx debacle a decade ago, when the painkiller was removed from the market over concerns that it increased the risk of heart attack and stroke.
To do a better job of spotting unforeseen risks and side effects, the Food and Drug Administration is trying something new — and there's a decent chance that it involves your medical records.
It's called Mini-Sentinel, and it's a $116 million government project to actively go out and look for adverse events linked to marketed drugs. This pilot program is able to mine huge databases of medical records for signs that drugs may be linked to problems.
The usual system for monitoring the safety of marketed drugs has real shortcomings. It largely relies on voluntary reports from doctors, pharmacists, and just plain folks who took a drug and got a bad outcome.
"We get about a million reports a year that way," says Janet Woodcock, the director of the FDA's Center for Drug Evaluation and Research. "But those are random. They are whatever people choose to send us."
After decades as a technological laggard, medicine has entered its data age. Mobile technologies, sensors, genome sequencing, and advances in analytic software now make it possible to capture vast amounts of information about our individual makeup and the environment around us. The sum of this information could transform medicine, turning a field aimed at treating the average patient into one that’s customized to each person while shifting more control and responsibility from doctors to patients.
The question is: can big data make health care better?
“There is a lot of data being gathered. That’s not enough,” says Ed Martin, interim director of the Information Services Unit at the University of California San Francisco School of Medicine. “It’s really about coming up with applications that make data actionable.”
The business opportunity in making sense of that data—potentially $300 billion to $450 billion a year, according to consultants McKinsey & Company—is driving well-established companies like Apple, Qualcomm, and IBM to invest in technologies from data-capturing smartphone apps to billion-dollar analytical systems. It’s feeding the rising enthusiasm for startups as well.
Venture capital firms like Greylock Partners and Kleiner Perkins Caufield & Byers, as well as the corporate venture funds of Google, Samsung, Merck, and others, have invested more than $3 billion in health-care information technology since the beginning of 2013—a rapid acceleration from previous years, according to data from Mercom Capital Group.
Wearable technologies are set to transform health and wellness experiences and massively increase our expectations of health and wellness services.
This customer shift will transform the health and wellness industry as a whole, dragging regulation and governance kicking and screaming into the 21st century.
Because there’s nothing quite like a vast, shouting mob (of wealthy voters) to drive change.
But first, a little background.The smartphone IS the killer wearable
Most of us have a smartphone. Comscore reports 69% of US citizens and 62% of Canadians own one. Every day more of us are connecting them to our daily activities, homes, cars and communities.
The expanding universe of “wearable” sensors and peripherals are often simply data inputs for a smartphone-based experience. We expect to see few devices succeed without this symbiotic relationship. Those that try, usually offer an experience that’s inferior to simply pulling out your phone.
The major smartphone manufacturers are heavily invested in developing wearable “ecosystems” around their devices. Through close-range sensing technologies like BLE (iBeacon), NFC and RFID, plus increased availability of mobile web access through Wi-Fi hotspots and cheaper data plans, there’s every reason to expect this trend to continue.
The smartphone already is a wearable. And it’s the hub – a “life tracker” with a growing entourage of sensory peripherals on our bodies, in our homes and all around us.We’ll share our lives in return for transformative wellness experiences
A paradigm shift is coming to the world of health and wellness. With the devices on our bodies and in our pockets gathering useful data about our movements, behaviours, preferences and wellbeing, more informed decisions become available.
So what happens next?1. The value we receive from sharing our wellness data will erode our privacy fears.2. Augmented reality will eventually become the new normal for healthcare professionals.3. Personal healthcare innovations will be swiftly subsumed into the major ecosystems. (Apple and Google)4. Healthcare providers need to embed digital capabilities, fast
Cardiologists in Los Angeles have developed a gene-therapy technique that allows them to transform working heart-muscle cells into cells that regulate a pigs’ heartbeat. This procedure, described today in the Science Translational Medicine, restored normal heart rates for two weeks in pigs that usually rely on mechanical pacemakers. The experiment, researchers say, could lead to lifesaving therapies for people who suffer infections following the implantation of a mechanical pacemaker.
"We have been able for the first time to create a biological pacemaker using minimally invasive methods and to show that the new pacemaker suffices to support the demands of daily life," Eduardo Marbán, a cardiologist at the Cedars-Sinai Heart Institute and lead author of the study, told the press yesterday. The approach is practical, added Eugenio Cingolani, a cardiogeneticist also at Cedars-Sinai and a co-author of the study, because "no open-heart surgery is required to inject this gene."
In the study, researchers injected a gene called Tbx18 into the pigs’ hearts. This gene, which is also found in humans, reprogrammed a small number of heart-muscle cells into cells that emit electrical impulses and drive the beating of the heart. The area in which this change occurred — about the size of a peppercorn — doesn't normally initiate heartbeats.
"We were able to get the biological pacemaker to turn on within 48 hours," Marbán said. To get the gene to the heart, the researchers sent a modified virus into the right ventricle through a catheter. The viral vector isn’t harmful, the researchers said, because the virus they employed was engineered to be "replication deficient" — meaning that it will not reproduce and spread beyond the heart.
While portal technology has been available in other industries for some years, access to health information and records via a secure login is only now becoming common place in healthcare by the end of the year.
Patient portal are excellent opportunities for providers to expand the way they engage with their patients. Here are a some best practices for using portals in your practice.
Patients with full-time jobs don’t always have the flexibility to communicate or interact with you during your traditional office hours. By offering a robust patient portal system, ideally tied into your cloud-based EHR, you provide patients with the opportunity to learn more about your practice and their health at their convenience, whether that’s late in the evening or on a weekend. This type of access provides patients a sense of comfort because they know their records are always within reach, even when your office isn’t open or you’re not on call. Including some personally written content or material for patients to view and reference online will go a long way towards creating a helpful presence, while also reducing the amount of time you have to spend explaining that information.
Similarly, many portals offer secure communication channels so patients can ask questions of you or your team. Have a plan in place to respond to these questions. Try to be as prompt as possible – within reason of course.
Some patient portals also allow for the ability to schedule – or at minimum request – appointments. By taking advantage of this feature, you can help eliminate lengthy wait times on the phone, which helps both your patients and your staff.
In return, you also have the ability to easily send patients appointment reminders or contact information when a patient needs their information for a referral.
Allowing the patient to fill out forms in advance of appointments or update their own address and billing information and emergency contact list not only helps the patient get through the intake process more quickly, it helps your team become more efficient. In addition, many portals also offer patients the ability to pay outstanding balances through a secure payment system. In more complex patient portals, patients can update their prescription information and problem list to help physicians reduce the likelihood of adverse events.
Explaining esoteric health information like lab results over the phone, or even in person, can be an inefficient method for educating patients. Since the information is often unfamiliar, the chance they’ll forget the information or misplace their printed instructions can be high.
Through a patient portal, you can not only deliver test results that can be read at any time, you also have the opportunity to educate the patient and his family about what those results mean. Having a library of fact-based information regarding specific conditions or upcoming tests can help alleviate stress or confusion – and maybe even prevent the patient from conducting random searches online, finding inaccurate information, and arriving at ill-founded conclusions.
It’s also a great way to educate a patient about specialists or other doctors that you may be referring him to. While the patient portal system can be very disparate – different offices may or may not be using the same portal – you still have the ability to give a patient a basic fact sheet and office contact information for the referred doctor. This is yet another way to put a patient’s mind at ease.
PHRs/Patient portals must look beyond MU. Patient Portals should go beyond being enterprise portals and become mediums for patient engagement, health tracking and a tool towards personalized health. They must include inputs from the patient and as such should be a bidirectional application rather than being a customized gorgeous front end to an EHR database.
I believe if done right PHR's will be a very useful tool to improving diagnostics, lowering care costs and also in prevention.
If you'd like to take a look at an inclusive bi-directional PHR system which goes beyond MU and is always evolving, contact me on twitter at @nrip or use the form on the right to setup a call.
In oncology, the notion of personalized medicine—in which genetic tools can be used precisely to characterize a patient's cancer and tailor treatment to a genetic profile—is now all but standard practice.
Though personalized treatments for diseases like amyotrophic lateral sclerosis (ALS), epilepsy, and bipolar disorders have remained frustratingly out of reach for neurologists, Harvard scientists say that could soon change.
A new technique for observing neural activity, developed by Adam Cohen, professor of chemistry and chemical biology and of physics, and colleagues including Venkatesh Murthy, professor of molecular and cellular biology, and Bernardo Sabatini, the Takeda Professor of Neurobiology at Harvard Medical School, will allow scientists to stimulate neurons and observe their firing pattern in real time.
Tracing those neural pathways can help researchers answer questions about how neural signals propagate, and could one day allow doctors to design individualized treatments for a host of disorders. The study is described in a paper in Nature Methods.
"This is a tool for looking in great detail at how signals flow through neurons, and how the signal flows through circuits of neurons," Cohen said. "You can think of this as a complete neuro-electronic interface, where you can stimulate any piece of the circuit, or any subcellular region, in any pattern of space and time you can dream of. And you can then record absolutely everything that's going on in that circuit."
In addition to offering invaluable insight into how healthy neural circuits work, the system can be used to probe how disease might cause those circuits to go awry.
It’s one of those thoughts many mHealth insiders and observers have at some point had: What if one could put the power of Watson analytics into a smartphone and interact with it like Apple’s Siri at the point of care?
Well, that specific dream moved closer to reality on Tuesday when Apple and IBM joined forces to create a mobile platform christened IBM Mobile First for iOS.
“For the first time ever we’re putting IBM’s renowned big data analytics at iOS users’ fingertips,” Apple CEO Tim Cook said in a prepared statement. “This is a radical step for enterprise and something that only Apple and IBM can deliver.”
IBM CEO Ginni Rometty added that the intention is to bring the same “innovations [that] have transformed our lives,” into the ways that people work, thereby “allowing people to re-imagine work, industries, and professions.”
To that end, the companies hope that IBM Mobile First for iOS will “transform enterprise mobility through a new class of business apps,” they explained.
It’s not all that often technology giants align and rattle off healthcare as one of their target verticals, much less that Apple joins forces with any of the IT old guard — which gives the partnership a booster shot of luster. And in an mHealth industry currently going like gangbusters with too many startups to count, the sheer scale that Apple and IBM bring at the very least has the potential for significant market-shaping.