Post image for Veterans Administration hospitals CIO says VA must become “iPad friendly”

In a nod to the reality of rapid physician adoption of tablets and smartphones, the CIO of the VA system recently stated that the VA must find a way to accommodate  iPads at a  conference on federal information technology.

According to Baker, the fact is that 100,000 residents rotate through the VA each year and “they’re all carrying mobile devices”. In order for them to do their jobs, they want to be able to access resources on the internet.

In an article published at, CIO Roger Baker said

I’ve told my folks I don’t want to say ‘no’ to those devices anymore…I want to know how I say yes

The key, according to Baker, is security. While the iPad can be secured, proper protocols need to be developed. Otherwise, the device can be likened to a “huge unencrypted USB stick with no pin”. In order to facilitate development of security protocols, a pilot program has been launched giving out iPads to select employees in situations where security is looser.

In an easy to understand analogy, he proposed

If it won’t go on a device where you’re willing to put all your banking information, your pins, your passwords, [then] don’t put veterans’ information on it.

As we have published on this site before, there are ways to secure your iOS device adequately for medical use (“How to secure your iPhone or iPad for medical use“). The issues are not always technological, often it is a question of policies and habits of the users. A positive contribution by a large scale institution like the VA can only help to instill good habits and a better understanding of security in future doctors.


Post image for JAMA study finds remote monitoring in e-ICUs reduced mortality

By: Ankur Gupta, MS1

A study published last week by the Journal of the American Medical Association shows that patients in the ICU of UMass Memorial Medical Center had significantly reduced mortality rate (8.6% as compared to 10.7%) when they were monitored by a remote “eICU.”

While there have been many studies conducted on eICUs previously, this is the first one to show a significant improvement in patient outcome. In theory, eICUs add another layer of care onto traditional ICUs – doctors and staff at remote sites can enforce treatment plans, ensure that caregivers followed best practices, and alert staff when alarms were going off.

Essentially they provide another set of eyes and ears in an already busy and stressed ICU, and can do this for multiple facilities. Patrick Muldoon, president of HealthAlliance Hospital argues in favor of eICUs: (read more)

Post image for For physicians, does using a smartphone increase your exposure to malpractice claims?

By: Joseph McMenamin, MD, JD

[Ed. We are excited to present this guest post by Dr. McMenamin, who was a practicing emergency physician before turning his sights to the practice of law. He is currently a partner at McGuireWoods LLP specializing in health-related litigation.]

A medical malpractice plaintiff must meet four tests: a duty, breach of that duty, causation (the “so what?” question), and damages.  A failure to prove any one of these elements is fatal to the plaintiff’s case.  In mHealth, the most complex of these may be the one that, in conventional care, is the simplest: duty.

In most health care, it’s usually pretty clear when I am your doctor and you are my patient.  Once that’s established, I owe you a duty -  a duty that, if breached to your detriment, you can sue over.  We may disagree about the extent of that duty, and whether, on the occasion in question, I complied with it, but the existence of the duty itself is often non-debatable.  Either I’m your doctor or I’m not.

Suppose, though, I maintain a Web site dedicated to a discussion of the diagnosis and treatment of lupus, and some of the information presented is out-of-date.  Can a reader claim that, in reliance upon my Web site, he was harmed, and is thus entitled to compensation?  If I write a blog to discuss medical topics, does my reader become my patient?  What if, in conformity with the 140-character limitation imposed by Twitter, I omit a discussion of subtleties that in a conventional medical text would be spread over 3 or 4 pages of dense print?  In general, if no doctor-patient relationship exists between my reader and me, I cannot breach the standard of care; if one does, I can.  The question thus becomes: when does that relationship arise?

(read more)

Post image for iBronch app provides a virtual glimpse into bronchoscopy on iPad, but is too abbreviated

By: Darwin Wan, MS2

Endoscopy is a very exciting field of medicine encompassing both diagnosis and treatment.  It allows us to perform remarkable tasks including visualize anatomy and pathology, biopsy and ultrasound tissues, insert stints and resect masses.

Much teaching however, is done using expensive virtual endoscopy simulators that are often reserved for residents and fellows.  Where are medical students to go for their endoscopy education?

iBronch is an app that aims to help students learn the basic anatomy of the trachea and bronchi through the lens of a fiberoptic bronchoscope.  By dragging your finger across a schematic of the pulmonary tree, you are able to view corresponding bronchoscopic images of the corresponding anatomy.  Branches of the pulmonary tree are labeled on the schematic and the bronchoscopy images. (read more)

Post image for iPad anatomy app that could replace a textbook? IMAIOS Mobile Atlas gets significant update

By: Wouter Stomp, MD

IMAIOS’ mobile application is an atlas of human anatomy for iOS which we reviewed just two months ago.

Although we were impressed, and in fact considered it one of the best anatomy apps in the app store, there were some key drawbacks. The app however has just received a major update fixing many of the issues we encountered and here we will be giving you our second impression.

Our most important gripes with the initial version were the lack of an iPad version, the high price, and the constant need for an internet connection for the subscription-based app. The update addresses all of these issues to some extent.

First, and most importantly, IMAIOS is now also available as an iPad app, making full use of the available screen space. (read more)

Post image for Mobile diabetes guide from Johns Hopkins helps doctors practice evidence-based medicine

Statistics from the 2011 National Diabetes Fact Sheet (link here) show that the prevalence of diabetes in the U.S. is 8.3% or 25.8 million people. In 2007, the total cost of diagnosed diabetes in the U.S. alone reached $174 billion. It is clear that diabetes is a major healthcare issue in modern medicine. On the basis of this, it is important that healthcare professionals are well informed about diabetes and its potential complications as it will have a significant impact on future practice. This is where the Johns Hopkins POC-IT Guide to Diabetes becomes invaluable.

The POC-IT guide is a universal app which can be accessed on the iPad or iPhone. It is developed by Unbound Medicine in cooperation with clinicians at Johns Hopkins Medicine and is part of the POC-IT series, which includes antibiotic and HIV guides . The Diabetes Guide is designed to assist clinicians by distilling complex material into need-to-know information, easily accessible for rapid viewing and which can be frequently updated. (read more)

Post image for IBM envisions Watson being used for mobile medical care, cite utility of medical blogs and iPad

Earlier this year, I wrote an article stating why IBM’s Watson could not replace a physician — in response to claims that were being made when Watson achieved world wide fame by handily defeating two Jeopardy contestants.

“Watson”, is an artificial intelligence computer system that answers questions posed in natural language, and is a product of IBM’s R&D department.

When it was announced IBM would be working with medical researchers at Columbia and the University of Maryland, some pundits made statements believing Watson could one day replace a physician — prompting my aforementioned response.

Yesterday, the Associated Press released details of IBM’s medical partnership, mentioning how IBM sees Watson’s role in medicine, focusing on potential mobile capabilities, and how medical blogs could be utilized for improving Watson’s diagnosing capabilities.  The results and ideas being floated are definitely fascinating.  (read more)

Post image for Virtual physician patient consulting apps set to release this year for iPhone and Android

Teledoc is the largest telehealth provider in the US — and now is bringing their telemedicine services to mobile apps.  The service allows board certified primary care providers to use video conferencing and other e-tools in order to provide medical expertise to patients.

The company reports that half their physicians are already using their mobile phones for chat consultations with patients — with over 80,000 mobile driven consultations reported.

The company recently announced they will be launching an iPhone and Android app later this year designed specifically for video conferencing with patients.

While these are all great ways to utilize mobile technology, until these types of mobile consultations are actually reimbursed by insurance companies they won’t gain much traction.  Obviously, Teledoc has a business model that works for them, and it doesn’t relate to insurance providers.

Of note, Teledoc states their service is not meant for emergency care, but rather for routine and non-specialty medical advice.

Link: Teledoc

Post image for United Kingdom Department of Health using iPads for post-op orthopedic follow up

By: Ankur Gupta, MS 1

The UK Department of Health is conducting a trial at the Royal National Orthopaedic Hospital (RNOH) in London of a system that tracks patients’ progress after spine surgery.

HealthUnlocked Tracker allows patients to record their progress on an iPad while in the clinic. After the patient is discharged, he or she can continue to update their information through an online system.

While monitoring patient progress is nothing new, this system gives medical staff live access to information on how patients are faring after different procedures. Dr. Matthew Shaw, the lead surgeon in the trial, states: (read more)

Post image for Johns Hopkins HIV Guide app synthesizes HIV information into mobile form for iPad & iPhone

By: Rajat Kumar, MS3

HIV is a disease that presents many challenges to physicians.  The spectrum of new complications and novel therapies that are related to HIV can be difficult to tackle, even for the expert clinician well versed in managing HIV patients.

The Johns Hopkins HIV Guide from Unbound Medicine presents an all-inclusive application that attempts to serve as a one-stop resource for everything related to HIV.

Available for many platforms (including Apple iOS, Android, Blackberry, and Windows), the application presents the user with up-to-date information regarding diseases and complications related to HIV and also provides evidence-based treatment strategies for management. However, it may not be for everyone.

(read more)

Post image for The Phone Oximeter peripheral measures pulse ox and respiratory rate, connects to iPhone

The Electrical and Computer Engineering in Medicine (ECEM) research group in collaboration with the Pediatric Anesthesia Research Team (PART) at the University of British Columbia have developed a mobile solution to measuring key vital signs — called the “Phone Oximeter”.

The Phone Oximeter uses a traditional FDA approved pulse oximetry sensor, but researchers have modified it to interface with a phone, in this case, your iPhone. Currently the setup is being interfaced with an iPhone for trial studies, but is compatible with Android, and other mobile operating systems.

What makes the Phone Oximeter special is its ability to capture SpO2 (blood oxygen saturation), heart rate, and respiratory rate — then dynamically comprehend the variables using the decision support software, giving medical staff or even laymen individuals key help in making decisions on medical care.

So how would a device like this be useful in the medical setting? (read more)

Post image for Differential Diagnosis i-Pocket app provides to the point differentials, but with drawbacks

By: Brian Wells, MSM, MPH

“Differential Diagnosis i-Pocket” is another variant on the differential diagnosis theme for apps. This application contains a list of hundreds of symptoms, diseases, and findings that help formulate a differential diagnosis.

On the surface, such an application would be a virtual treasure trove of information for a clinician, especially when packed into an easy-to-use mobile application. Of course, the real key is in the implementation.

(read more)