When Republicans were swept back in to power earlier this month, one of their first vows was to either repeal the whole healthcare reform bill or dismantle it piece by piece. It’s starting to look like they will accomplish their goal without ever having to say the word “healthcare” on the Congressional floor. In Virginia, a lawsuit brought by the Republican state Attorney General challenging the insurance mandate portion of the law is awaiting a decision Federal district court. And as described in the New York Times,
Virginia’s attorney general, Kenneth T. Cuccinelli II, a Republican who filed the Richmond lawsuit, argues that if Judge Hudson rejects the insurance requirement he should instantly invalidate the entire act on a nationwide basis.
Such a ruling could be a disastrous setback for the transformational movement currently underway in healthcare IT. While much of these efforts are funded by the stimulus act rather than the reform act, there is a fair amount of interplay between the two. For example, the latter authorizes the Department of Health and Human Services to establish many of the interoperability standards that will be critical in the information exchanges and electronic health records funded by the former. And it seems like this setback could occur because of a simple “oversight.”
One of the most fundamental, and perhaps most difficult, skills to learn as a physician is how to tell when a patient is sick. That sounded absolutely ridiculous to me the first time I heard it, some time around the start of medical school.
But as I’ve progressed through my training, I’ve finally come to understand what that means – being able to triage patients quickly and safely. While much of that is grounded in thought on a purely intellectual level, a lot of it is an instinct based on seeing and talking to the patient.
So any technology that lets me do that sooner and more efficiently seems like it would be a valuable asset, which is why I was very interested when I came across the Transport AV platform from GlobalMedia, being used by the Cincinnati Children’s Hospital Medical Center. As described by GlobalMedia,
The GlobalMedia Transport AV telemedicine system combines the TotalExam examination camera, a handheld high-resolution video camera about the size of a dry-erase marker, and a digital stethoscope, microphone and headset all connected via the internet from the ambulance to CCHMC. Transport teams use the TotalExam examination camera to send real time live video and freeze-frame images of the patient to the doctors back at CCHMC.
Completely integrated into the gurney used by the ambulance, it is an innovative, not to mention pretty cool, way of extending medical care from the hospital to the field.
Here we review Radiology 2.0: One Night in the ED, designed by Dr. Daniel Cornfeld. Dr. Cornfeld, an Assistant Professor of Diagnostic Radiology at Yale University School of Medicine who specializes in Body and Emergency Medicine Imaging, and Mohammed Kaleel, a medical student at Saba University, teamed up to create this app for the iPhone, iPad, and iPod Touch. [Editor's Note: The iPad version of this apps review is at the end of this post]
In 2005, Dr. Cornfeld started a website, titled “One Night in the ED,” dedicated to teaching common Emergency Medicine imaging pathology.
This website – particularly the case to imaging to discussion format provides the inspiration for the Radiology 2.0 app we are reviewing here. Of note, Dr. Cornfeld has not created any other apps in addition to this one. (read more)
Our friends over at MedGadget are giving away an iPad for their “imagine medicine photo competition”. The contest challenges you to come up with the most artistic and thought-provoking image of medicine.
The full rules to the competition can be found here. There have been some amazing submissions so far and we encourage our readers to submit their own images!
By Brian Wells, MS-3, MSM, MPH
Few areas of medicine remain as wondrous and mysterious as neuroscience. Trying to visualize the brain in three dimensions using the two dimensional diagrams from which I was learning often left me staring off into the field outside the study hall, rather than on the neuroanatomy books and of class notes in front of me. Of course, there were models of the brain and numerous MRIs and CTs to examine, but nothing which elegantly combined information with images, transforming 2D slice to 3D realism. This is the goal which Brain Tutor HD seeks to achieve.
The program information is divided into five “atlases”: Lobes, Gyri, Sulci, Brodman Areas and Functional Areas. Each atlas contains numerous structures, which when selected highlight the corresponding areas in the 3D brain representation. Each entry also includes an arrow which, when tapped, loads the description, nomenclature, location, function and connectivity.
By providing integrated MRI images, computer-rendered mockups of the brain and information about each structure, Brain Tutor HD for the iPad ($1.99, iTunes link) is able to deliver a unique and valuable experience for the student learning neuroanatomy. [Video demonstration included at end of post]
Despite the costs associated and the uncertain financial rewards for physicians, adoption of electronic health records (EHRs) is on the rise. For many practices, it seems the benefits of cheap information retrieval and the protection against audits outweighs the costs of an EHR. Plus, the monetary incentives of the HITECH act may just sweeten the pot enough for the those still sitting on the fence.
Many EHR implementations include patient portals and some even include full fledged patient health records (PHRs), yet thus far the extent of patient adoption of PHRs has not been as gratifying. The most successful PHRs thus far are those deployed by care providers, especially large ones like Kaiser and Mayo Clinic, which are tethered to the providers’ EHRs and thus are already pre-populated with a patient’s own records. Kaiser’s PHR, in particular, is a rich portal that is often held out as an example of the potential of PHRs.
But what about a simpler approach? Two iPhone apps, Capzule PHR and Gazelle aim to provide a way for patients to store their own health records, including medical conditions, vaccinations and physician contact information. The approach for both apps is fairly similar with screens organized by information type, options to store and display laboratory data, and options for sharing information.
Both apps have gained a significant amount of press recently, most notably Gazelle – due to the large company that made it. However, both apps have issues overcoming data silos preventing their full functionality.
Verizon Business recently made a big splash with plans to offer free access and usage of their Medical Data Exchange system to over two million US healthcare providers. Sounds like a pretty generous offer, right? On first pass, I’d certainly have to agree though I have a sneaking suspicion it may not turn out to be quite as altruistic as many of the headlines I saw make it sound. As one report described,
The credentials will allow doctors and clinicians to access medical data via the Verizon Medical Data Exchange through a secure, private inbox. The inbox is part of Verizon’s Healthcare Provider Portal, which it has added to the exchange.
The data exchange system itself is primarily designed to enable exchange of information between different electronic medical record platforms, with this personal inbox component added later. What this offer focuses on is individual healthcare providers and that’s precisely what makes it both interesting and disappointing.
Android lags behind the iPhone platform in medical app development – both in volume, and in quality. There isn’t even a medical category in the Android marketplace, an issue we wrote about extensively last week.
Developers have relayed to us some of their concerns and technical hurdles in creating medical apps for the Android marketplace. We have complied some of the major themes of their comments – some might actually shock you.
As our recent coverage of the mHealth Summit shows, medicine has developed some pretty lofty expectations for mobile technology in healthcare. A big part of that promise has been in telemedicine, where the opportunity to remotely provide care on a wide range of platforms, including the iPhone, could be a huge asset in chronic disease management. With that hope in mind, a group of researchers at the National Heart, Lung, and Blood Institute (NHLBI) launched a large, multicentered randomized controlled trial to evaluate the benefits of a telemedicine system called Tel-Assurance from Pharos Innovations – basically an automated phone-in system which they used to monitor patients at home for signs and symptoms of worsening disease. Their study showed that within the approximately 1600 patients randomized, there was no significant benefit in terms of death, hospitalization, or length of stay. However, a closer look at the study and its shortcomings suggests that these results may fall far short of being a nail in the coffin for modern telemedicine in heart failure.
Last week an Australian politician, Victorian Premier John Brumby, announced as part of his health policy platform the distribution of iPads to every physician. He is promising $12 million in funding to buy iPads for every doctor working in Victoria’s [second most populous state in Australia] public hospital system. On initial take, such a proposition seems outlandish.
Critical thoughts that come to mind: What is giving an iPad to every physician going to accomplish if proper teaching and work flow lessons are not taught? Whats the point in having an iPad if you don’t have the proper software or EMR? These is no way the program can only cost $12 million if you’re giving an iPad to every physician in the second most populous state in Australia.
While these thoughts do have merit, the state of Victoria is surprisingly one of the best suited places for such a program to thrive due to the following three reasons: (read more)
Epocrates, the venerable medical reference company, has bought Modality – a prolific iOS app making company. With the launch of the App Store by Apple, Modality bet big early by focusing on apps and were the first large company in the medical educational app space – boasting titles such as Netters and Procedures Consult and bringing them to life in a mobile and aesthetically pleasing form. We have reviewed quite a few of their apps and more often than not come away impressed [click on links for full reviews by iMedicalApps].
Although Modality does boast a wide variety of medical apps, they have worked on non-medical apps as well. It will be interesting to see if this partnership will cause Modality to focus more on the medical and health care aspect of app making or if they will maintain their non-medical educational component.
This is clearly a move that makes sense for Epocrates. From the press release, it appears they are eager to use Modality’s mobile app development expertise for medical app making – possibly for an iPad customized Epocrates app? Remember, Epocrates still does not have an iPad customized app. To those who might be unaware, Skyscape came out an iPad customized version of their medical reference app many months ago – currently I defer to Skyscape instead of Epocrates when using my iPad to look up medical reference information. (read more)
Sometime in November, Apple will be releasing a new free software update, termed iOS 4.2, that introduces quite a few notable improvements and changes for the iPhone, iPod Touch, and most dramatically, the iPad. This update is especially significant for iPad users because it marks the first meaningful software update since its release in April, and finally brings it on par with the iPhone and iPod Touch in regards to many features – such as multitasking and folders.
We’ve given numerous examples in the past of how the iPad is being used in healthcare and medicine – from all the med students at Stanford and UC-Irvine being given iPads, to a more broad adoption in the health care setting and it’s use in the hospital.
The iPad non withstanding, the update still brings helpful improvements that should make even the iPhone and the iPod Touch more readily equipped for the hospital or clinic. Highlighted below are some of the features that could have an impact on healthcare and how the iPad is used by medical professionals. (read more)