Navigating Healthcare – Patient Safety and Personal Healthcare Management

Former Apple CEO on Future of Medical Technology

Posted in Uncategorized by drnic on September 28, 2011
Nice piece on FastCompany Former Apple CEO John Sculley On The Future Of Medical Technology And Health Care’s Killer App 

As a trail blazer for original tablets in the 80’s it must be gratifying to see the uptake of the iPad and it’s competitors. In his mind not going to start with a single “killer app”

I think that the health care industry is so complex that it doesn’t necessarily start with a single killer app. You go back to the early days of the personal computer–when I joined the industry, we really didn’t know what the killer app was going to be. All we knew was that it was going to be possible to create very low-cost, shrink-wrapped applications. It wasn’t for several years until we understood that electronic spreadsheets, word processors, and eventually desktop publishing would become killer apps.

But some combination of a solutions integrated and focused on ease of use. The technology has reached a point of penetration and ease of use that makes adoption that much easier in healthcare

So the intimidation of technology is no longer the issue now that it was just a few years ago.

I’d add one thing – the disruptive technology must include ease of interaction and data capture that does not inhibit adoption and as highlighted in this piece on MedScape EHR Voice Recognition: An End to the ‘No Eye Contact’ Problem which highlights the significant contribution of effectively speech enabling EHRs to

allows for maintenance of the doctor-patient relationship by minimizing the attention paid to the laptop computer inevitably and uncomfortably sitting between a physician and patient when using the point-and-click method
The same is true with other healthcare technology that can interfere with the clinician-patient interaction. As John Sculley said: “You combine those conditions and it creates an opportunity for entrepreneurs to come in and find disruptive solutions.”

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Speed of light no Longer a Maximum

Posted in Uncategorized by drnic on September 23, 2011
This piece of news is mind blowing – CERN scientists identified sub atomic particles traveling at a speed greater than the speed of light……..

I need to repeat that:
CERN scientists identified sub atomic particles traveling at a speed greater than the speed of light.

Here’s the paper and live conference today Friday Sep 23 at 16:00 Zurich time

This is “crazy” result could upend our understanding of our universe more than we have seen with previous revolutionary theories (Copernicus, Galileo, Einstein…..) 

One Statement from Bachmann, Two Steps Back for HPV Vaccine

Posted in Uncategorized by drnic on September 20, 2011

But the harm to public health may have already been done. When politicians or celebrities raise alarms about vaccines, even false alarms, vaccination rates drop.

“These things always set you back about three years, which is exactly what we can’t afford,” said Dr. Rodney E. Willoughby, a professor of pediatrics at the Medical College of Wisconsin and a member of the committee on infectious diseases of the American Academy of Pediatrics. The academy favors use of the vaccine, as do other medical groups and the Centers for Disease Control and Prevention.

The vaccine, recommended by the medical groups for 11- and 12-year-olds, protects against the human papillomavirus, or HPV, a sexually transmitted infection that can cause cancer. Use of the vaccine was disturbingly low even before the Bachmann flap, health officials say. That is partly because of the recent climate of fear about vaccines in general, and partly because some parents feel that giving the vaccine somehow implies that they are accepting or even condoning the idea that their young daughters will soon start having sex.

Allegations that vaccines could cause autism have frightened some parents away from giving them to children. But the question has been studied repeatedly, and there is no evidence for such a link; the research that first promoted the idea was subsequently proved fraudulent.

Indeed, a report published last month by the Institute of Medicine, which advises the government, found that the HPV vaccine was safe.

It did find “strong and generally suggestive” — though not conclusive — evidence that the vaccine could cause severe allergic reactions. But such reactions have been rare.

Historically, Dr. Willoughby said, vaccine scares have caused vaccination rates to drop for three or four years, and have led to outbreaks of diseases that had previously been under control, like measles and whooping cough. Measles cases in the United States reached a 15-year high last spring, with more than 100 cases, most in people who had never been vaccinated.

Once the disease begins to reappear, parents become worried and start vaccinating again. With cervical cancer, Dr. Willoughby said, “unfortunately, the outbreak is silent and will take 20 years to manifest.”

This time, he said, there will be no symptoms to scare parents back into vaccinating their daughters until it is too late.

HPV infection is extremely common — the most common sexually transmitted infection in the United States. More than a quarter of girls and women ages 14 to 49 have been infected, with the highest rate, 44 percent, in those ages 20 to 24.

Millions of new infections occur each year, and researchers think that at least half of all adults have been infected at some point in their lives. The genital region is teeming with HPV, and any kind of intimate contact — not just intercourse — can transmit the virus. In most people, HPV is harmless: The immune system fights it off. But in some people, for unknown reasons, the viruses persist and can cause cancer.

Although the HPV vaccine was initially approved in 2006 to prevent cervical cancer, more recent data has shown that HPV also causes cancers of the penis, anus, vagina, vulva and parts of the throat. Many scientists think that the vaccine can prevent those diseases as well.

Last month, the Centers for Disease Control and Prevention published a report on vaccination rates in girls that was “a call to action” to do a better job with the HPV vaccine, according to Dr. Melinda Wharton, deputy director of the National Center for Immunization and Respiratory Diseases.

“We’re not meeting our goals,” Dr. Wharton said. “Girls are not getting an important preventive measure that they need.”

Nationwide, last year only 32 percent of teenage girls received all three shots needed to prevent HPV infection, the disease centers found. Rates of vaccination were much higher (at least 45 percent) in a few states — Massachusetts, Rhode Island, Washington and South Dakota. Those furthest below average (20 percent or less) included Idaho, Mississippi, Arkansas and Alabama.

The report was particularly troubling, Dr. Wharton said, because it showed use of the HPV vaccine lagging far behind that of two other vaccines that were licensed around the same time, one for meningitis and a combination shot against tetanus, diphtheria and whooping cough.

“This vaccine has been portrayed as ‘the sex vaccine,’ ” said Dr. Mary Anne Jackson, a professor of pediatrics at the University of Missouri-Kansas City and a member of the infectious disease committee of the American Academy of Pediatrics. “Talking about sexuality for pediatricians and other providers is often difficult.”

Dr. William Schaffner, an infectious diseases expert at Vanderbilt University, acknowledged that 11 or 12 is “a pretty tender age, and parents are having a hard time getting used to this concept.”

But like the measles vaccine and others, this one must be given before a person is exposed to the virus or it will not work.

“Here we’d like to get it completed before the young woman initiates her sex life,” Dr. Schaffner said. “Of course parents, particularly fathers, think that’s going to happen at around age 34.”

The average age of first intercourse in the United States is about 17 for both boys and girls, according to the Kinsey Institute. About 25 percent have had sex by age 15.

Even before Mrs. Bachmann’s comments, family doctors were negotiating with reluctant, confused parents. Dr. Schaffner said he knew a pediatrician who postponed the HPV shots until most patients turned 15 specifically to avoid parents’ objections at the younger age.

In what is an increasingly common occurrence we find someone with a stage making unfounded statements (and later apologizing stating that “she is not a doctor or scientist”. But the damage is already done.
Vaccines are safe and the diseases they prevent are potentially lethal. As people stop vaccinating disease will occur and it could be your relative/child. THere is no evidence that vaccines cause autism and the original research that suggested this has been subsequently shown to be false.
Don’t be fooled by brash unfounded statements and if in doubt study the evidence. All my family are vaccinated…I would not do it if I did not believe it to be safe.

mHealth Holy Grail

Posted in Uncategorized by drnic on September 20, 2011
In a nice expose on the need for speech recognition on mobile devices: Accurate speech recognition: mHealth’s Holy Grail for docs on Fierce Mobile Health   covers off the need for the inclusion of speech in the mHealth future. As they discovered

Doctors constantly tell me how much they love their iPhones and Android tablets, but they also complain about the difficulty of data input. Few find the touchscreen keyboard handy for inputting notes or updating their comments about patient progress. Most use the devices as data viewers.

Offering up MedMaster Mobile as a good example of integrating speech into a mobile healthcare application and speaks to the power and value that speech recognition brings to mobile devices in healthcare to ensure usability and quality data capture.

The article includes a good list of checkpoints when considering speech for the mobile platform including
  • Voice quality – The primary consideration in getting good results
  • Connectivity – if you rely on cloud based services you need a reliable good quality connection
  • Accuracy – with good voice quality will achieve the right results
  • Editing – one of the more challenging aspects is an easy way to edit any mistakes that do occur
So Speech Recognition is the secret ingredient to making mobile devices catch-on with clinicians and will transition these great mobile devices from cool but limited practical application to rock solid mobile tool set for mHealth

The 7 Deadly Sins of EMR implementation | Healthcare IT News

Posted in Uncategorized by drnic on September 8, 2011

Congratulations! You’ve committed to an EMR, which is an accomplishment in itself. But the hardest part is still to come: getting it to work.

From failing to plan to skipping out on training, many mistakes can be made during the implementation process. And although they may not be as juicy as wrath, envy or lust, the Seven Deadly Sins of EMR implementation could wreak just as much havoc.

Steve Waldren, MD, director of the American Academy of Family Physicians’ Center for Health IT, and Rosemarie Nelson, principal of the MGMA Consulting Group, gave us the worst sins providers can commit during EMR implementation.

[See also: Top 5 worst EMR myths.]

 1. Not doing your homework:  Avoiding supplier problems means background research and thorough evaluations of vendors and products. And beware: vendors tend to make promises they can’t keep. According to Waldren, it’s important to get the specifics down on paper. “Often, a doctor will ask if [an EMR] can do this or that, and a vendor will say yes. Then, they’re surprised when in reality, it doesn’t. Doctors need to make sure all expectations are met in writing.”

2. Assuming the EMR is a magic bullet
: It’s important to remember the EMR is a conversion, not an upgrade. Although the system will save you time and money in the long run, Waldren warns it isn’t an instant fix to issues in the workplace. “Most people think an EMR solves problems,” he said. “But an EMR will only amplify problems that already exist in the practice.”

3. Not including nurses in the planning stages
: Nelson says doctors tend to think a new EMR is all about them. “They don’t think about how much the nurse preps the chart, how often the nurse presents information to them, and how much the nurse handles patients over the phone,” she said. Having nurses involved from the beginning avoids future conflicts, and considering their thoughts on product selection and implementation will only help with workflow. “[The implementation] needs to be done with the support of staff; everyone needs to be involved,” added Waldren.

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Nice highlight of some major faux pas on EHR implementation – I especially like Rosmarie Nelson’s comment on forgetting nurses #3: “doctors tend to think an EMR is all about them”….quite

Other great points including training (and actually attending!), trying to replicate existing processes – business process reengineering was a catch phrase for a number of years and has dropped off from regular use but applies to all EMR implementations.

But perhaps most of all “Assuming the EHR is the magic bullet”. I have said this before but worth re-itertaing…implementing an EHR is the first step in a journey that while it will have some interim destinations will continue to be a voyage of ongoing discovery. And that train has left..you are either on the train or watching from the station as the train leaves.