Friday, April 22, 2016

Virtual Care: The Course

Virtual Care is nothing new, nor extraordinary.  Since the advent of the telephone physicians and patients have conversed about illness over the phone. We have taken this for granted and do not think of this as Virtual Care.

Whether it is the M.D., RN or PA the patient calls the office and often describes what are their symptoms, the physician's office will either recommend a face-face visit or give some interim treatment advice, or tell the patient to make an appointment immediately.

In many ways telemedicine is the same, only better. A video image supplements the verbal exchange, and the patient is more engaged than they would be in a telephone conversation.

CME courses with category 1 credits are now available from several sources.

Digital Health Space offers these excellent Post-Graduate Courses that are accredited  for CME requirements for re-license.


However, as in many progressive  developments physicians are skeptical, and averse to criticism and/or medical malpractice liability. (As well they should be). There are several caveats, some described in the Virtual Care, The Course

As yet, there are no reliable studies indicating how many legal claims have been filed against providers offering virtual consults.

Some issues include

1. Abandonment

2. Failure to diagnose

3. Not meeting a standard of care

4. Failure to refer

In most cases physicians are already well trained in these areas during medical school and/or post-graduate training.

Additional information should be posted on a telemedicine platform prior to the online connection with the provider listing the 'rules of engagment".  And perhaps an electronic signature of the patient, recorded in the record.

Ideally as technology advances each telehealth session will be recorded in the electronic record of the patient.


What is Telehealth?

Short Educational Videos

Telehealth Training Programs

Open Mic Webinar Recordings  This link offers a broad spectrum of questions and answers about telehealth issues including 

Telehealth Tool Kits

For patients and providers: The Bottom _______________

Virtual Care: The Course

Monday, April 18, 2016

What Happens when Algorithms Lie ? (Bots)

This article was written for other industries, such as retail or sales organizations. However much of it’s content can be extrapolated to medicine, health and wellness and technology/

However, who watches the algorithms, or the bots ?

Most humans are conditioned to trust authority but what causes people to decide whether a computer is authoritative or not? That is, are we more or less likely to trust a piece of information when it comes from a computer versus from a person? Researchers continue to study this question but it’s one which may become increasingly important in a future of bots – is it a human? a computer? Will the phrasing of the response change based upon the bot’s degree of confidence in the answer? And to what extent will regulations play a role in this, especially in areas of legal or medical advice?
Rather than it being too early to start considering these questions, they’re exactly what came to my mind when reading a recent article about technology companies now hiring writers, poets and other professionals to try and figure out what communicating with a bot should feel like.
“Now she’s applying her creative talents toward building the personality of a different type of character — a virtual assistant, animated by artificial intelligence, that interacts with sick patients” the article says of one woman who used to write scripts in Hollywood.
And later in the article, “how human can — and should — the bot sound? Should the virtual assistant be purely functional or should it aspire to connect emotionally with the user?”
Should a shopping bot provide positive affirmation about the clothing items I have in my virtual shopping cart? “Oh you’ll look hotter in this,” the bot coos as it pushes a $150 sweater as an alternative to the $25 sweatshirt I was considering. Is that a lie? Doesn’t a salesperson at a store do the same thing? Is it better or worse when it’s done by a computer simultaneously to 10,000 customers?
Will multivariate testing of our bot future contain ethical parameters in addition to performance measurement? Techniques like priming can be used to dramatically impact behaviors. For example, asking you if you are a “good person” and having you answer in the affirmative, before I request something of you, increases the likelihood you’ll do what I want, driven by a need to live up to the identity you created for yourself. There are many choices of software for multivariate analysis.

My friend Anil Dash talks about the need for CS departments to teach ethics and I’ve always nodded but as we move towards a conversational, AI future maybe we’re about to see a step-function in the importance of teaching these concepts.

Wednesday, April 6, 2016

Virtual Reality Expo — LA Convention Center August 5-6

Health Information Technology is expanding well beyond the classical boundary of Electronic Health Records, Health Information Exchanges, Telemedicine, Televideo, Mobile Health, and the confines of Meaningful Use confines of Medicare.

Digital Health Space will be participating at the VRLA Exposition.

Look for our display poster at our booth.    

                                                                Digital Health Space

                                                       Images from the Winter VRLA

Augmented and Virtual Reality

are already in use in some industries. The Robotic  Systems has used this technology for almost a decade to perform prostatectomy,  and is most useful in small incision surgery such as laparoscopy.

Some knowledgable 'insiders' describe the new medium akin to the color televisions on exhibit in the early 1950s.  And just as we now take television for granted in about five to ten years VR and AR will be the 'wow' factor.  Our children may well not know what life and work were before AR and VR

There will be AR/VR schools. at the exposition as well.

                                             Virtual Reality School re-cap Winter 2016

VRLA School is a monthly series of educational workshops and speaker sessions led by experts in VR and AR. The events will serve as an intimate environment for learning new skills and meeting new people in the immersive tech industry.
Please email to learn about teaching and/or sponsorship opportunities.

The Proto Awards announced at VRLA Winter Symposium 


VRLA is the world's largest virtual and augmented reality expo, welcoming both consumers and industry professionals. The expo will feature cutting-edge demos of the most exciting projects in development for the Oculus Rift, HTC Vive, PlayStation VR, Google Cardboard, Samsung GearVR, and more! Each day will be stacked with a lineup of insightful presentations, panels, and announcements. No other event offers this level of access to the general public and professionals alike.

Expo — VRLA

Saturday, April 2, 2016

Congress Set to See a Flurry of Telehealth Activity

One bill is introduced this past week, and another is on the way. It's all part of what the American Telemedicine Association calls 'skyrocketing' interest in the technology

A Senate bill introduced this past week would spur additional Medicare coverage of telehealth in rural areas by allowing more telehealth projects at the Center for Medicare and Medicaid Innovation.
It’s one of two pieces of telemedicine legislation expected in Washington this month, and comes at a time when telemedicine “is skyrocketing,” according toAmerican Telemedicine Association CEO Jonathan Linkous.
The Telehealth Innovation and Improvement Act, sponsored by Sens. Gary Peters (D-Mich.) and Cory Gardner (R-Colo.), would require the Health and Human Services Department to allow eligible hospitals to test new telehealth concepts at the CMMI. It would also compel the CMMI to separately evaluate new telehealth models on the basis of cost, effectiveness and improvement in quality of care without increasing the cost of delivery.
“People living in rural Colorado should have access to the same healthcare services as those living in urban areas,” Gardner said in remarks introducing the legislation. “Telemedicine has the power to increase access to specialized services in underserved communities, and potentially lower costs and improve patient outcomes.”
Gardner said his bill “would pave the way for Medicare to expand coverage to additional telehealth services, and potentially provide those living with life-threatening conditions in rural America with more opportunities and more options to receive the care they need. At the same time, this legislation would incentivize the industry to develop cutting-edge technology that could revolutionize healthcare delivery. As we work toward a healthcare system that lowers costs and increases choices for consumers, it is important that we advance commonsense legislation like the Telehealth Innovation and Improvement Act to achieve those goals.”
Meanwhile, Sen. Brian Schatz (D-Hawaii) has let it be known he intends to submit a bill before the end of the year that would enable healthcare providers to use telemedicine technology in new, alternative payment programs overseen by the Centers for Medicare & Medicaid – including telestroke programs covered by Medicaid Advantage.
During the ATA’s monthly online webinar this week, Linkous said Schatz’s bill “is imminent,” and said he and Gary Capistrant, the ATA’s senior director for public policy, recently talked to the senator about the pending legislation.
“He comes with a background (in telemedicine) and a clear understanding” of where the industry can go, Capistrant said.
Linkous and Capistrant said Schatz’s pending bill is riding the crest of a wave of telemedicine activity in Washington, where CMS is in the midst of finalizing new Medicare codes, next-generation accountable care organization and bundled payment programs are loosening their restrictions on rural and originating sites, and Congress is working on two separate pieces of legislation that would clarify or ease licensing restrictions for telemedicine.
Linkous also noted the Medicare Payment Advisory Committee (MedPAC) “is looking at telehealth.” MedPAC backing of telehealth legislation, he said, could spur the Congressional Budget Office to take up the concept as well – something the CBO hasn’t been asked to do in 15 years. That in turn could give Congress a better picture on just how the technology could affect the nation’s staggering healthcare budget.

Congress Set to See a Flurry of Telehealth Activity

Telehealth Scores Big in Joint Replacement Bundled Payment Plan