The digital health space refers to the integration of technology and health care services to improve the overall quality of health care delivery. It encompasses a wide range of innovative and emerging technologies such as wearables, telehealth, artificial intelligence, mobile health, and electronic health records (EHRs). The digital health space offers numerous benefits such as improved patient outcomes, increased access to health care, reduced costs, and improved communication and collaboration between patients and health care providers. For example, patients can now monitor their vital signs such as blood pressure and glucose levels from home using wearable devices and share the data with their doctors in real-time. Telehealth technology allows patients to consult with their health care providers remotely without having to travel to the hospital, making health care more accessible, particularly in remote or rural areas. Artificial intelligence can be used to analyze vast amounts of patient data to identify patterns, predict outcomes, and provide personalized treatment recommendations. Overall, the digital health space is rapidly evolving, and the integration of technology in health

Tuesday, October 29, 2013

2014 International CES

 

IT’s that time of year again. Slightly before the holiday season.

One of these days before I oxidize into dust particles I will attend. It is not far from where I live.

I have placed this on my bucket list….Are you reading this Jack Nicholson and Morgan Freeman?  Please send your private jet to me on opening day.

Digital Health Space finds that many general tech devices intended for the general public often are scooped up by innovative physicians who find  ‘CHEAPER’ way to do things than buy apps and/or devices from medical device companies.  The medical industry niche is so much smaller than the overall CE marketplace that their offerings are far overpriced, even when hardware specs are identical.  Of course there are regulatory fees from those people in D.C. who want to protect us from ourselves.

Here is what is coming in January 2014

3D Printing Technology

Ultra HD    After several years of decline, television sales are improving along multiple metrics as new devices ascend. What will the slate of UltraHD and curved OLEDs mean to the TV market? Will uptake be sufficient to restore TVs to their vibrant category? How should retailers and manufacturers approach these changes?

The Breakthrough oft he Year Awards: This category deserves two separate awards, one offered by Popular Mechanics and the other offered for Breakthroughs in Life Sciences

Academia Tech and

Eureka Park:

Techzones

          Fashionware

 

We look at the newest innovations—body sensors, mind and gesture controlled devices, personalized headsets, and the latest wrist-wear and eyewear. Style, function and technology intersect in this wow-factor, high-tech exhibit space. Plus we’ll have an after party and live runway show, to add to the excitement.Soon to  be announce is the Google Smartwatch rumored to be in production.

MotionTech and Much Much More

 

For those of you who want to sit at the front of the bus:, Register Here and use this special code Priority Code A2.  I have sent this code to a limited number of friends on the interweb   5 X 1010    at last count.

epilogue:

CES has an outstanding web site. You will find it here. No explanation necessary, except for my opinon which means you will not click on the above. If you have…..you have made it through the secret door and down the hole into Alice in Wonderland.

And if an when you survive the fall to the Exhibit Hall there you will find the mushrooms.

What fare does CES have in store?
Apple Device

 

Like mushrooms which appear almost mysteriously in infinite colors shapes and sizes, a collage of mushrooms tantalizes at what CES 2013 will offer.

mushroom-lights-by-Yukio-7mushroom-lights-by-Yukio-2  

mushroom-lights-by-Yukio-4mushroom-lights-by-Yukio-8

The real rabbit hole lies somewhat east of Las Vegas

IMG_4834.jpg

Is this a home,a restaurant, a guided missile launching platform, it may even be a left over abandoned alien transporter left over on their way to build the pyramids. Local rumor says that Elvis is buried  here.

#ces2014  cesweb.org   Tuesday January 7 through Friday,January 10, 2014 Las Vegas, NV

 

Wednesday, October 23, 2013

Physicians Digital Marketing Guide for 2014

 

Most physicians shy away from marketing. Our ethics discourage self-aggrandizement and most marketing falls into that category.

However there are alternative positive reasons for promoting your medical practice.

Charitable and Philanthropic Goals

      

Public Health Informational Content

      

Mission positive statements

      

Clarity and Distinction from other Medical enterprises

Informational, educational and training opportunities

  

Location Information using Mapping technology, Directions to facility

With these ideas in mind, today’s lesson will be on Digital Marketing for 2014.  The information is time-limited due to the nature of electronic media.

White papers on digital marketing, social media, organic marketing, are readily available online,in digital form and for downloading as printed documents.

Conventional 20th Century marketing in industry publications, journals, meetings,and even emails are passé. 

 

Emails are considered spam and frequently deleted without being opened. Email is also considered a viral threat is attachments and/or links are opened.  Readers will frequently not click on a link in the body of the email.

Online marketing can be a challenge to analyze what, when and where potential clients (patients) read online content.

Recent experience and reports from media experts also reveal the fluid and ever-changing tools and structure of social media platforms.

Social media is dynamic and must be interactive, with Q&A capabilities. Social media platforms allow for business pages (Facebook, Google +)

Not only is what you say important, but how you say it, where it is placed in your content, and who reads your material.

Modern search algorithms have morphed into natural language processing and semantic interoperability.  If your content is designed properly it will favor  a ‘viral message’

 

 

Tuesday, October 22, 2013

HEALTHCARE.GOV: IT COULD BE WORSE

 

That is a title in the New Yorker Magazine by Rusty Foster, on October 21st 2013.

His article implies, “what did you expect?” given the history of U.S. IT efforts in the past, including the development of the DHS (Homeland Security) centralized data bases for the FBI CIA FEMA, State Databases, and more.

Here is another troubled scenario that has taken over a decade to work. While Health Benefit Exchanges may not be as complex, the story has interesting comparisons

“On September 11, 2001, the F.B.I. was still using a computer system that couldn’t store or display pictures; entering data was time-consuming and awkward, and retrieving it even more so. A 9/11 Commission staff report concluded that “the FBI’s primary information management system, designed using 1980s technology already obsolete when installed in 1995, limited the Bureau’s ability to share its information internally and externally.” But an overhaul of that system had already begun in the months leading up to 9/11. In June, 2001, the F.B.I. awarded the contractor Science Applications International Corp. (S.A.I.C.) a fourteen-million-dollar contract to upgrade the F.B.I.’s computer systems. The project was called Virtual Case File, or V.C.F., and it would ultimately cost over six hundred million dollars before finally being abandoned, in early 2005, unfinished and never deployed. V.C.F. was then replaced with a project called Sentinel, expected to launch in 2009, which was “designed to be everything V.C.F. was not, with specific requirements, regular milestones and aggressive oversight,” according to F.B.I. officials who spoke to the Washington Post in 2006. But by 2010, Sentinel was also being described as “troubled,” and only two out of a planned four phases had been completed. Sentinel was finally deployed on July 1, 2012, after the F.B.I. took over the project from the contractor Lockheed-Martin in 2010, bringing it in-house for completion—at an ultimate cost of at least four hundred and fifty-one million dollars. In the end, the upgrade took the F.B.I. more than a decade and over a billion dollars.

My first question would be, “What decade of IT was the HBE software developed?

Developing good software is a complex and sometimes unpredictable process.

Healthcare.gov is not so much a Web site as an interface for accessing a collection of databases and information systems. Behind the nicely designed Web forms are systems to create accounts, manage user logins, and collect insurance-application data. There’s a part that determines subsidy eligibility, a part that sends applications to the right insurance company, and other parts that glue these things together. Picture the dashboard of your car, which has a few knobs and buttons, some switches, and a big wheel—simple controls for a lot of complex machinery under the hood. All of these systems, whether in your car or on Healthcare.gov, have to communicate the right information at the right time for any of it to work properly.

For large software projects, failure is generally determined early in the process, because failures almost exclusively have to do with planning: the failure to create a workable plan, to stick to it, or both. Healthcare.gov reportedly involved over fifty-five contractors, managed by a human-services agency that lacked deep experience in software engineering or project management. The final product had to be powerful enough to navigate any American through a complex array of different insurance offerings, secure enough to hold sensitive private data, and robust enough to withstand peak traffic in the hundreds of thousands, if not millions, of concurrent users. It also had to be simple enough so that anyone who can open a Web browser could use it. In complexity, this is a project on par with the F.B.I.’s V.C.F. or Sentinel.

Healthcare.gov was given only twenty-two months from contract award to launch—less than two years for a project similar to one that took the F.B.I. more than ten years and over twice the budget.

 

Early in a project, there is a phase in which the client and the contractor work together to create a description of what is to be built. This is called the specification, and building a complex software product without a clear, fixed set of specifications is impossible. The Times reported that

the biggest contractor, CGI Federal, was awarded its $94 million contract in December 2011. But the government was so slow in issuing specifications that the firm did not start writing software code until this spring…. As late as the last week of September, officials were still changing features of the Web site.

This is like being told to build a skyscraper without any blueprints, while the client keeps changing the desired location of things like plumbing and wiring.

“Train wrecks” are never a surprise to anyone working on them. They are not discrete events; they are part of drawn out processes. We only saw the wreckage of Healthcare.gov on October 1st, but the contractors have been working on a wreck for almost two years.

 

The inevitable political overtones are, inevitable, “the political people in the administration do not understand how far behind they are.

The Democrats and Mr.Obama have written a check that cannot be cashed.

The case for semantic interoperability.

Even as the ONC promotes interoperability amongs EMR providers and a national network to support that function, HHS the very agency that has incentivized acquisition of EMR and Health Information Exchange has stumbled in it s own path to Health Benefit Exchange.

The opening of the national exchange has been a disaster. CMS lacks its own expertise to build such a system to interface multiple data bases.

One major problem slowing repairs, people close to the program say, is that the Centers for Medicare and Medicaid Services, the federal agency in charge of the exchange, is responsible for making sure that the separately designed databases and pieces of software from 55 contractors work together. It is not common for a federal agency to assume that role, and numerous people involved in the project said the agency did not have the expertise to do the job and did not fully understand what it entailed.

The case for semantic interoperability.

Even as the ONC promotes interoperability amongs EMR providers and a national network to support that function, HHS the very agency that has incentivized acquisition of EMR and Health Information Exchange has stumbled in it s own path to Health Benefit Exchange.

The opening of the national exchange has been a disaster. CMS lacks its own expertise to build such a system to interface multiple data bases.

One major problem slowing repairs, people close to the program say, is that the Centers for Medicare and Medicaid Services, the federal agency in charge of the exchange, is responsible for making sure that the separately designed databases and pieces of software from 55 contractors work together. It is not common for a federal agency to assume that role, and numerous people involved in the project said the agency did not have the expertise to do the job and did not fully understand what it entailed.

Speaking in the Rose Garden this morning, President Obama acknowledged the problems with Healthcare.gov, but said that “the Web site’s gonna get fixed.” He echoed the “surge” language in his statement, saying, “We’ve got people working overtime, twenty-four-seven to boost capacity and address the problems…. We’ve had some of the best I.T. talent in the entire country join the team, and we’re well into a tech surge to fix the problem.”

Can a “tech surge” work? In his seminal book on software project management, “The Mythical Man-Month,” Fred Brooks writes that “adding manpower to a late software project makes it later.” This is known as Brooks’s Law, and it is taken as gospel by programmers because it is usually true: it takes so much time for new coders to comprehend the system that they’re supposed to be fixing that typically it would have been faster not to include them at all.”

The obvious analogy here is the “Troop surge” in Afghanistan, with more boots on the ground….Let’s hope they can ‘re-boot’  Healthcare.gov

Rusty Foster is a computer programmer and writer who lives in Maine.

attributions:  New Yorker Magazine

Monday, October 14, 2013

EHRs and Excrement

 

EHRs, EMRs,HIEs,HITECH, MEANINFUL USE, AFFORDABLE CARE, HEALTH BENEFIT EXCHANGES,

                          

As far back as 2005 I  pontificated about the misdirection and poor design of EHRs.  Ethnology was and is uppermost in my attitude about electronic medical record systems.

Human-Machine interfaces are critical for accuracy, and efficiency. Not only is a poorly designed H-M interface (call it a GUI if you must) a liability it drastically alters good clinical practices. It greatly increases fatigability and frustration for users.  Most important is that it disrupts the face-face provider bond eye to eye contact.  No patient is going to believe a provider is interested in them when the provider is  staring at a computer screen or waiting on the PC to catch up. 

EHRs do not simplify nor make a broken practice work better. That used to be an important criteria. Today the feds have muddled an already hazy future for HIT, with incentives, penalties, meaningful use criteria.  All these meant to rush acceptance of HIT which is not ready for prime time.  As usual HHS has primed the pump for more rapid medical inflation (despite their unending programs to ‘flatten the cost curve of health care)

I see a future with greatly increased costs for health care with mandated HIT. The incentives are an example where it will backfire on the  providers who naively accept it, .

Perhaps the system can spin it as cost saving device,but for whom"?  I see my overhead rising and rising.

Darwinian health IT: Only well-designed EHRs will survive

                                     

Medsphere Systems Corporation  Edmund Billings, MD, is the chief medical officer for Medsphere Systems Corporation

Recently Dr Billings wrote about EHR dissatisfaction in HealthCare IT News

Health IT assumes healthcare will buy what we’re selling because the feds are paying them to. And, like the Pinto,and the Edsel what we’re selling inspires something less than awe. In short, we are failing our clinical users.

Myopic efforts to meet certification and compliance requirements have added functionality and effort tangential to the care of the patient. Clinicians feel like they are working for the system instead of it working for them. The best EHRs are focused on helping physicians take care of patients, with Meaningful Use and ICD-10 derivative of patient care and documentation.

Dissatisfaction is increasing regardless of practice type or EHR system. These findings highlight the need for the Meaningful Use program and EHR manufacturers to focus on improving EHR features and usability to help reduce inefficient work flows, improve error rates and patient care, and for practices to recognize the importance of ongoing training at all stages of EHR adoption.

Additional survey results show dramatic and pervasive dissatisfaction:

  • Clinicians who would not recommend their EHR to a colleague increased from 24 percent in 2010 to 39 percent in 2012.
  • 34 percent of users were “very dissatisfied” with the ability of their EHR to decrease workload — an increase from 19 percent in 2010.
  • 32 percent of responders had not returned to normal productivity since EHR implementation compared with 20 percent in 2010.
  • Dissatisfaction with ease of use increased from 23 percent in 2010 to 37 percent in 2012.
  • Satisfaction with ease of use dropped from 61 to 48 percent.

According to Modern Healthcare, natural selection may already be taking place in the EHR environment as Meaningful Use 2014 and Stage 2 introduce more exacting requirements. The magazine’s review of federal records shows a massive drop in the number of health IT systems being tested for Stage 1 2014 and Stage 2 certification.  While around 1,000 EHR technologies were certified for 2011 Stage 1 requirements, as of last week only 79 systems were certified for 2014 standards. Almost all companies are scrambling. Some will get certified in time. Many more won’t.  What will current users do if their systems are not upgraded to Stages II-IV? How much will it cost them?

 

This is just the beginning of the shakeout … there is an asset bubble in electronic health records and health IT,” said Dr. David Brailer, founder and CEO of Health Evolution Partners and former head of the Office of the National Coordinator for Health Information Technology.

“The data suggests that it is likely we’ll see a sizable reduction in the number of EHR vendors listed for 2014 edition certification,” predicted Steven Posnack, director of federal policy, and Dustin Charles, a public health analyst, on the ONC’s September 13 blog post

MU is not really about patient care.  It’s about data which HHS claims will improve outcomes.

                          

At the end of my day, it is what it is….millions of man-hours have gone into what we used today.  It is going to take time to hew out the bad, smooth out the rough edges, fill in the potholes….and if all goes well we will most likely have bankrupted the health  system (to say nothing about the Affordable Care Act.)

 

In one of my upcoming blogs I will discuss the ICD-10.

 

Wednesday, October 9, 2013

The Perfect Storm

 

I have used this metaphor, the perfect storm, several times during the past ten years to sum up the simultaneous multiple counter-intuitive shifts in medicine .

Another perfect storm has developed with the confluence of health information exchanges, health IT, the affordable care act, and the debt crisis as well as congressional gridlock.

Storm # 1 (to be named)

Health Benefit Exchanges:  The initial rollout has been sporadic with variability in reliability and accessibility. Initial success is much greater in the state sponsored and operated online health benefit exchange portals.  The federal HBE at Healthcare.gov has  receive a failing grade from consumers attempting to sign up for the individual mandated coverage.  Most reach the page shown on the Healthcare.gov portal.

Why are the state sponsored sites working well and the federal site poorly? What exactly is plaguing the federal insurance marketplace website, healthcare.gov, even as most state exchanges are functioning well, remains unknown. But Web developers and software engineers across the country have a few ideas. In the best tradition of the Internet, they've been crowdsourcing their various diagnoses on Reddit, the popular social media site.

The difficulties appear to be more technical than political. The sheer scale of a national network are much greater than individual state networks. The individual state networks stand alone and depending on which state the national HBE link will take you to the state HBX.  However if the state HBX is run by the FEDS it is a different story.  The Reddit site goes into much detail by ‘nerds and geeks’.

Those who are familiar with the DOD EMR and the VAEMR know how many years and iterations have occurred with those systems.

Second guessing is always easier to do than getting it right the first time. Heavy initial demand may be part of the problem as everyone tried to sign on at once.

HHS, CMS and federal contractors, meanwhile, are trying to address problems they find through testing and that are reported from users, all while asking for patience from would-be shoppers and encouraging them to visit assistance centers or to call and speak with navigators.

However despite the IT nature of the challenge it makes a bad political statement for the Affordable Care Act along with other postponements such as the employer mandates and many other waivers.

While the HBXs undergo a shakeout and even if they are running smoothly, that is only the high tech side of it. The real ‘back end’ is how consumers and insurers will face off after the application process.  What health systems (insurers, hospitals, and providers) will be ready and operating correctly.

We should not forget what this is all about….patients.   We always need to remember this is about patient and patient care….high tech serves them and it should never be the master//

Doctors are cautious about HIX, says MGMA, and many 
say they're still weighing their options

Storm #2

Docs 'stressed and unhappy' about EHRs. No less important and on the other side of the equation is the effect EMRs have had on efficiency and quality of care.  Regardless of what data analytics, statisticians, and bean counters claim EMR is affecting quality of care at the bedside, and in the clinic. Patients, despite their wanting their MD to use EMRs find that the next clinic encounter their ‘beloved’ doctor is paying more attention to his tablet, or laptop.

While physicians recognize the benefits of electronic health records, they also complain that many systems deployed nowadays are cumbersome to use and often act as obstacles to quality care, according to a new report from RAND Corporation.

The most poignant results from physician surveys: (Rand)

While physicians recognize the benefits of electronic health records, they also complain that many systems deployed nowadays are cumbersome to use and often act as obstacles to quality care, according to a new report from RAND Corporation.

The findings are from a project, sponsored by the American Medical Association, designed to identify influences on doctors' professional satisfaction – a snapshot of physician sentiment as the U.S. healthcare system moves toward new delivery and payment models.

Docs who were surveyed expressed concern that current EHR technology interferes with face-to-face discussions with patients, requires physicians to spend too much time performing clerical work and degrades the accuracy of medical records by encouraging template-generated notes, according to the RAND report.

In addition, they worry that the technology has been more costly than expected, and cited frustrations about poor EHRinteroperability, which prevents the transmission of patient data when and where it's needed.

"Physicians believe in the benefits of electronic health records, and most do not want to go back to paper charts," said Friedberg in a press statement. "But at the same time, they report that electronic systems are deeply problematic in several ways. Physicians are frustrated by systems that force them to do clerical work or distract them from paying close attention to their patients."

Other items that have created physician frustration are given in the article (page 1)

Administrators of all sizes, and shapes love this stuff…numbers,graphs and seemingly measurable data objectified. It’s a digital world. However patients and medical care are analog. It may be excellent for imaging and lab reports.

 

Monday, October 7, 2013

Google Expanding role in Health Information Technology

 

Google Offers HIPAA Business Associate Agreements for Google Apps

Monday, October 7, 2013

Last month, Google announced that a HIPAA business associate agreement for Google Apps is available, TechRepublic reports.

Details of Business Associate Agreement

The business associate agreement applies only to certain Google App services, such as:

  • Gmail;
  • Google Calendar;
  • Google Drive; and
  • Google Apps Vault.

To sign up, a health care organization administrator must answer three online questions:

  • Are you a covered entity (or business associate of a covered entity) under HIPAA?;
  • Will you be using Google Apps in connection with protected health information?; and
  • Are you authorized to request and agree to a business associate agreement with Google for your Google Apps domain?

After responding to the questions, the health care administrator will be taken to the online business associate agreement (Wolber, TechRepublic, 10/2).

Implications

According to Health IT Security, the business associate agreement could help remove a barrier for some health care organizations to adopt Google applications, particularly for smaller organizations that use fewer Google App services.

However, for larger organizations that use more than Gmail, Google Calendar and Google Drive as part of their cloud services package, the Google business associate agreement will likely not have a significant effect, Health IT Security reports (Ouellette, Health IT Security, 10/3). 

Sunday, October 6, 2013

Leading the Charge in Wireless Health (continued) Part II

Watch this video

from an article from CNN by Leslie Saxon M.D.

When it comes to digital health products, the prevailing attitude among physicians is still deep suspicion. While many people look at physicians as the drivers of change in digital health, I am in the minority of innovators in this field. There are some physicians who are on the vanguard of talking about it, but only a few are actual innovators. Many of the advances will come from non-healthcare innovators–the “pull through” demand will come from the public who recognize the benefits of new technology to help them become healthier and smarter about their lives.

It is ironic but technology has taken me back to my patients, who are the reason I entered medicine so many years ago. Just as digital technology has enabled us to stay connected to others, it has helped me connect more immediately with my patients. For the patients there is more control as well. Just as we control our finances, our schedules, our travel plans, and music selections through technology we can have greater control over our health and our care.

Technology will always be second to Patient Care.  Patients will remain central to all of reform. Physicians, hospitals, and other health care providers must make this their compass.

The fact is that Life with a capital L—my patients’ real, authentic experiences—mostly happen outside of my office. How can I make better observations? How can I—a highly trained person with 25 years of experience—take my knowledge and help more people? Or, help my patients at a deeper level? How can I be a better witness to their story, edit it, and make it better? There are new answers and we hold them in the palms of our hands.

Technologic advances don’t happen in isolation. There are many different elements— cultural and technologic — that must come together to turn an innovation into a scalable business product, and then, possibly—but rarely—a cultural phenomenon.

The internet, for example, changed banking, journalism, and commerce in many parts of the world. But the connection, information, and convenience it afforded missed medicine because the innovation and the cultural desire hadn’t yet arrived. Advancing technologies will soon radically change healthcare. The cultural and technologic pieces are coming together like a rising storm. I remember, like it was yesterday, when we hosted our first University of Southern California Body Computing Conference. It was in 2007.

I wanted to bring together various experts, from Academy Award winners to engineers, to imagine the future of healthcare in a digital world. In several instances, people left in a huff, or laughed off the notion of digital technology changing healthcare. Many of the physician-attendees said the change wouldn’t happen “for two decades.”

The reactions interested me because, in my experience, where there is anger, there is also fear and irrationality.
Just this week Congressional hearings debated digital medicine because lawmakers and regulators recognize that there are hundreds of millions of dollars—including the $10 million Tricorder X Prize—being invested in new, consumer-oriented technology. And these products will soon start hitting the market. At this point, some of the products are more marketing fluff than reality, while others are too difficult to use.

 

 

But there is a realization that consumers want, and need, products to connect them with their physicians, their medical records, and with relatives who are helping to manage their care. Mobile phones and other ubiquitous devices are becoming so advanced that the technology within them can be turned into a “health device.” Having changed music and communication, consumer device makers are looking for new revenue streams and they are identifying health as a way to create new revenue streams, and the result will be a change in medicine, which has been working from a 2,000 year old paternalistic doctor-patient model. Guided by Apple Computer Inc., digital technology changed the music industry. Why not change medicine?

When it comes to digital health products, the prevailing attitude among physicians is still deep suspicion. While many people look at physicians as the drivers of change in digital health, I am in the minority of innovators in this field. There are some physicians who are on the vanguard of talking about it, but only a few are actual innovators. Many of the advances will come from non-healthcare innovators–the “pull through” demand will come from the public who recognize the benefits of new technology to help them become healthier and smarter about their lives.

Shortly after the first USC Body Computing Conference, I started a center at the University of Southern California to study and create health solutions. We study digital health by evaluating products in clinical and non-clinical settings, as well as create a variety of solutions, including health games. Calling myself an innovator still feels pretentious. True innovation is really difficult. Being in the innovation trenches has taught me many lessons and given me new respect for the world’s innovators. Being creative and bringing different expertise together is difficult but critical in digital health. We work with different innovators, athletes, engineers, story-tellers and others because health is an all-encompassing issue that a physician alone cannot solve. Working with many of the smartest people in this field, as well as bringing “creative” into medicine, has given me a more holistic view. Being around so many “creative types”—and being exposed to soon-to-be-released technology has also given me special insight into the way the world will look in the near future:

1.  Body worn sensors that can transmit your heart rate, blood pressure, brain waves, and other vital signs. Physicians will be looking at this data, and calling you to check in with your specialist;

2.  Medical content that is of high quality and accurate and specific to you. Currently, medical content is generalized and not very compelling. (We did a study at USC that showed that many popular medical sites have inaccurate information.) Several companies are working on how to “mash up” different bio statistics. It may seem unusual for you to record your every heart beat today, but it might not be too farfetched for your children. Soon there will be inexpensive, tattoo-like sensors that will record information and filter it through analytics—without relying on highly subjective information;

3. New applications that help patients with chronic diseases manage their care, lab results, multiple physicians and medication, and reward patients. A major issue in medicine is compliance. As a physician, I can only get a snapshot of your life, but if I can learn more about you, and if you can help learn yourself, we will be better partners in your care. Eventually, with the information that we learn, we can spend our resources more wisely. There are a lot of promises around Big Data: there are a lot of smart people working on ways to capture and design smart analytics to sift through terabytes of data that could impact millions, if not billions, of people.

Even in the most developing of countries, mobile technology is pervasive. An example of what this could mean: just last year, I was sitting at home. Someone was using a smart phone ECG on the other side of the world. I diagnosed a Nigerian, traveling in Mumbai, who had a heart condition. I can use my unique knowledge and training to help more people, not just my patients in Los Angeles.

There will be people who read these predictions and dismiss them. What about reimbursements? What about FDA regulations? Won’t insurance companies use this information negatively? Won’t there just be medical white noise?

The questions are valid, and they need to be asked. It is always easy to over-simplify and get caught up in the hype. But—as I have learned from other innovators—demanding simplification can return fascinating results. There is a good lesson in the music industry, which stood by helplessly as their industry changed during the digital revolution. There is rapid change happening, and it’s how we address it early, and use the technology to help people, that will dictate our children’s lives. Saying it won’t happen just shows willful blindness.

I welcome the questions. But I’m optimistic. I see the innovation first hand. As a physician, I can see the possibilities for good.

Helping patients deal with the emotions that come with health issues is a large part of the "art" of doctoring. People see their lives and their health as a story. Since that first Body Computing Conference in 2007, I have spent more time with storytellers, especially my colleagues at USC’s School of Cinematic Arts. I have learned a lot about the power of story, of how the story of our lives is in many ways a health narrative.

It is ironic but technology has taken me back to  patients, who are the reason I entered medicine so many years ago. Just as digital technology has enabled us to stay connected to others, it has helped me connect more immediately with my patients. For the patients there is more control as well. Just as we control our finances, our schedules, our travel plans, and music selections through technology we can have greater control over our health and our care.

The fact is that Life with a capital L—my patients’ real, authentic experiences—mostly happen outside of my office. How can I make better observations? How can I—a highly trained person with 25 years of experience—take my knowledge and help more people? Or, help my patients at a deeper level? How can I be a better witness to their story, edit it, and make it better? There are new answers and we hold them in the palms of our hands.

 

Saturday, October 5, 2013

LIFE-HACK: Encrypted Heartbeats Keep Hackers from Medical Implants

 

The mobile health market for remote monitoring presents some new risks. “Hacking your Heart” is featured in this article from the NY Times

 

Implanted medical devices like defibrillators and insulin pumps now include wireless connections to let doctors or technicians update software or download data—but such improvements could open the door to life-threatening wireless attacks.

Security researchers have shown that they can surreptitiously reprogram an implanted defibrillator to stay inactive despite a cardiac emergency, deliver a 700-volt jolt when not required, or drain its battery.

It seems there should be a straight forward solution to this problem if pro-actively addressed. Our military manages to remote control drones using radio signals via satellite over great distances whose command and control systems remain secure to prevent purposeful hacking or accidental changes.

 

A Florida hospital has developed a system for wireless real-time monitoring and reprogramming of cardiac devices, including pacemakers and defibrillators, using an iPad. A doctor can suggest changes to a cardiac device’s settings, then relay the information for a nurse in the hospital to execute using a touchscreen laptop.

n95a1cr8 Wireless Pacemaker Programming Device Unveiled at USC Body Computing Conference

At the Body Computing Conference held on September 23 at the University of Southern California, Karten Design (Los Angeles, CA) introduced a wireless, cloud-connected device designed to simplify the programming of pacemakers.