The ICU and How to Deal with the Tsunami of Information

Walk into the intensive care unit in just about any American hospital, and you’ll be bombarded with beeping and blaring noises and flashing lights. It may look high tech. It’s not.


In fact it is not. The modern ICU is still functioning in the ear of the 1960s.  It’s “no different than it was 50 years ago,” said Dr. Peter Pronovost, a critical care physician at Johns Hopkins Hospital in Baltimore. “There are stacks and stacks of machines with wires sticking out of them. It’s chaos.”

ICUs are one of the most crucial departments of any hospital — heroic places with devoted staff who pull the sickest of patients from death. But many ICU physicians say they’re also woefully — and often dangerously — out of date. Six million patients in the United States pass through ICUs each year, and studies show serious and sometimes fatal medical errors are routine. And a recent reviewpublished in the journal Critical Care found no major advances in ICU care since the field’s inception in the 1960s.

Now, a handful of doctors and nurses in places like Baltimore, Boston, and San Francisco are trying to yank the ICU into the 21st century.

In addition to the side effects of beeping monitors, ventilators and other critical life support systems there is the aspect of the patient experience.

For many patients, time spent in an intensive care unit is a deeply disturbing experience, and not just because they are suffering from a serious illness. They are often heavily sedated, encircled by beeping equipment, unable to talk or even think clearly. Doctors and nurses prod their bodies as scores of trainees watch.

“I could feel people touching me but I couldn’t move,’’ said Ashleigh Robert, 30, who spent three weeks in the ICU at Beth Israel Deaconess Medical Center in Boston awaiting a liver transplant. “It was extremely frightening.”

It is even overwhelming to normal healthy visitors. The environment is foreign, sterile and stripped of humaness,  without decoration or art. It is inhumane.

Medical advances such as heart pumps and ventilators have led to more ICU survivors. About 80 percent of the 5 million patients who end up in intensive care each year return home. But there is a growing realization that many are left emotionally troubled by the experience, which can be marred by hallucinations, poor communication, lack of respect for privacy, and, later, post-traumatic stress syndrome.

New technology may also help ICUs — once notorious for alienating families and keeping them at arm’s length — better include loved ones in a patient’s care.

UCSF is now testing bedside tablets that patients or families can use to upload photos and descriptions of themselves. They can let doctors know what they like to be called, what their hobbies are, what they fear about their hospital stay, and what their healing goals are. The care team can then see them as individuals — and not, Schell-Chaple said, as just some 48-year-old man in Bed 8 who had a liver transplant.

“The ICU environment,” she said, “is not set up to treat people with respect and dignity.” Now, a group of leading hospitals, including Beth Israel Deaconess, is working to make the ICU less terrifying and more humane, using innovative tools such as iPad applications that feature patient biographies and journals kept by nurses.

Solutions such as AWARE and EMERGE have been developed to cope and assimilate important information into a coherent structure.

MULTI-PATIENT DASHBOARD

Enhanced Communications

•  Multiple  organ systems displayed at once
• Less time spent looking for information  across different systems
• Communication  dashboard – whiteboard,  goals of care, tasks, etc.
• Better communication  with patient and family members

Reduced Overall Care Needs

• Lower utilization of central lines
• Fewer unplanned surgeries
• Fewer radiology tests
• Fewer transfusions
• 
  

SINGLE-PATIENT DASHBOARD

Patient-centered Care

• Patient data organized by organs and systems
• Multiple  organ system monitoring
• Task list that is implemented & updated
• Best practices checklist at the Point of Care

Promote Timely Delivery of Evidence-Based Interventions

• Smart alerts provide clinicians relevant information for potential patient care needs
• Task oriented viewers include ICU checklists and timelines

Performance Metrics

• Quality improvement metrics
• Comprehensive reporting
• Reporting infrastructure for external compliance with quality indicators

The dashboards display sets of data grouped by individuals in a readily available user friendly display.

Project Emerge | Johns Hopkins Armstrong Institute

How Google Plans to Reinvent Healthcare -- The Motley Fool

Try, try again.  How Google has failed to suceed in entering the health care field.  It is not for want of trying. Perhaps because Google (Alphabet) is so large and cash heavy they fail to find and fill a need not already filled by hundreds of others. Google started with HealthVault as an early rendition of a personal  health record. Google continues to re-sort it's huge data mine.  Hopefully something will click....maybe IBM Watson can offer Google AI some advice.

The long and short of it

Apple, Microsoft, Intel -- virtually all the tech titans, in fact -- are now pursuing major initiatives in healthcare. A confluence of factors, such as digitization of records, machine intelligence, genetic engineering, and rapid advances in medical equipment, have made the field ripe for disruption from data-enabled, mobile-based, and miniaturized devices.

Even more enticing are the opportunities to massively grow revenue. The tech giants are billion-dollar companies, but healthcare spending is approaching $3 trillion annually in the U.S. alone. Looking globally, the World Health Organization estimates the annual expenditure at $6.5 trillion.

Bottom line: Despite the big carrot enticing it, Google has yet to come up with anything that can lay claim to changing healthcare. Although Alphabet could be a potentially interesting addition to your healthcare portfolio, it should be added with the understanding that there are many other pure-play companies with a much clearer path and investing thesis than Verily.

Sanofi, AbbVie, and Biogen  have also teamed up with Verily over the past few years. Big pharma hopes to tap into Google's data analysis tools, as well as license Verily's miniaturized medical devices (after they are developed), to tackle various disease targets. In a slightly different kind of venture, Johnson & Johnson has inked a deal with Verily to develop medical robots.

Verily through its parent Alphabet seems to be the banker for many spinoffs.  Must be a good write-off for the Google.  How about putting some of that money into direct care payment.

Now that is a foreign thought...to pay for patient care.All those trillions of dollars going toward paying for care.  What a novel idea !

The path is well worn. Google should use it's resources where it will do more good.







How Google Plans to Reinvent Healthcare -- The Motley Fool

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FDA declines to scrutinize manufacturer claims for “low risk” mhealth apps, devices. What’s the takeaway?

Here in the US of A the Food and Drug Administration holds sway over regulating medical devices and medications. They analyze claims of effectiveness and transparency from companies that produce medications and biomedical devices.  Prior to regulating such things they analyze possible risk factors of devices used on patients.

The FDA is tight lipped about approving such things, and often the US of A is the last to approve medications and devices. The U.K. and countries in the Euro-zone approve much before the FDA. Almost all device and drug manufacturers  outsource their R&D to foreign zones.

The regulatory burden is more than enormous.  It adds to the cost of development.

The scope of such regulations is enormous.

FDA said it will ease up vetting general health and wellness apps, but it will scrutinize clinical applications and devices. Does this mean the FTC will step up?

The U.S. Food and Drug Administration has issued final guidance on “low-risk” digital health apps and devices for general health management 18 months after it  came out with draft guidance.

The document offers information on the kinds of apps and devices for which it will and won’t take action. Apps promoting or maintaining a healthy weight or to assist with weight loss goals and healthy eating are OK.  The guidance says that companies can make claims that their apps and devices can help with healthy lifestyle choices to reduce the risk of chronic conditions such as Type 2 diabetes, high blood pressure and heart disease or improve their management. But those lifestyle choices have to be advocated by the likes of the American Heart Association or American Association of Clinical Endocrinologist or peer-reviewed medical journals.

So what are some examples of what’s not OK? Claims that a product will treat or diagnose obesity, an eating disorder, such as bullimia or anorexia, or an anxiety disorder. Digital health entrepreneurs are also encouraged to ask themselves the following questions:

Is the product invasive?
Is the product implanted?
Does the product involve an intervention or technology that may pose a risk to
the safety of users and other persons if specific regulatory controls are not applied, such as risks from lasers or radiation exposure?

If the answer is yes to any of the above, they need to assume their products are considered clinical applications, will be scrutinized and should act accordingly.

My takeaway from the guidance is twofold. It’s a question of resources. Although there are thousands of general wellness apps, more and more medical device and pharma companies are developing digital health devices and apps of their own.  Second, the Federal Trade Commission has shown it is willing to take action against companies that it deems to be making false health claims about their apps and devices.

The distinction now is 'false claims" such as those made by Focus Education , which produces.

The Federal Trade Commission has singled out Focus Education for making what it calls unsubstantiated claims for its computer game, including that it “permanently improves” children’s focus, behavior and children with ADHD, according to a statement from the FTC.

In a ruling. Makers of Jungle Rangers Computer Game for Kids Settle FTC Charges that They Deceived Consumers with Baseless “Brain Training” Claims

In another consent agreement the FTC takes action against melanoma app marketing claims, and concerns over consistency. They also took action against  Moledetective  another smartphone app

FDA declines to scrutinize manufacturer claims  and shifts regulation to the Federal Trade Commission.