My goal in Tech Medicine will be to explore the intersection of medicine, new technologies, and the Internet. This is a purposefully broad topic. Several times weekly I will post focused reviews of issues interesting to health professionals and nonprofessionals alike. Posts may include examinations of medical devices, pharmaceuticals, scientific advances, internet services, and other technologies involving health care and the practice of medicine. Mirroring as it does the nature of the Internet and the sometimes surprising nature of new technologies, the content may also include topics that are wonderful, unusual, hilarious, or strange.
I'm trained as a nephrologist (a kidney and blood pressure specialist). For the last two years I've written Kidney Notes, a blog designed to filter and process medical news. Most recently, Kidney Notes has become a collection of links, commentary, and scraps of information -- a reference database of interesting things with the help of a popular social bookmarking service called del.icio.us. While I will continue posting to Kidney Notes, several friends have asked me to write longer posts of original content -- and this is what I will be writing on Tech Medicine. Recently, I have also written a blog on personal productivity called The Efficient MD (in association with the American College of Physicians). I'm also writing a book on physician productivity and lifehacks.
There are many topics I plan to cover, but I'm also open to suggestions, tips, and even posts by guest bloggers. Please email techmedicine@gmail.com.
Image via WikipediaThe folks over at MedGadget (full disclosure: I'm a proud editor there) and Amy Tenderich of DiabetesMine™ are sponsoring the 2nd Annual DiabetesMine™ Design Challenge, a "a competition designed to foster innovation in diabetes design and encourage creative new tools that will improve life with diabetes."
Here's the official announcement:
2nd Annual DiabetesMine™ Design Challenge*
* a competition designed to foster innovation in diabetes design and get the creative juices flowing around new concepts and tools to improve life with diabetes*
Two of the most enticing design concepts will win a package of prizes to help further their creative efforts: $1,000 in cash, some pro-bono professional advice from world-renowned design experts, and free access to the next Health 2.0 conference for one adult winner.
This contest is co-hosted by my friends over at Medgadget, the Internet journal of emerging medical technologies, and supported by the world-renowned design firm IDEO, with headquarters in Palo Alto, CA. The campaign is generously sponsored by Cory and Justin Oringer, two young brothers (ages 14 and 11, respectively) who have both been living with Type 1 diabetes for more than 10 years each and have already seen and personally experienced many wonderful benefits of design innovation in diabetes technology. Just a few of the innovations that have changed their lives include:
blood glucose tests that previously took 30 seconds now take only 5 seconds
5 microliter droplets of blood required have now shrunk to just .3 microliters
where we once there was finger sticking only, we can now use alternate sites (nighttime toe testing gives the boys' fingers some healing relief)
multiple injections have now given way to the option for pumping with convenient temp basals, correction calculators, and "bolus wizards"
21g lancets have slimmed down to just 30g needles, now available in "virtually painless" lancing devices like Renew and Pelikan
These devices provide the lancet needles in cartridge form, doing away with accidental needle sticks (Cory's schoolmate once poked himself with a lost lancet, creating havoc at their school)
At the same time, Cory and Justin have witnessed (and lived) the revolution in communication we fondly know as Social Media. Who ever heard of a "blog" back when they were diagnosed? User-generated content has changed lives, and driven a whole new wave of excitement about contests and challenges (think American Idol, Dancing with the Stars, Survivor, and The Apprentice).
"With a father deeply entrenched in the diabetes business, Cory and Justin inevitably wind up in the midst of numerous innovation-brainstorming conversations. They’re very excited to be involved in the DiabetesMine Design Challenge," the family writes to me.
Now for the particulars:
THE BACKGROUND
It was just about this time last year that I posted my Open Letter to Steve Jobs, calling for the gods of consumer design to help revolutionize design of diabetes devices. This spurred a ton of conversation across the blogosphere and mainstream media. In the weeks and months that followed, all sorts of individuals and organizations came forward with many compelling new prototypes, designs, and ideas.
This year, we're making it an official competition, laying down the gauntlet, as it were, to anyone passionate about diabetes and product design. Whether you're a pharma R&D pro, an independent engineer, a design student or an enterprising patient, we want to hear from you.
ELIGIBILITY
This competition is open to all individuals and organizations developing devices or supplies for people with diabetes (medications not included), or enterprising patients with unique prototype concepts. DiabetesMine™ will accept submissions in two categories: under age 18, and age 18 and older.
CONTEST TIMELINE
Submissions can be made beginning April 30, 2008, until Monday, May 26st, 2008, at 11:59 pm PST. The winners will be announced on Friday, May 30th, 2008.
PRIZES
The winners will receive a combination of rewards intended to help take their ground-breaking diabetes design concept to the next level: prize money, consulting advice, industry event exposure and media coverage.
Sponsors Cory and Justin Oringer generously offer $1,000 each in two entry categories: under age 18 and over age 18 (total prize money $2,000).
Health and wellness consultants from world-renown design firm IDEO will host a two-hour workshop to help each winner refine their concept.
Organizers of the “innovation incubator” Health 2.0 Conference have generously offered one free access ticket to their Fall conference in San Francisco, October 21-23rd, 2008, for the winner of the adult competition.
Medgadget and DiabetesMine™ will promote the winners through articles and blogs, and possibly also feature some of the coolest finalists.
COMPETITION GUIDELINES
All entries must be in the form of a movie or an animation, no more than 2 minutes long (all content in English), which will be submitted by uploading into the DiabetesMine™ channel on YouTube.
Each product or design concept must be new, i.e. introduced within the last half-year, or in development phase, possibly undergoing user testing now.
One video per product idea only, please.
The product or design concept needs to have been created in its entirety by the submitting team, i.e. it must not infringe or violate the rights of any third parties, including, but not limited to the copyrights, patents, trademarks, trade secrets, and right of publicity/privacy.
Each video submission needs to contain your brief but complete "Elevator Pitch," covering the following aspects describing your new design:
Explanation of the everyday problem(s) your concept is designed to solve – how does it help improve life for people with diabetes?
Description of the medical application of the product.
Detailed depiction of the product's look and feel, material, and dimensions. Ideally the video will include a 360-degree shot of the product or design concept.
Demonstration of the product in action and its various functions, if possible.
Each video segment must display the 2nd Annual DiabetesMine™ Design Challenge screen at the beginning and end for five seconds. (See instructions below on where to download that slide)
4. Post a comment on this blog below providing the following information to help identify your video:
Video title
Your name and age (category you are entering)
Valid email contact info
State of residence
Your status (medical professional, start-up company, independent designer, student, etc.)
5. Note that by submitting an entry for the 2nd Annual DiabetesMine™ Design Challenge, submitters agree to these additional OFFICIAL CONTEST RULES.
THE JUDGING CRITERIA
Winners will be evaluated both popular vote and by a panel of three judges. In a sort of reverse American Idol system, reader voting will be taken into consideration, but the final determination will be made by the judges.
The judging panel will consist of one MD/Editor from Medgadget, one design expert from IDEO, and Amy Tenderich of DiabetesMine™ providing the patient perspective on user experience/desirability of the product. Entries will be judged on three-pronged criteria:
Efficiency - how does it solve a real-life problem for people living with diabetes?
Clinical Efficacy – how realistic and applicable is this product from a medical standpoint?
Aesthetics - it's the look and feel, Baby! How good is the pure design?
Remember, good design can be applied to anything, even something as "low-tech" as a special container for disposing of used glucose test strips. Let the innovation begin!
Sermo, the online network for physicians, just started a board for medical jobs:
Goodbye recruiters! On Sermo Jobs™ there are no more third parties—no recruiters, no headhunters, and no conflicts of interest. Sermo Jobs™ provides the perfect forum to connect with one another, discuss job opportunities, and network—all in real time.
Scientists from Harvard Medical School's Beth Israel Deaconess Medical Center in Boston, the University of Massachusetts Amherst and the University of Washington in Seattle say they were able to launch cyber strikes against and glean private patient data from an ICD's communication protocol while testing the device's safety and security.
Below are juxtaposed three visions of the future of healthcare. The first is from Microsoft, a conceptual video which echoes 2001. But the computers don't remind me of HAL. They remind me of, um, the iPhone. The video follows a pre-diabetic (presumably type 2) patient as she's out on her run, with all her physiologic data being automatically uploaded to her personal health record, which is then sent to a researcher who enrolls her in a clinical trial... For more commentary, see Dr. Bill Crounse's post on Microsoft's Health Blog. (Did you know they had a health blog?)
The second video is of Dr. Jay Parkinson -- who's in the running for medical iconclast of the year -- displaying the Myca Platform. Myca aims to be a revolutionary interface for the medical record. Here's a description from the website:
Myca is a technology platform that opens intelligent channels between patients and doctors. It supports access to a better care experience through the entire range of connections, from live video communications, video mail, chat and secure email to face-to-face office visits. It is designed to use everyday consumer technologies and be consumer-friendly.
What the Myca platform delivers:
* Video, voice and data communications across multiple platforms and channels, including mobile phones and PCs * Practice automation through documenting and archiving of communication * Intelligent system offers rules to validate diagnoses delivered through a compelling, easy-to-use interface * On-line personal health records * Secure access to each interaction for patients and doctors * Integrated scheduling and billing * Integration with remote monitoring devices and services * Online prescriptions with dosage guardrails and medication interactions alerts * Automatic medical coding for diagnostics and therapy * Ability to add nutrition and wellness features to support preventive medicine
With a single communications and clinical information platform, Myca offers an elegant solution to the three top healthcare issues; access, high-quality medical care, and cost management.
Finally, the third video was taken at the recent EconHealth conference in New York. It features executives of many popular Health 2.0 Websites describing their vision of the future (and present) of healthcare. The Panelists include Raj Amin, CEO and co-founder, HealthiNation; Steven H. Krein, CEO and co-founder, OrganizedWisdom; Daniel Palestrant, CEO, Sermo; Dean Stephens, president & COO, Healthline. The Moderator is Michael Mason, Health Editor of the New York Times.
Kreuziger’s experience is shared by most Americans: They want the convenience of e-mail for non-urgent medical issues, but fewer than a third of U.S. doctors use e-mail to communicate with patients, according to recent physician surveys.
“People are able to file their taxes online, buy and sell household goods, and manage their financial accounts,” said Susannah Fox of the Pew Internet & American Life Project. “The health care industry seems to be lagging behind other industries.”
Doctors have their reasons for not hitting the reply button more often. Some worry it will increase their workload, and most physicians don’t get reimbursed for it by insurance companies. Others fear hackers could compromise patient privacy _ even though doctors who do e-mail generally do it through password-protected Web sites.
There are also concerns that patients will send urgent messages that don’t get answered promptly. And any snafu raises the specter of legal liability.
Many patients would like to use e-mail for routine matters such as asking for a prescription refill, getting lab results or scheduling a visit. Doing so, they say, would help avoid phone tag or taking time off work to come in for a minor problem.
Still, a survey conducted early last year by Manhattan Research found that only 31 percent of doctors e-mailed their patients in the first quarter of 2007...
I'm surprised that almost a third of doctors emailed their patients, frankly. I would have suspected the number would be lower.
The article goes on to say that Cigna and Aetna have piloted programs which pay doctors for making "virtual house calls" through email. This is a step in the right direction. Dr. Robert Center points out that the lack of payment has been a major barrier to more widespread adoption of patient-physician email.
As I write repeatedly, physicians are not paid for their time, they are paid by the widget. The patient visit is our version of the widget. Anything that we do to prepare for that visit, communicate between visits, review the tests induced by that visit or discuss you problem with another physician is gratis. We cannot bill for the proper use of time to improve the patient experience.
For further reading on patient-physician email, see
The iStan Medical Mannequin: it Sweats, Bleeds, and Breathes.
Saturday, April 19, 2008
Joshua Schwimmer, MD, FACP, FASN
There's an appeal to learning medicine on virtual patient simulators, like Simantha, a simulator for cardiologists that I wrote about last week. You can practice dealing with emergencies and challenging patient situations that you might rarely encounter in practice. You can learn from your mistakes. You can be tested in a standardized fashion with actual clinical situations. And you can learn about pathophysiology and the effects of medications without the need for laboratory animals or actual patients.
The excellent blog, Clinical Cases and Images, brought a new patient simulation to our attention -- the "iStan" medical mannequin. iStan is a "wireless, sweating, breathing, bleeding training mannequin," according to Chris Seper of the Cleveland Plain Dealer. A video of iStan is below:
Live from ShowCASE: iStan
iStan is completely wireless. Procedures that can be performed on iStan include defibrillation, chest tube, catheterization, and needle decompression. He can also "drool, cry, and bleed out of his ears."
iStan was originally designed for use by the U.S. Army. For more information on iStan, as well as interviews with the engineers who created it, see the METI website.
Designed from the inside out, METI has created the first patient simulator truly based around a human-like skeletal structure. A revolutionary development in itself. But iStan also closely mimics the anatomical workings of the human body to a level of realism not possible with other simulators. Spine, neck, arms and hips all move with incredible life-like accuracy. And iStan is fully wireless and battery operated for amazing portability and versatility. Modeled from a unique cast of a real person, the skin of iStan truly acts, looks and feels like real human skin. Finally, iStan comes fully loaded, boasting an unsurpassed array of new, breakthrough features that will take simulation training to a new and exciting level of realism.
Image via WikipediaThis is a guest blog post by Dr. Arnon Krongrad, a urologist and founder and director of the Krongrad Institute for Minimally Invasive Prostate Surgery. It illustrates some of the ways physicians are utilizing the internet and online social networks such as Ning.com to educate patients about their practices.
--
“I hope you are not one of those used car salesmen turned robotic surgeon.” Rhonda said that her husband had had his prostate removed. She sounded like she regretted his decision. If so, she is not alone. A paper to be presented at a urology meeting reports that the likelihood of regret is approximately 2.5-fold higher for men having robotic prostate surgery.
I am a prostate cancer surgeon. In 1999, I introduced minimally invasive prostate cancer surgery to the United States. The surgery that Rhonda’s husband had is a form of this surgery. Given that minimally invasive prostate surgery reduces bleeding and pain, her words seem ironic. Why would a technical advancement that reduces bleeding and pain be associated with regret? There is no answer, although regret may represent a mismatch between expectations and delivery.
Rhonda’s regret comes in the context of acrimony in the public arena. Consider that 2007 saw death threats against commissioners of the Food and Drug Administration if they voted wrong on a prostate cancer vaccine. In various ways, one picks up signs that communication between the physician and prostate cancer patient communities has broken down. One feels that expectations are not being met and frustration by patients is intense, that there is a need to build bridges. The question is how.
In November 2007, the not-for-profit Prostate Cancer Mission, which I chair, held a public experiment. It conducted a seminar in which world experts on various aspects of prostate cancer addressed an audience of lay men and women. The event carried no drug company or device maker sponsorship. It succeeded brilliantly at showing that doctors and patients can enjoy each others’ company and learn from one another. When commercial bias is minimized, we can build bridges and communicate.
The question then became how to leverage the positive experience of 300 people into something broader and more sustainable. The obvious answer is the internet, which provides an unlimited potential to share information. As it stands, most of what one finds on the internet today is biased, ignorant, or shrill. It is not useful to the vast sea of men and women who need simple, relevant, and interactive information. What do do?
In 1994, the world’s first prostate cancer web site was introduced. It ran as the New Prostate Cancer InfoLink until it died a computer viral death in 2001. Uniquely, the InfoLink presented articles in simple English and offered an “Ask Arthur” section in which men and women could write in questions about their situations and get answers.
We are now introducing the New Prostate Cancer InfoLink as a modern incarnation of the original. Like the original, it will have articles in simple English that are written by some of the world’s foremost authorities on prostate cancer. It will have a blog to help you interpret the news. Uniquely, it will have an expended Ask Arthur that now brings a doctor, layman, and wife with 50 man-years of prostate cancer experience. You can get information and news and online, interactive guidance about your situation.
We are also developing a New New Prostate Cancer InfoLink social network. Modeled on Facebook, this sister site is far less structured and permits organic growth, group formation, and broadcasting of questions and answers. Here we can also bring together doctors, scientists, patients, government officials … anyone with an interest in prostate cancer. It is our hope that the Prostate Cancer InfoLink sites will let us build bridges between physician and patient communities to the benefit of both.
If you run a web site or blog, please consider providing a link to the sites. Then you too can be part of a global bridge building effort:
I'm Writing a Book with the American College of Physicians
Friday, April 04, 2008
Joshua Schwimmer, MD, FACP, FASN
The ink on the contract is drying, so I'm finally able to make this announcement: I'm writing a book with the American College of Physicians. This means that I'm humbly joining the ranks of other medical bloggers with book deals based on their blogs. (I'm aware of several, but I'd love to see a complete list.)
Writing a book was never my intention. I started The Efficient MD because I was interested in ways physicians could increase productivity and improve patient care using simple principles from books like Getting Things Done and The Successful Physician. I realized there were no websites devoted solely to lifehacks for the medical profession, so I decided to create one.
And as it turned out, the publishers at ACP Press became fans of The Efficient MD website. They felt, as I did, that this was a worthwhile topic. After several meetings, we decided to turn the ideas on that site into a book.
Some thoughts on the project:
The medical blogosphere will be prominently featured. The book will describe ways the blogosphere benefits both health care professionals and patients.
I've already spoken with several physicians and consultants with innovative ideas who will be featured in the book. If you'd like to be interviewed -- or if you'd like to offer help, feedback, stories, or ideas -- please contact me.
To make it easy for healthcare professionals to share their advice on medical practice with others, Dr. Ves Dimov -- Hospitalist at the Cleveland Clinic, Clinical Assistant Professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and writer of Clinical Cases and Images -- and I are creating The Efficient MD Wiki. Like Wikipedia, this will be a public website to which anyone can contribute. It will be devoted to clinical pearls, helpful links, general advice, and strategies for improving the practice of medicine.
More information to follow. Thanks for reading. Of course, comments and feedback are welcome.
Joshua Schwimmer, MD, FACP, FASN
About the American College of Physicians
The American College of Physicians (ACP) is a national organization of internists — physicians who specialize in the prevention, detection and treatment of illnesses in adults. ACP is the largest medical-specialty organization and second-largest physician group in the United States. Its membership of 125,000 includes internists, internal medicine subspecialists, and medical students, residents, and fellows.
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Image from WikipediaWhat's this blog all about?
