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 three 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) and hosted The Efficient MD Wiki. I'm also writing a book with the American College of Physicians on physician productivity and life hacks. My collected posts may be found on jschwimmer.net, a tumblelog.
There are many topics I plan to cover, but I'm also open to suggestions, tips, and even posts by guest bloggers. My email is techmedicine@gmail.com.
Under the settlement, which is subject to court approval, the money will be used to set up a book registry, resolve existing claims by authors and publishers and cover legal fees. Copyright holders will also be able to register their works and receive payment for book sales and use by individuals and for subscriptions by libraries. Revenue from those programs will be split between Google, the publishers and the authors.
Translation: the ebook industry is primed to explode.
A complete answer was found in 53% questions sent to PubMed or UpToDate. A partial or full answer was obtained in 83% of UpToDate searches and 63% of PubMed searches (p less than 0.001)...
It looks like UpToDate is gradually becoming "the universal textbook of medicine." Do you remember the last time you opened Harrison's to consult about a clinical topic? Was that in 1997 or 2001?
I don’t mean that he would have been first in line at the doctor’s office to get a needle jabbed into his famously furrowed brow. I mean that Darwin would have loved to use Botox as a scientific tool—to eavesdrop on the intimate conversation between the face and brain.
The New England Journal of Medicine is seeking to bring together a group of visionary medical students and trainees to help NEJM push the boundaries of traditional medical publishing. We are looking for creative minds to join the editors for a weekend to explore what's possible. We anticipate a vigorous dialogue around the ideas that invited participants and other speakers share with the group.
We can be thankful for a new trend that's emerged among medical bloggers: twittering useful dispatches from the conferences they attend. (For an introduction to Twitter, a microblogging tool, see this post.) In order to make their Twitter postings (or "tweets") easily searchable, many bloggers are now including "hash marks" or tags with their tweets. For example, Twitter users who wrote about the recent Health 2.0 conference including the tag #health2con. Dr. Theresa Chan from the excellent Rural Doctoring blog recently reported from the Society for Hospital Medicine conference in San Francisco with the tag #SHM. And Drs. Dimov and Walker both twittered from the NEJM's Horizons conference with the tag #NEJM. (You can search Twitter at search.twitter.com, the site previously known as summize.com, which Twitter acquired.)
Here are some selections from Ves and Graham's dispatches from the conference. (Thanks again to both of them for sharing their thoughts.)
grahamwalker: Off to Boston on 1.5 hours sleep for NEJM-sponsored super meganerd medical computer tech conference. Woot.
allergynotes: #NEJM The typical medical resident relies heavily on UpToDate and Google, even checks Wikipedia, whether you like it or not.
allergynotes: #NEJM I was surprised how many of the conference attendees and NEJM staff read my blog. Feel humbled.
allergynotes: #NEJM We talked about why blogging is difficult. If you set the bar too high for your posts, you may not blog at all.
allergynotes: #NEJM Typical resident does not do much for fun in their free time because they have so little of it.
allergynotes: #NEJM Typical resident only listens to medical podcasts when driving or exercising. Note to podcast editors: don't put us to sleep.
allergynotes: #NEJM My suggestion: all NEJM articles should have comments open and authors should be able to reply if they wish to do so.
allergynotes: #NEJM It looks like I will be on NEJM student/resident advisory board, at least until the editors read my Twitter updates... :-)
allergynotes: #NEJM Many conference attendees have iPhones (and love them). Not many Palm/Treo users.
allergynotes: #NEJM 3-4 conference participants (out of 20) told me they heard about the conference from my blog. Nice. Smart readership, not the writer.
allergynotes: #NEJM Typical resident has a Facebook profile. Note to conference/course organizers - use Facebook in your programs.
grahamwalker: #NEJM Choose your own adventure for clinical cases online. 81M p/w cough and chest pain: do you want a cxr, cbc, d-dimer, and why?
grahamwalker: #NEJM No surgeons, OBs, Peds here, overwhelmingly Medicine focused.
grahamwalker: I feel like a super lazy computer nerd compared to the people at this #NEJM conference.
allergynotes: #NEJM Suggestion: Add video summary be the editor on the front page - 5 minute long, make it available on YouTube.
allergynotes: #NEJM The grand number of Twitter users? 3, Graham and I included.
allergynotes: #NEJM Note to teaching attendings - you can be great without being intimidating, take example from NEJM editors.
allergynotes: #NEJM All discussions are taped with digital recorders for full transcriptions later. NEJM really wants to know what we think :-)
allergynotes: #NEJM Discussions about the future of medical education with NEJM editors continued in the lobby bar until midnight. That's dedication!
This is a dramatically big web company. Crunchbase says it has 4.2 million unique visitors a month. So, getting his point of view on anything is interesting, but hearing his view on the economy at this time is even more interesting (he is seeing an effect even on his company, so my advice that healthcare will be recession resistant might not have been that good, although he says they are setup very well to thrive long term)...
He also tells me about the recent Health 2.0 conference, the efforts of Google and Microsoft in the healthcare market, privacy of your health records, among other things, including what he thinks Barack Obama will be able to get done in healthcare if he’s elected President.
Twittering for public health. PF Anderson, a health care librarian that I also follow on Twitter, posted a presentation on "Twittering for Public Health" on SlideShare.
Waiting for the doctor. CNN posts a story on strategies for dealing with long waits in doctors' offices. Strategy #1? Stage a revolt.
"I ended up waiting two hours to see my gynecologist once, and I just went nuts," says Joanna Lipari, who lives in Santa Monica, California. "I'm a New York Italian, and we don't go well for this kind of stuff. I was so irritated that I gathered together the other eight ladies in the room and joked, 'Let's stage a revolt.' "
The other women took her seriously, and wrote letters to the doctor. "I told her she's a wonderful doctor, but this really wasn't cool. I told her it was inconvenient, uncomfortable and spoke badly for an otherwise exceptional medical practice," says Lipari. "I was trying to change her behavior, and it worked. They changed the way they scheduled appointments."
Among those potential changes is likely to be a shake-up in the physician workforce as older physicians put off retirement while young would-be doctors meet resistance in securing medical school loans, according to a series of interviews by MedPage Today on the predicted fallout from the sharp economic downturn.
At the same time, medical group practices will have trouble making payroll or updating technology. And hospitals will be forced to change their "bigger is better" mindset and delay massive construction projects.
Now Continuing Medical Education content that we broadcast on our XM satellite radio channel is available to iPhone and iTouch users directly with this new application. Just download the ReachMD CME iPhone app to your iPhone or iTouch, listen to the program and easily take the CME certification test from your iPhone, iTouch or here on our web site.
Tech Medicine Links is a collection of selected developments in the worlds of technology and health care. Have a suggestion? Please email techmedicine@gmail.com.
As I write this piece looking out the 19th floor window of my room at the W Hotel, a large yellow constructions crane interrupts my view of the Bay Bridge, water and mountains beyond. It strikes me as the perfect metaphor for Health 2.0.; It is rising up all around us, but where is all this technology taking us? Are patients better served and is care being improved because of health-specific search engines, patient and disease social networking, on-line personal health records, and retail genetic testing? Or is the plethora of health information that is now available to patients only frustrating them because the health delivery system and their personal physicians are so unprepared to deal with it? How will an industry being rattled by shortages of skilled labor and a burgeoning populating of aging patients with chronic diseasesrespond to an ever-increasing demand for services? It certainly won't be able to respond using the work-flow and business models of the past. Telling patients they must make a phone call, book an appointment, drive across town, wait in a waiting room, and wait again in an exam room for 5-10 minutes with their doctor just won't cut it anymore. And yet, if we don't make changes to a reimbursement systems that only pays doctors for seeing patients one on one in an exam room somewhere, how can we expect the health delivery system to incorporate and embrace new models of care?
West Shell, CEO of Healthline, had a nice demo of his health search site - he talked about their intelligent ad targeting and how they have built a taxonomy to make the ads more contextually relevant - When searching for "AAA" on a health site, think "Abdominal Aortic Aneurism," not flat tires.
Turning our attention away from Health 2.0 for a moment: the Bioethics Blog discusses sending anonymous STD notification greeting cards by email. The website is inSPOT. (It's a great idea — but how long until the idea is co-opted by malicious spam?)
More of thepublic (57.4%) than the [medical trauma] professionals (19.5%) believe that divineintervention could save a person when physicians believe treatmentis futile.
Tech Medicine Links is a collection of selected developments in the worlds of technology and health care. Have a suggestion? Please email efficientmd@gmail.com.
The Health 2.0 Conference in San Francisco is underway. For those of you who aren't attending — like myself — I've complied a list of resources to help you follow the action from afar. Of course, Even if you are attending, you still might find these resources useful.
Information: Most valuable aspect of the Internet: “people.” Those who think about health information think of individual transactions–but the value is when people share this information. Yahoo Groups, “the first social software,” illustrates tremendous public demand for collaboration with others. “Wherever people trust each other, the information will flow...”
Parallel: In healthcare, the standing command-and-control structure sees “healthcare” as the sum total of providers, payers, etc.–the established institutions. But the patients are healthcare too–and they outnumber professionals by 100 to 1. Once they collaborate, the central institutions lose power–and have to change.
Edelman's Health Engagement Blog is also writing about the conference. (If you know of other blogs related to the Health 2.0 Conference, please leave a comment.)
Finally, three Twitter users that I follow are microblogging the Health 2.0 Conference: SJ Davidson, Enoch Choi of MedHelp (the previous author of Tech Medicine), and the prolific Jen Mccabe Gorman — who was kind enough to post a compendium of her health 2.0 demo tips. (Of course, if you're twittering the conference as well, feel free to post a comment.)
The Health 2.0 Conference starts tomorrow (October 22) in San Francisco. We've previously discussed Medicine 2.0, so in case you have difficulty keeping all these terms straight, here's a definition of Health 2.0 by Matthew Holt, one of the founders of the conference:
Our definition is currently focusing on user-generated aspects of Web 2.0 within health care but not directly interacting with the mainstream health care system. That means, a) search, b) communities, c) tools for individual and group consumer use. But clearly there are blurring boundaries between all these, and the question of connecting Health2.0 user-generated content to the wider health care system--which hasn't exactly adopted Web1.0 with a flourish yet--is coming into closer focus as more clinicians and organizations start to use these technologies to communicate with consumers.
I believe the panel on Pharma and Health 2.0 moderated by Jane Sarasohn-Kahn is going to be of special interest. Jane’s publication outlining web technology in medicine and healthcare has practically served as a roadmap for many of the new companies coming into the mix. And last, but not least, Craig Stoltz (Web2.0h...really?) will be moderating a panel on Consumer Health Searches. This is one of the most diverse areas of Health 2.0 and one of the most critical - of particular interest are Organized Wisdom (a user powered search) and Healia. With more and more consumers, like physicians, turning to the web for health related information, the more efficient, refined, and accurate consumer searches can be the better.
I'll be blogging some of the highlights of the conference, but I'm sadly not able to attend in person this year. If you'd like to send me updates, links, or commentary, please email efficientmd@gmail.com.
Image by -RobW- via FlickrFuturology is the art of postulating possible futures. Here's a tour of some possible futures of medical care.
Medinnovationblog, written by Dr. Richard Reece, imagines a detailed vision of what medicine might be like in 2020. He discusses a burst health care bubble, global competition, consumer driven care, and the future of EMRs.
Well, it 2020. I’m happy to report the U.S. health system has finally developed a sustainable health system. It’s been a long haul, and it hasn’t been easy.
It’s the story of a 12 year struggle with realities – coping with a severe economic contraction; making tough political compromises between liberals and conservatives; decentralizing of health institutions, including virtual monitoring and managing of the chronically ill and dying at home; competing globally for the health care dollar; responding to consumer demands for affordability, convenience, choice, and access; optimizing clinical benefits for money spent; and most importantly, developing sustainable business models in which outcomes matched money expended.
The resulting U.S. system hasn’t satisfied the two political parties. Democrats, particularly its liberal wing, are disappointed a single-payer approach hasn’t evolved. Republicans are unhappy a consumer dominated system hasn’t caught fire. “Progressive capitalism,” the U.S. version of socialism, has replaced unfettered capitalism.
MedGadget, a fantastic source of information on new, emerging, and potential technologies, discusses the auctioning of medical care. In this case, radiology services:
To start the bidding process, clients post their requests and all radiologists pre-qualified by them receive an email invitation to bid. The lowest bidder wins the contract, downloads the cases and uploads the final radiology reports. There are no possible delays in diagnosis because the bidding process is settled months in advance “The system has advantages for all parties,” said Dr. Roubein. “Hospitals and imaging centers benefit from market competition that gives them the best price for radiology interpretation services at any given time."
The Health Care Blog discusses the new medical wikis, Google's Knol and MedPedia, as well as other emerging wikis that you've never heard of.
What makes these efforts particularly interesting is that, through a collaborative Web-based process, they attempt to distill and document the current best knowledge about any topic. In health care, the goal is easily accessible state-of-the-science information, the equivalent of ongoing medical/scientific review articles that detail what we know and don’t know about life and care processes.
MedPedia and Knol are merely two in a line of health care wikis. The Joint Commission established WikiHealthCare, an interactive forum for health care professionals. Clinfowiki is devoted to clinical informatics. And of course this blog’s readers will be familiar with the Health 2.0 wiki, which has assembled information about that burgeoning sector.
The best known series about the ordinary working life of a doctor of the future are the Sector General novels of James White, which follow Dr. Conway and his human and alien colleagues of the multi-species, multi-environment space station/hospital Sector General. Most recent in the series are The Galactic Gourmet, in which the galaxy's greatest chef undertakes the galaxy's greatest gastronomic challenge - to make hospital food palatable - and sets about it with such utter singlemindedness as to cause havoc, Final Diagnosis, in which a xenophobic patient arrives suffering from a mysterious illness, and Mind Changer. In contrast to the 'tertiary care centre' that is Sector General, Calhoun in The Med Series (Murray Leinster) is the public health inspector, travelling from colony to colony, alone but for Murgatroyd, an ape-like creatures who acts as a living toxicology and immunology laboratory. Alan E. Nourse's Star Surgeon portrays life for the interns of the future, as new graduate Dal Timgar and his two colleagues set out aboard the General Practice Patrol Ship Lancet. Surgeon Dr. Cherijo Grey Veil, herself the product of illegal genetic engineering, leaves a sheltered life on isolationist Earth for an understaffed clinic on a multispecies colony and finds friendship, love, strange physiologies and plague, in S.L. Viehl's Stardoc. In the sequels, Cherijo's life goes from bad to worse as she is hunted by her progenitor, enslaved by the Hss'kt, enthralled by the enigmatic telepath, Duncan Reever, and re-captured by her progenitor/creator.
I've described the iPod Touch as the next great technology for medical education, but the Kindle is also a device with great potential. We've recently implemented Kindle support for all our 20,000 educational resources at HMS... Our integration on the Mycourses educational website enables any Word or PDF document to be delivered to the Kindle wirelessly... HMS is the first Medical School to offer such a green alternative to all of their compatible resources to be downloaded directly to an eBook.
As the first EMR to be offered completely free and web-based (announced in October, 2007), Practice Fusion is now being used in 45 states, by nearly 2,000 users, and is one of the fastest growing EMR communities in the US. The company continues to focus on innovation by leveraging and supporting latest technology. Practice Fusion is now supported on all major operating systems and web browsers, thereby lowering the barriers to entry for physician practices and eliminating significant technology hurdles present with other vendors.
National Survey Indicates U.S. Adult Health Blogger Population Stands At 13.6 Million; Second Edition of Global Health Blogging Poll Shows Fewer Hide Identity, Most Respondents Confident
The tools and services of web 2.0 can facilitate the work for medical professionals and help patients as well. If you would like an even more efficient medical practice; more productive research, pharma team; or you would like to know web 2.0 sites focusing on your medical condition, Medicine 2.0 Personalized Packages are created for you.
A Comparison of "Mediquations," "MediMath," and "Medical Calculator," Three Medical Calculators for the iPhone
Tuesday, October 07, 2008
Joshua Schwimmer, MD, FACP, FASN
Image by Roberto_Garcia via FlickrRemember when there weren't any medical calculators for the iPhone? Now there are at least three — Mediquations for $1.99, Medimath, which is free until 10/12 (and will be $4.99 thereafter), and Medical Calculator (also free for a limited time). All are rated four stars at the iTunes store, and all are excellent and easy to use. As there are certain variations in the formulas included in each program, I've provided them here to make your choice easier:
Dr. Kevin Pho, the medical blogger who writes Kevin, MD, recently wrote an op-ed piece in USA Today about electronic medical records (EMRs). It's worth reading and tackles an important issue. Specifically, Kevin bemoaned the lack of EMRs in many doctors' offices and explored the reasons why more physicians don't invest in EMRs.
The biggest reason? The cost of an EMR can be as high as $36,000 per physician, and the benefits to individual physicians are uncertain. Other potential barriers include a steep learning curve. In the words of Dr. L. Gordon Moore, "When you put an EMR into a primary care practice, your life is hell for the next year." And frankly, the user interfaces of many EMRs are awful. Dr. Jay Parkinson put it this way: "[Many EMRs] look and function like they were designed by freshman engineers on Windows 98."
Practice Fusion, a free, ad-supported, web-based EMR, provides one novel solution to this problem. Previously available only for Windows systems, Practice Fusion recently became entirely browser-based. MedGadget has a review here.
Another potential solution is to have the government provide physicians with an EMR based on the VA's system. (There is a program in place to provide this to physicians, but I don't personally know of any doctors that have taken advantage of it.) While a government-provided EMR has certain disadvantages, here's a description of how the system works in the UK. From the Nephrol mailing list:
For several years all government hospitals in the UK have their own secure email systems. All government clinical staff have an account on the system where they work which they can use to send confidential patient information to other staff within the same institution.
For the last few years we have a secure national email system (NHS.NET) which can be used to send patient information anywhere within the European Union. NHS.NET email is encrypted and account holders can only log in from a PC within the European union (so subject to our data protection laws which have been standardized within the European Union). The email message is encrypted on the user's PC and only decrypted on receipt by the recipient's PC. Any person employed in a clinical capacity by the UK national health service (NHS) can have an account on NHS.NET.
Renal patients in the UK also can access their electronic patient records over the internet using http://renalpatientview.org .
Data is sent (encrypted) from the hospital renal electronic records into RenalPatientView each night. Patients can see their up-to-date lab results, drug lists clinical records etc. using a web browser. The web site has some patient information specific to their diagnoses also.
In my clinics, I ask the patient to look up their results the next day, then discuss them with me by email. I tell the patient what to look for (e.g. rise in creatinine).
I can access the patient records over the internet from home or while travelling and can communicate with the patient and clinical colleagues by email if required.
General practitioners may also access the patients renal records over the internet (with the patient's permission). This is useful as we co-operate in the patient care and the general practitioner need to know the results of our clinical consultations, up to date drug lists etc.
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Image from WikipediaWhat's this blog all about?
