Happy New Year. The following is part 2 of a collection of the best posts from Tech Medicine in 2008.

The New 3G iPhone, Doctors, The App Store, and Medicine

What follows is the result of a brief brainstorming session about potential applications of the iPhone for doctors. Some have already been announced for the iPhone, are available on other platforms, or are currently in development. Let's see how many of these applications are eventually released and sold in the App store. My guess? All of them.

Your Next Stethoscope Should be Electronic. Here's Why. (Littmann Electronic Stethoscope Model 3000 Review)

To test the performance of the Model 3000, an internal medicine resident and I listened to the heart of a patient with hypertrophic obstructive cardiomyopathy. We each auscultated the patient's murmur with both a conventional acoustic stethoscope and the Model 3000 — but to level the playing field, we placed the electronic stethoscope on the patient's hospital gown and placed the acoustic stethoscope directly on the patient's skin. We heard the patient's murmur better with the electronic stethoscope on the patient's clothes than we did with the acoustic stethoscope on bare skin.

The Doctor's Room on FriendFeed

Enter FriendFeed, founded by a few ex-Google employees. The entire service is based on an obvious concept — that people you like can introduce you to information you’re likely to enjoy. (Strangely, although the concept is obvious, it’s difficult to wrap your brain around, and it took me months before I really understood it.) Briefly, FriendFeed allows you to create a stream (or feed) of your activities on the net — blog posts, pictures or videos you like, comments on Twitter, and data from over 40 other services that you may choose to share. Other people can then “subscribe” to you, see what you’re doing, and post comments on your feed.

How Doctors Can Use Evernote As A Professional Memory Accessible Anywhere (Part 1 of 3)

In contrast, the digital world — and we can substitute "cyberspace" or
"the cloud" or your favorite phrase here — is inhabited by electronic
medical records, web-based email, and online databases. The
characteristic of this world is that information is searchable,
available-anywhere, and (hopefully) securely backed-up online in
multiple locations.

Bulletproof Backup Strategies

The ideal backup system should be invisible — that is, you should "set it
and forget it," but trust that it will work when you most need it.
Fortunately, the price of online storage and of external hard drives
has plummeted in recent years, and backup systems have become simpler,
more reliable, and less expensive.

Creating a Voicemail System for Patients using Free or Inexpensive Services Online (Google's Grand Central and CommuniKate)

One of the biggest flaws with the telephone system in many doctor's offices
is that human beings — with limited time and attention — are often
involved when they don’t need to be. They spend too much time triaging
calls and scribbling down messages. And when humans really do need to
be involved, they’re busy, much to the frustration of patients calling
the typical doctor’s office.

100+ Tips for Doctors on Call (Part 1)

Several weekends ago, while seeing nearly fifty patients in the hospital, I
asked readers of this blog and my followers on Twitter a question:
"What advice do you have for physicians on call?"

Twitter Dispatches from the New England Journal of Medicine's Horizons Conference

We can be thankful for a new trend that's emerged among medical bloggers: twittering useful dispatches from the conferences they attend.

Medical Applications in the iTunes App Store for the iPhone and iPod Touch

As of this writing, there are are over 100 medical applications for the
iPhone and the iPod Touch in the iTunes App Store. (The link is here.)
Less than six months ago, as the store was launched, I tried to guess
what applications might become available. Let's revisit that list to
see which apps have been released so far.

Happy New Year. The following is a collection of the best posts from Tech Medicine in 2008.

Take a Contract out on Yourself on StickK.com

And this is where it gets even more interesting. Let's say you support gun control. So you tell StickK that if you don’t accomplish your goal, you want all the money you’ve put down to go to the National Rifle Association. (Conversely, if you are against gun control, the money could go to the Fund to Stop Gun Violence.)

Is it better if your heart stops in a mall?

So what's the implication? You're better off arresting in a crowded mall with an automatic defibrillator nearby than you are in a hospital with trained personnel?

Post-Surgery Rounding by Robots as Good as Rounding by Actual Humans

Surprisingly, the study showed that between the two groups -- human-rounding vs. robot-rounding -- there was no difference in complication rates, length of hospital stay, and patient satisfaction.

Plans for Microsoft's HealthVault, a Personal Health Record

PHRs have the potential, at least in theory, to significantly improve communication between doctors, hospitals, and patients. The ideas is that patients and participating health providers can enter data into an online database. All the information in this database -- including allergies, medical conditions, medications, and laboratory results -- would be available to any provider who needed it. No more fumbling with handwritten lists of medications or calls to doctors offices to obtain a patients medical history. Ideally, all this information should be easily and securely available to any healthcare provider, anytime. (For an example of how this might work in the case of a patient presenting with a heart attack, see this article from the American Academy of Family Physicians.)

Medicare (and now other Insurers) will no longer pay for "Preventable Hospital Errors"

On the other hand, these complications are only potentially preventable. Even after following best practices, there are certain conditions -- like lower extremity blood clots, intravenous and urinary catheter infections , and C. Diff colitis -- that are likely to happen in the sickest hospital patients. Viewed another way, these rules are just another way of reducing payments to hospitals that are already on shaky grounds financially. Invariably, the list of uncovered medical conditions will grow to include many situations that may not "reasonably have been prevented," but for which insurance companies would simply prefer not to pay.

Google Book Search and Medical Education

Initially modest, the project has evolved into a screamingly useful, many-headed creature built on a massive body of books — and I mean massive, as in the complete searchable text of several university libraries. Google Book Search also includes lots of extras, including links to book reviews, references on websites, references from other books, and Google Maps of every place each book mentions.

The Physician Success Strategies Conference: What Can Doctors Learn From Consultants?

Many of my colleagues and I have experienced our desks disappearing under a pile of papers and charts, suddenly realizing that we’re an hour and a half behind schedule in the office, or finishing our workday to discover that we still have a stack of urgent messages that need answering. And physicians, almost universally, have been forced to see more patients, more quickly, yet are reimbursed less for their efforts.

Eavesdrop on Doctors and Medical Students on Twitter

Twitter is an instant messaging service, a microblog, a social networking phenomenon, a chatroom, the best crowdsourcing utility ever invented, or a colossal waste of time — depending on who you ask.

Slideshare and the Lifehacks for Doctors Presentation

Life hacks are productivity strategies that solve everyday problems — especially problems related to information overload. Slideshare featured Life Hacks for Doctors on their home page. In a week, it was viewed over 1300 times. The service also features tagging and searching for presentations, and it allows you to create your own groups, for example, Improving Medical Practice and Health 2.0. Slideshows occupy a singular category of knowledge. The results of a Slideshare search are qualitatively different from what you'd find from searching Google or YouTube. Here's the best way I can describe it: the presentations on Slideshare are concentrated, surfable bursts of thought.

My Experience Creating a Medical Wiki

I recently decided to start a new medical wiki — The Efficient MD Wiki, focused on productivity tips for doctors — and I took this opportunity to review some of the available wiki platforms and hosting services. It was a daunting task. I'll share my experiences here for those interested in starting their own wiki.

Happy New Year!

If acoustic stethoscopes — the kind physicians have used for over two hundred years — are the equivalent of typewriters, then electronic stethoscopes are like word processors. Okay, this analogy is non-intuitive, but hear me out. Electronic stethoscopes, like word processors, are newer, more expensive than the previous generation, and are — well — electronic, with all the advantages and disadvantages this implies.

The advantages to electronic stethoscopes are many. As I've written previously in my review of the Littman Electronic Stethoscope Model 3000, it's simply easier to hear heart and lung sounds with an electronic stethoscope than it is with an acoustic stethoscope. (For real-world examples of this, see the previous review.) Plus, some models, like the Littmann 4100 Electronic Stethoscope, allow you to record and playback — think copy and paste — heart and lung sounds for reference or teaching.

But anything electronic is prone to failure, and when electronic stethoscopes fail, they fail spectacularly. Don't misunderstand: I'm a fan of my Littman Model 3000, but it's worth pointing out the oddities you should expect if you decide to purchase one of these things. (Some of these observations are taken from my postings on Twitter.)

First — and this might sound obvious — the electronic stethoscope requires batteries. Eventually, these batteries will die. Unexpectedly. At exactly the wrong moment. Almost certainly, when you're examining a patient. At this time, your electronic stethoscope will make a sad little noise, then — silence. An eerie silence. And unless you're walking around with an extra AA battery in your pocket — which you will suddenly realize is probably a good idea — you will then say, apologetically, "I'm sorry. The battery in my electronic stethoscope just died."

Second, if you carry around an iPhone or a BlackBerry, you will experience intermittently the faint faraway static of your mobile device as you're listening to the heart of a patient. And while this doesn't interfere with your physical exam, it's unnerving.

Finally, if you were planning to place another type of diaphgram on your electronic stethoscope — such as the excellent SafeSeal stethoscope covers by DRG — don't. It will cause unbelievable amounts of feedback. As I learned recently, placing incompatible diaphragms on electronic stethoscopes makes your patients' hearts sound like they're being played by Jimi Hendrix.