July 30, 2006
Disaster Technology from China?
Cellphone technology (aka text messaging) could possibly have saved lives during the Katrina disaster?
In a story from "The Book of Joe" weblog:
In this past Wednesday's (July 26) New York Times appeared Jim Yardley's brief story about Typhoon Kaemi, which "came ashore on the southern China coast Tuesday afternoon [July 25], prompting the evacuation of more than 643,000 people in a region still recovering from an earlier storm that caused major flooding."
According to Joe, here's the sentence that blew me away: "State news media reported that officials had sent text-message warnings about the storm to six million cellphone users in the region."
Impressive.
On July 13 the Times ran an article about how the U.S. is planning to institute an updated system for disaster alerts.
That's the good news.
The bad news is that a FEMA official said that doing it the way the Chinese did, via text message to affected cellphone users, "may not be available for some time."
At least FEMA didn't come right out and say, "real soon now."
Read the articles at the Book of Joe weblog
July 23, 2006
IOM Report Calls for E-Prescribing
According to a report issued last Thursday by the Institute of Medicine (IOM), all prescriptions should be written electronically by 2010 in an effort to reduce prescription drug errors. According to the IOM, e-prescribing "is safer because it eliminates problems with handwriting legibility and, when combined with decision-support tools, automatically alerts prescribers to possible interactions, allergies and other problems."
The committee that wrote the report recommended a series of actions for patients, health care organizations, government agencies, and pharmaceutical companies. In addition to recommending that all prescriptions to be written electronically by 2010, other recommendations include steps to increase communication and improve interactions between health care professionals and patients, as well as steps patients should take to protect themselves. The report also recommends the creation of new, consumer-friendly information resources through which patients can obtain objective, easy-to-understand drug information. It also suggests ways to improve the naming, labeling, and packaging of drugs to reduce confusion and prevent errors.
The report finds that more than 1.5 million Americans are injured annually by drug errors in hospitals, nursing homes and physician offices. At least 25% of medication-related injuries can be prevented, according to the report. Technology could help prevent some errors, but hospitals and other providers have little incentive to invest in it, according to J. Lyle Bootman, the University of Arizona's pharmacy dean and chair of the IOM investigation. "We're paid whether those errors occur or not," he said.
Currently, fewer than 20% of prescriptions are electronic (AP/Yahoo! News, 7/20). Three percent of hospitals have electronic health records, the New York Times reports (New York Times, 7/21).Medications' sheer volume and complexity illustrate the difficulty. There are more than 10,000 prescription drugs on the market, and 300,000 over-the-counter products. It's impossible to memorize their different usage and dosage instructions, which may vary according to the patient's age, weight and other risk factors.
Some of the IOM's report recommendations include:
- The government should speed electronic prescribing, including fostering technology improvements so that the myriad computer programs used by doctors, hospitals and drugstores are compatible. E-prescribing does more than counter bad handwriting. The computer programs can be linked to databases that flash an alert if the prescribed dose seems high or if the patient's records show use of another drug that can dangerously interact.
- Patients and their families must be aggressive in questioning doctors, nurses and pharmacists about medications. Get a list of each drug you're prescribed, why and the dose from each doctor and pharmacy you use, and show it at every doctor visit.
- The nation should invest about $100 million annually on research into drug errors and how to prevent them. Among the most-needed studies is the impact of free drug samples, which often lack proper labeling, on medication safety.
- The Food and Drug Administration should improve the quality of drug information leaflets that accompany prescription drugs, but often have incomplete information or are written in consumer-confusing jargon.
- The government should establish national telephone hotlines to help patients unable to understand printed drug information because of illiteracy, language barriers or other problems.
July 14, 2006
Beta Test Tarascon Pharmacopoeia PDA
The new Tarascon Pocket Pharmacopoeia PDA edition is now more complete than ever. Many additional features join the existing trusted content to create the most valuable drug reference available for Palm and Pocket PC devices.
New Features Include:
- New Graphical Interface gives the application a sharp, new look for hi-resolution devices
- 6 New Calculators assist with adult GFR, pediatric GFR, Temperature Conversions, and Weight Conversions
- New Content Preferences feature allows users to customize the order in which content is displayed in their application
- New Bookmarks enables further customization of frequently used content
EHR: Two Approaches
Two interesting EHR related stories this week.
VA's EHR System Wins Harvard Award
The Veterans Affairs Department was honored for its extensive electronic medical record system, known as VistA. The system is credited with bringing veterans the highest quality, lowest cost medical care in the country.
Harvard University's Kennedy School of Government singled out an electronic health information system for praise this week. The VA was one of seven government initiatives chosen for the annual Innovations in American Government Award.
This is a decentralized, flexible approach which has consistently offered the highest quality and lowest cost medical care in the country. The software stores veteran's health care records electronically and makes them easier to share among clinics. It also uses a bar-code system to make sure medications are given to the right patient at the right time.
Remarkably, the VA is actually reducing costs and errors even though health care costs outside the system continue to soar. It is estimated that The cost of maintaining the system is $80 per patient per year.
New Pilot Program to Evaluate PHR with Senior Citizens
A new project for senior citizens through the combined efforts of Intel and Eskaton, an elder care non-profit based in California will evaluate the best way to bring Internet-based personal health records to the elderly residents of Eskaton facilities. In this program, residents will volunteer to use the system to help them manage their own health and medical information online.
Paper forms and documents can be faxed by the resident or healthcare provider to become part of the record. The residents will manage their own files and grant access to individuals of their choice and review historic documents.
The goals of the project are to use internet-based technology: to promote participation of the seniors in their healthcare, reduce costs, improve quality and evaluate the usefulness of such a system.
7/17/2006
Follow-up
A nicely done video on the Veterans Affairs hospital system VistA system can be found here.
July 12, 2006
Brain Meets Computer Again
Brain meets computer, the next chapter. A brain-computer-interface technology created by researchers at Columbia University could turn our brains into automatic image-identifying machines that operate faster than human consciousness.
By combining the processing power of the human brain with computer vision, researchers have developed a novel device that will allow people to search through images ten times faster than they could on their own.
Supported by a grant from Darpa, or the Defense Advanced Research Projects Agency, the hope is that this cortically coupled computer vision system, known as C3 Vision, would allow hours of footage to be very quickly processed, so security officers could identify terrorists or other criminals caught on surveillance video much more efficiently. 
According to the lead researcher, Paul Sajda at the Laboratory for Intelligent Imaging and Neural Computing, "Our human visual system is the ultimate visual processor." This system harnesses the brain's well-known ability to recognize an image much faster than the person can identify it.The brain emits a signal as soon as it sees something interesting, and that "aha" signal can be detected by an electroencephalogram, or EEG cap. While users sift through streaming images or video footage, the technology tags the images that elicit a signal, and ranks them in order of the strength of the neural signatures. Afterwards, the user can examine only the information that their brains identified as important, instead of wading through thousands of images.
No existing computer vision systems connect with the human brain, and computers on their own don't do well at identifying unusual events or specific targets.The new system's advantage lies in combining the strengths of traditional computer vision with human cortical vision.
For example, when a computer searches for vehicles, it will identify and discard parts of the image that contain water. The human user, who is more likely to easily spot oddities, can then look only at the parts of the image that matter. This could allow time-sensitive searches to be performed in real time.
Laboratory for Intelligent Imaging and Neural Computing
July 07, 2006
Implantable Microchips
Four hospitals in Puerto Rico will begin implanting a microchip the size of a rice grain in patients who suffer from illnesses such as Alzheimer's disease
The hospitals will start using the microchip, made by the Verichip Corp. It is inserted in the forearm, costs $200 and is voluntary.
VeriChip is the only company with U.S. FDA approval to implant such chips in people. The company has implanted more than 2,500 people worldwide with chips that give hospitals access to their identification, which is used to retrieve medical information from an Internet database.
According to the Verichip website:
It is the world's first and only patented, FDA-cleared, human-implantable RFID microchip, VeriChip is able to offer rapid, secure patient identification helping at-risk patients get the right treatment when needed most.
The VeriChip is about the size of a grain of rice, it inserts just under the skin and contains only a unique, 16-digit identifier. The chip itself does not contain any other data other than this unique electronic ID, nor does it contain any Global Positioning System (GPS) tracking capabilities. And unlike conventional forms of identification, the VeriChip™ cannot be lost, stolen, misplaced, or counterfeited. It is safe, secure, reversible, and always with you.
Once inserted just under the skin, via a quick, painless outpatient procedure (much like getting an injection), the VeriChip™ can be scanned when necessary with a proprietary VeriChip reader, whether handheld or wall-mounted. A small amount of radio frequency energy passes from the reader energizing the dormant microchip which then emits a radio frequency signal transmitting the individuals unique verification number. This number can then be used for such purposes as accessing personal medical information in a password-protected database or assessing whether someone has authority to enter into a high-security area.
Verichip also has wearable and attachable RFID tags.
Wearable RFID Tags
Refer to VeriChip’s selection of active RFID tags that can be worn by an individual (usually on the wrist or leg). For example, VeriChip's Hugs and HALO Infant Protection Systems utilize wearable Infant Tags and Mother Tags to help prevent infant abductions and accidental mother/baby switching. Patient Tags worn on the wrist are used within VeriChip's RoamAlert and WatchMate systems to prevent residents from wandering out of designated areas.
Attachable RFID Tags
Refer to VeriChip’s selection of active and passive RFID tags, such as the Asset Tag found within Assetrac, that can be affixed to items. "Attachable" also refers to the bar code technology used within the HOUNDware line of management systems for mobile industrial assets. Possible assets to be tagged include medical equipment, laptops, tools, and supplies ensuring assets can be found when needed, tracked for maintenance and replenishment, and protected from theft, loss, and hoarding.
July 05, 2006
The Growth of Open Source Software in Healthcare
According to the Wikipedia, open source software refers to computer software available with its source code and under an open source license. Such a license permits anyone to study, change, and improve the software, and to distribute the unmodified or modified software. It is the most prominent example of open source development.
The use of Open Source Software (OSS) solutions by health care providers and organizations is an increasingly important trend today. The number of OSS solutions currently available has grown to be quite substantial. The number of new OSS health care solutions under development is equally impressive.
Critical to the development of Open Source Software (OSS) solutions is the existence of formal and informal networks of developers, companies and individuals that are supportive of this movement. Many clinical OSS projects may only be supported by a few developers; others could include dozens, hundreds, or even thousands of participants. Often times, the larger clinical OSS initiatives have dedicated not-for-profit entities coordinating and facilitating development efforts.
For example:
VistA Software Alliance (VSA)
WorldVistA
Selected Examples of a Wide Range of Clinical OSS Solutions
The following are just a few of the many hundreds, if not thousands, of freely available open source software solutions or knowledge bases in the public domain.
- AMPATH Medical Record Systems (AMRS) - AMPATH is an international open source project that has built a scalable, flexible electronic medical record EMR system built on open standards. Visit www.amrs.iukenya.org and http://openmrs.org/wiki/
- BLOX - The purpose of the project is to develop a quantitative medical imaging and visualization program for use on brain MR, DTI and MRS data. It is a joint project of the Kennedy Krieger Institute and the Johns Hopkins University, Psychiatric Neuroimaging Lab. There have been 22 developers involved in this effort. In addition, the MedIC service from Johns Hopkins provides access to a variety of other free medical software at the MedIC web site. See http://medic.rad.jhu.edu/download
- CARE2X - Care2x integrates data, functions and workflows in a health care environment. It currently contains the following four major components: HIS - Healthservice Information System; PM - Practice (GP) Management; CDS - Central Data Server; and HXP - Health Xchange Protocol. Visit http://www.care2x.org/ and www.liferecord.com
- CAREWare - From standalone system to the Internet, this is a scalable software application developed by HRSA for managing and monitoring HIV care. See http://hab.hrsa.gov/careware/
- ClearHealth - ClearHealth claims to be the first Free and Open Source (FOSS) Practice Management System to address the big five features: Medical Billing, Medical Accounts Recievable, Scheduling, Access Control, and EMR . Visit http://www.clear-health.org
- Clinic Assessment Software Application (CASA) - CASA is a tool for assessing immunization practices within a clinic, private practice, or any other environment where immunizations are provided. See http://www.cdc.gov/nip/casa/Default.htm
- ClinicalTrials.Gov - The U.S. National Institutes of Health (NIH), through its National Library of Medicine (NLM), has developed ClinicalTrials.gov to provide patients, family members and members of the public current information about clinical research studies. See http://www.clinicaltrials.gov/
- Drug Abuse Warning Network (DAWN) - DAWN is a national public health surveillance system that monitors trends in drug-related emergency department visits and deaths. Various reports can be generated from their online database. Visit http://www.dawninfo.net/
- Epidemiology Info/Map - Epi-X, Epi Info and Epi Map are public domain software packages designed for the global community of public health practitioners and researchers. See http://www.cdc.gov/epiinfo/
Given the emergence of numerous viable OSS solutions, the increasing cost of commercial software, and limited funding available to health care institutions, all health care organizations need to seriously evaluate OSS solutions and related benefits as part of their information technology strategy.
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