Innovative Healthcare Technology

Cloud Computing in Healthcare Expected to Grow

2012-08-02T16:54:00Z

This guest post by tech writer Jason Hunter addresses cloud computing in healthcare:

Across many different industries, cloud computing has already contributed to cutting costs, sharing information and increasing productivity. Now the cloud has its sights set on the healthcare industry. In 2011, cloud computing in healthcare was worth $1.8 billion; by 2017 it is expected to grow to $5.4 billion. The growth will be driven by many different factors that will fuel the growth, but physicians are urged to make the switch sooner rather than later.

Current Changes in Healthcare and Payment Processing

With healthcare reform and payment processing, the cloud will become a cost effective tool for the healthcare industry. As cloud payment processing is paid incrementally, healthcare providers, physicians and healthcare organizations only have to pay for what they need when they need it rather than purchasing all of the equipment up front.

New changes in healthcare will also create the need for additional file storage, collaboration and faster information processing. The cloud has already proven to be successful in these areas of business throughout other industries by combining mobile computing, unlimited cloud storage and the ability to send large files over the internet. As the healthcare industry continues to convert to cloud computing, we will see faster diagnostics, collaboration between physicians and the ability for physicians to access information from anywhere.

These features will drive many physicians to make the change now, as others may wait until the cloud has a proven rate of cost savings within the industry. The cost and time to make the switch currently holds back most in the industry. However, many providers who are opening new practices are starting with cloud services rather than changing later.

Healthcare Security and the Cloud

Since the introduction of the cloud as a business standard, security has always been a question and concern. Unlike some of the other industries currently using the cloud, the health care industry is based on sensitive patient information. However, new innovations and detail has been put into creating HIPAA-compliant cloud services.

These services include cloud storage, offsite backup, file transfer and sharing and cloud application hosting. Healthcare organizations can feel secure while still utilizing the technology cloud computing, the cost savings and the increase in care and productivity.

The cloud is more versatile and beneficial than many people realize. The ease of use, multiplatform support and real-time accessibility is causing the cloud to change technology and business as we know it. As more organizations in the healthcare industry adopt cloud computing, we will see an increase in personal care and less data loss regardless of which hospital or provider we see.

Jason Hunter is a tech writer who follows cloud computing security and suggests you click here to find out more about cloud services and security.

Re-Mission and Other Healthcare Games

2012-07-05T17:24:00Z

I have written previously about using game-play increases the potential for people to use software more frequently and, if applied to healthcare, could dramatically improve the health of individuals. One example might be using a medication adherence app that makes taking medication more interesting and engaging.

Well, not only do game manufacturers understand that the more interesting a game and its challenges are the more likely you will play more, but also the games can benefit patients. New research shows that when cancer patients play a game called Re-Mission (in which players fly through the body, shooting and destroying cancer cells), they increase their positive motivation. As a result they are more medically compliant with their treatment regimens. A followup study may have found the why (see videos, photos and articles about this and other healthcare-related games in an ADVANCE compilation titled Health Gamers).

Researchers used functional MRI scans to evaluate participants who either actively played Re-Mission or passively watched/heard the game play done by another remote player. The research demonstrated that the parts of the brain that improve patient's treatment motivation were dramatically more active in those who were actively engaged in the gaming activity over those who simply watched it. The researchers also found that patients had an increase in positive outlook of their cancer treatment immediately after playing and, upon retesting at one month.

The Re-Mission game is currently free but does accept donations. I believe it is one that is worth a quick look and donation, even if you have no intention of ever playing the game. I can envision, children and young adults who have been hit with cancer, playing this game and, not only adhering better to treatment, but feeling like they may have a little control over their lives: control that was ripped from them the day of their diagnosis.

Sci-Fi Medicine

2012-05-09T21:24:00Z

I am a sci-fi nut (for those of you would do not recognize it, that abbreviation it is for "science fiction"). I love it. Go figure, the CEO of a healthcare technology company likes sci-fi, how original. I grew up watching Star Trek, marveling at its technology and wishing I had some of the gadgets the characters used every day. Imagine being able to bypass the TSA and transporting to the Bahamas for a few drinks on the beach and then transporting home (wonder if I would be subject to TUI laws — transporting under the influence). We have already been using technology similar to the original Star Trek when we talk on our cell phones (the communicator), use an iPad (they are actually smaller than Captain Kirk’s tablet), and Google translate (the Universal Translator).

If any of you were sci-fi geeks, you have probably thought a robot would be a cool thing to have. No more getting up from the couch to grab a beer from the refrigerator, no more vacuuming (yes I own the iRobot Roomba, Scooba, Dirt Dog, and the Looj [would not recommend this one]), and no more taking out the trash. Awesome! Of course, I would become a complete blob like the characters on Disney’s Wall-E.

The inventors at iRobot have developed a robot that can assist us in the home more directly. More specifically, it can aid in keeping the elderly in their own homes longer. The robot is named Ava and she is essentially a telemedicine platform on an iPad or Android tablet that can follow you around and help connect to medical personnel in remote locations. This would allow senior citizens to see their clinicians, family and other caretakers more frequently without the monumental problem of finding transportation. Once the transportation problem goes away, they can see their clinicians more often. They can get diabetes education more easily and frequently. Family can check on their well-being and how they are managing their prescriptions.

The Star Trek technology I have wished I had more than any other would be the medical Tricorder. For those of you who do not remember this sci-fi gadget, the medical personnel walk over to a patient on a stretcher or on the ground, take out a device that is about the size of a couple of smart phones, and wave it over the persons body. Then, viola! The diagnosis is made. It can test for foreign organisms inside or outside the body as well as act like a portable MRI machine. There are current ultrasound devices that have been deployed in hospitals that are used with smart phones but evidently researchers at Harvard’s Medical School have found a way to make the tricorder a reality. The researchers found that they can detect and diagnose cancer cells better than the current gold standard (96% vs. 84%) with a smaller amount of tissue and do it in a matter of hours rather than the typical 3 day turnaround. They do this using a small handheld smart phone and MRI type of technology. It is not unreasonable to expect that we will see the ability to diagnose a multitude of diseases with this type of device in the very near future. Thank goodness for Star Trek.

You Can Make Life Easier for Your Patients

2012-04-18T16:04:00Z

Have you ever taken time out of your day to live what your patients experience at your office? Think about it; they take time off work, fight traffic and get to your office just in time to sit in a waiting room for 30 minutes past their appointment time. Of course we are busy and our days are filled with frustrations, but are there better ways to treat our patients? Perhaps changing the way our practices operate will decrease our own frustrations. There have to be better ways to streamline the office and provide better service to those that depend on us.

I really believe that technology holds the key to improving how patients perceive the healthcare we provide (and we had better improve their perceptions as more insurers start basing payments on outcomes and patient satisfaction). I will not bore you with how bringing telemedicine into the home would obviously improve this situation. Instead there are plenty of other technologies that are easy to use and provide the type of care our patients crave. Here are but a few:

1. Facebook: What if you setup a Facebook page for patients to openly discuss their particular disease states? You could set up a Facebook page that focuses on diabetes, for instance, and encourage your patients to share (yes this can be HIPPA compliant if they sign a waiver) and learn from other patients. You could also post timely articles, videos and cartoons to help educate and motivate your diabetics. Perhaps even sponsor contests for those who get the biggest improvement on their Hgb A1C levels. And by the way, your patients are connected to the Internet. At Smart House Calls, we are finding that about 85% of patients are connected and that includes Medicaid and Medicare patients.

2. Twitter: Imagine you are sitting in a waiting room while your child is undergoing surgery. How wonderful would it be as a parent to get regular tweets or texts as to how everything was going? All it would take a nurse, CRNA or surgical tech is about 20 seconds to write a text to let you know your child was awesome and doing very well.

3. Here is a radical idea. How about letting your patients schedule their own appointments without having to call, be placed on hold, and be placed into a very inconvenient time only because they did not want to irritate the receptionist! Companies like ZocDoc allow you to set your schedule and allow patients to pick the available times that work for them. Imagine if the airline industry forced you to call them to make seating arrangements instead of being able to book instantly online and choose the seat you feel is the best that is available at the time that best suits your schedule.

4. Oh! I have found so much enjoyment showing up at medical offices 30 minutes early to fill out paperwork! On top of that, how fun does it sound for a busy patient to have to drive to the office to get copies of their lab and test results? If banks operated this way, we would be stuffing money into mattresses. What if your office used a medical portal that allowed patients to fill out their forms prior to showing up at the office? What if they could download their lab results from the same portal, allowing them to take it to specialist or just keep it for their records. I will tell you what would happen; they would be pleased and your front office staff would be a lot less harried and probably nicer.

Gang, it’s time that the medical and nursing community caught up with EVERYONE else doing business. Technology can make your office more efficient and your patients happier. Ultimately, everyone wins.

Hybrots and Rat Brains, for Healthcare

2012-04-04T14:48:00Z

What happens when you mix a blob of rat brain cells with ingenuity and a few thousand dollars of robotic controls? You have a “hybrot,” a hybrid robot that is controlled by a living brain! This science fiction came true in 2002 when Georgia Tech scientists married a few thousand-rat brain cells with a robot. When neurons fired, the robot moved. Absolutely incredible!

U.K. scientists at the University of Reading are taking those early experiments further by working to enhance the ability of the rat-brain-robot combination. Scientists are researching ways to enhance the learning of the rat brain so the robot as the ability to learn and interact with its environment. In an interesting twist, the brain isn’t even located inside the robot. The brain is securely stored in a case separate from the robot and commands are issued via Bluetooth technology.

So, what does this amazing technology have to do with healthcare? Researchers are looking to gain additional understanding of memory especially as it relates to disorders such as Alzheimer disease. In addition, researchers at other labs are investigating ways to leverage the technology to control prosthetic limbs.

I guess new chapters will eventually have to be written in to Harrison’s Manual of Medicine to include differential diagnosis for Bluetooth and robotic controls – smile.

Happy Computing!
Cheers,
Joe

Sizing Up Nutritional Supplements – Top 5 Sites

2012-03-14T15:39:00Z

Frequently patients ask about nutritional supplements. It’s difficult to find objective information without being bombarded by commercial advertisements and offers to purchase products. Last weekend I picked up a nutritional magazine at the health food store. The first article was about the benefits of coffee. I love coffee, so I was happy to see the article illustrating the benefits of my favorite beverage. However, immediately following the “research” article, there were multiple advertisements for various coffee and coffee-like supplements extoling the benefits over my regular cup of morning java. As I skimmed the rest of the magazine the same pattern of article-then-sales pitch repeated itself many times. Needless to say, I tossed the magazine in the garbage.

As clinicians, we need to have definitive sources of information about nutritional supplements and complementary medicine. In a series of blog posts I will provide some links for you to bookmark so you have a reference library for you and for your patients.

Below I evaluated my top 5 favorite picks for information on nutritional supplements. If you have others, feel free to send me your suggestions.

#1 – Mayo Clinic: http://www.mayoclinic.com/health/drug-information/DrugHerbIndex

This is my favorite site for nutritional information for my patients and myself. The site offers the broadest range of information on nutritional supplements as well as the latest research and evidence. For those of you interested in getting the latest news from Mayo Clinic, be sure to check out their RSS new feed section. They offer news alerts on a number of topics that are both informative and timely.

#2 – WebMD: http://www.webmd.com/vitamins-and-supplements/lifestyle-guide-11/default.htm

WebMD may be the most recognized of sites for the average patient. WebMD provides a tremendous wealth of topics. As a clinician you should be aware of the site because patients use it heavily for research on their medical conditions and supplements. This is one of my personal favorite sites for medical information and may be one of yours too.

#3 – National Center for Alternative and Complementary Medicine: http://nccam.nih.gov/

What I like about this site are the articles covering a wide range of health topics. In addition, they offer fact sheets very useful for patients. The NIH even offers video casts of various topics that you can find here. Be sure to check the site and the rich source of information it provides.

#4 – Office of Dietary Supplements: http://ods.od.nih.gov/factsheets/list-all/

This is a great site offering fact sheets for your patients. The one thing I don’t like about the site is the navigation to the fact sheet page. Once you click on the supplement name, a reasonably blank screen appears. You then need to click on the supplement name again, to retrieve the fact sheet in a new window. Page navigation could be more intuitive. However, the site does offer excellent information that you can use for patients. As a side note, some of the references point back to my #3 favorite pick at the National Center for Alternative and Complementary Medicine. However, the site does provide additional information that is very useful.

#5 – University of Maryland Medical Center: http://www.umm.edu/altmed/

The University of Maryland Medical Center provides a list of common supplements along with excellent information about uses and potential side effects. In addition to finding information about alternative medicine, the site also provides information about various medical conditions in an easily readable format useful for your patients. Although the center does offer an iPhone medical encyclopedia, it provides limited information compared to the rich source of information of their main website.

If you have favorite sites be sure to post them and let me know.

Happy Computing!
Cheers,
Joe

Will the iPad Transform Healthcare Delivery?

2012-02-29T22:14:00Z

Not yet, according to research just published by Spyglass Consulting Group. The study showed that 98% of physicians interviewed used mobile devices in their personal and professional life. However, the study also showed strong resistance by hospital information technology groups to deploy mobile technology.

A reported 75% of hospital IT groups resisted deployment of mobile technology, citing security risk and high costs as the main hurdles to widespread adoption and deployment. I believe Gregg Malkary and company at Spyglass Consulting are right on track with this survey. Gregg’s team clearly illustrated that the end consumers, namely the physicians, are very willing to adopt the technology.

Historically, end consumers have resisted new technology within corporate structures. However, mobile computing has dramatically changed the view of many, especially highly educated individuals who are generally early adopters of technology.

I certainly can understand resistance by some IT groups. Prior to my career as a physician assistant, I was both an IT consultant and held a director-level IT position at a Fortune 500 firm where I was responsible for the global IT infrastructure. The continual pressure of cost reduction loomed large over every decision I made. Generally low cost won out over increased productivity.

Fortunately, there are many shining examples of very large hospitals such as The Cleveland Clinic Foundation who embrace technology. I was very fortunate to have worked with the Chief Medical Officer, Dr. Martin Harris at The Cleveland Clinic Foundation. Dr. Harris is an outstanding example of both a physician and a leading expert in information technology. He is clearly an industry leader dedicated to radically integrating technology within healthcare delivery.

I’m interested in hearing your views on this topic. Is your organization in the process of deploying mobile technology, or is there resistance? If so, what do you believe could be done to help continue the push to deploy mobile technology for healthcare delivery?

Happy computing!
Cheers,
Joe

Would You Pee on Your Smartphone?

2012-02-22T16:28:00Z

Yes you read that right and no, I have not lost my mind. Let me explain. For the longest time our patients with diabetes, hypertension and myriad other chronic conditions have relied upon home monitoring devices to test their disease states. We would write the prescription; they would file insurance, go to a medical supply store and pick it up. But … something has changed the market ... The Smartphone.

Recently, smartphones have begun outselling traditional cell phones, not only in this country but especially in 3^rd world countries. People in these areas find that buying a computer, purchasing Internet access and purchasing a cell phone is not economical. It is much easier and cheaper to buy a smartphone for all three needs. Smart House Calls has been talking with major Medicaid private payers and their data demonstrate that between 50% and 70% of their population have smartphones for this same reason; they also realize it is more economical than the previous alternatives.

Because of the smartphone proliferation worldwide, companies have been developing inexpensive apps that, in combination with monitoring equipment like blood glucose monitors and pulse oximeters, have the ability to replace the brains of previous all-in-one devices. Suddenly, a patient can buy an inexpensive attachment that plugs into the phone docking port, download an app at a minimal cost (if not for free), and have a very smart blood sugar monitor. The monitor is much smarter and more user friendly than any of the previous all-in-ones and can now transmit its data directly to you, their provider. What I find particularly interesting is that smartphones could very quickly rival the computing power of our present day laptops and, as such, allow creative programmers to really develop more effective and engaging ways for patients to improve their health outcomes. For instance, how much more engaged would a juvenile diabetic be in controlling her glucose levels if her readings could affect a game on her smartphone or she could enter into competitions with other diabetic peers worldwide? What about a social networking site based on disease states? The possibilities are endless.

But I digress; let’s get back to my original question. Would you pee on your smartphone? Researchers believe that the future of medical devices on phones will not be through add-on hardware but instead will use the amazing capabilities of the touch screen itself. According to this article, the capacitance (ability to sense electric charge) of your touchscreen is so sensitive that it may be able to detect disease biomarkers. The researchers have demonstrated that it can differentiate the amount of bacteria in a sample and should, in theory, be able to detect specific bacteria. Amazing.

I guess that throws out any chance that I will ever again buy a smartphone on eBay …

Healthcare Providers Distracted by Technology

2012-02-01T19:38:00Z

As a biology college professor I continually struggle with whether to allow laptops in the classroom for students to take notes or have them take notes the “old fashioned way.” As a technologist, and having a background in computer software and networking prior to becoming a PA, I understand the clear advantage of technology. However, for students, the distraction of a computer usually leads to updating a Facebook status rather than taking class notes.

I have informally polled other faculty members and they relay similar problems in their classrooms. Many have established outright bans on technology. For me, I have taken an approach that I will allow students to use a laptop, but if I discover they are doing anything other than relevant classwork, they lose the technology privilege for the rest of the semester.

Personally, I know the draw of having a laptop in front of me during meetings, and like my students, I find myself opening up email and browsing the web to keep myself from lapsing in to a coma during an especially long meeting. Of course, this is an editorial comment on my lectures — they may be boring as well!

However, I started thinking, with the proliferation of technology in medical facilities around the world, I wondered how many clinicians are distracted by technology when working with patients.

Robin Wulffson, MD, wrote an excellent article on the topic of technology and healthcare providers and I have included the link below. Wulffson reported that a peer-reviewed survey in the journal Perfusion showed that 55% of cardiac bypass equipment technicians talked on their cell phones during a cardiac procedure — a potentially scary admission in the use of technology.

The New York Times also published an excellent article on technology distracting physicians during patient encounters. Of course, the same could potentially be said of PAs or NPs if we allow technology to interfere with quality patient care.

Some institutions and clinicians are now reporting banning technology in certain areas or certain types of patient encounters. I’m not sure if it is appropriate that technology be banned or if a greater need for awareness of appropriateness of use is required. Certainly, there are significant advantages of technology, however like all things used inappropriately, problems will arise.

I’m curious on your views and if you have experienced clinicians using technology in ways that you believe are inappropriate for the setting. Please post a comment and provide your views.

Happy Computing!

Joe

Telemedicine Kiosks in Hospitals

2012-01-18T16:57:00Z

Yeah, I love telehealth/telemedicine. Yeah, I love it so much that I started my own telemedicine company. So, whenever I have a chance to talk about it, much to my wife’s chagrin, I do. I find it absolutely fascinating how it is growing by leaps and bounds. There are 12 states now that currently require telemedicine/telehealth visits be covered at the same amount as a face-to-face visit and most other states have insurance carriers who will pay for it. Medicare and Medicaid will cover the full price for these services. What they are finding is that when you begin to make healthcare more convenient for patients, their outcomes improve and their healthcare costs decrease. Unfortunately, government payers, unlike most private payers, require the patient to be in a rural area and be in a qualified medical facility. I guess patients in urban areas should have no problems trying to find and pay for transportation to specialists. What about home-bound patients who could use more contact with their healthcare or mental health providers? It is incredibly difficult for them to find transportation and spend a day in a waiting room. Once that is over, then they have to spend time waiting at a pharmacy for their new prescriptions. Usually this group sees multiple doctors and goes through this chaos several days per month.

Then I think about our critical access or smaller urban hospitals that have sick patients but cannot attract enough specialist physicians. They are forced to send them to larger medical institutions which ultimately delays patients' access to timely expertise/care. It is easy to set up a telemedicine cart in a small hospital ER or ICU and nurses, physicians, nurse practitioners and physician assistants could gain immediate expert guidance when treating a critical patient. This would allow the hospital to provide better care at a lower cost. It would allow patients to stay closer to their support systems while getting the expert care they deserve. It would improve these smaller hospitals ability to survive as we move to an outcomes-based payment models. Unfortunately, CMS does not reimburse for this type of care.

Thankfully, a letter to the CMS acting administrator (Marilyn Tavenner) by Jonathan Linkous of the American Telemedicine Association raises the idea that critical care staffing should include telemedicine staffing capability. This letter requests that CMS allow specialist and other types of staffing to be allow through the use of telemedicine. There are services out there like Reach, being paid for by hospitals, which allow stroke patients immediate care that improves their outcomes and costs dramatically. Why can we not do that for the ICU?

It is my firm belief that once we fully realize that moving data is much better than moving people, the United States healthcare system will become more nimble, cheaper and more responsive. You will get the care at the time you need it and will be healthier for it.

iPhone and Medical Apps

2012-01-12T18:33:00Z

Thirty-five percent of adults own a smartphone and fully 83% of all Americans own a cell phone, according to Pew Research in a report published earlier this year.¹ That is a staggering number and certainly easily observable just by walking past a bustling Verizon store.

In early 2010, I published an article in ADVANCE titled, “iPhones: The Tricorder is Here.” In that article I reviewed several iPhone medical content applications including Epocrates, Medscape, BlackBag and others. It may be time for an update given the explosive growth in medical and health related applications for the platform. As of the writing of this blog post, the number of medical iPhone applications is a staggering 4,697!

When I published my original article, the iPhone medical applications numbered in the dozens. I’m not even sure how I would approach writing an article today on the most relevant and useful applications.

Part of the challenge is first categorizing the apps. Clearly, some applications such as AirStrip Cardiology are in a class of professional applications. In fact, AirStrip was the first medical iPhone application to receive FDA clearance. Others fall in the personal health category such as the Nike Training Club application. Still others, such as Skeletal System Pro II are primarily an educational application.

One thing certainly is clear; Apple’s iTunes software needs a dramatic update to the application search query screens to deal with the burgeoning supply of applications. The simple “sort by” release date or name within iTunes is an antiquated and not easily usable feature for the volume of applications. A redesign could make it easier for both end users to find applications and for developers looking to develop new niche applications.

I’m curious on your thoughts … do you have any favorite medical applications? Do you have any thoughts or suggestions on better ways to find applications on iTunes? Post your comments and share your opinion.

Happy Computing!

Joe

1. Aaron Smith, “Americans and Their Cell Phones,” Pew Research Center, August 15, 2011.

Editor's note: We welcome Joe Weber, MBA, MPAS, PA-C, with his first post to Innovative Healthcare Technology. Weber is a past blogger at Scalpel: Technology at the Edge of Healthcare by ADVANCE for Physician Assistants, a predecessor to ADVANCE for NPs & PAs.

Skype for Healthcare: Is It Safe?

2011-11-22T19:42:00Z

Technology in the healthcare arena has enhanced the lives of our patients. CT and MRI scanners have improved the accuracy of disease diagnosis and treatment, mobile devices have put data at the clinicians fingertips at the bedside, laparoscopic procedures are allowing patients to heal much faster, and home-based technologies are allowing the elderly to remain at home longer at a significant savings. Telehealth and tele-mental health technology is allowing rural populations to get care they could otherwise not expect without great hardship. It is estimated that approximately 70% of the U.S. population lives in rural areas that are frequently underserved.

Politicians on both sides of the aisle are interested in improving access through this medium. In the meantime, I have spoken with many professionals who have chosen to become front-runners and are offering telehealth and tele-mental health services as an option for their patients. They understand that by improving convenience, much like convenient care clinics, their patients are more like to feel satisfied with their care and get treatment earlier in the disease cycle. They also see the potential to become more entrepreneurial and increase their income.

Some of these motivated professional began implementing telehealth services when Skype began offering video along with its Voice Over Internet Protocol (VOIP) phone service. The quality was not great but it was good enough to manage patients safely and their patients were excited about the opportunity of having easier and more convenient access. And, the service was free at both ends! I often wonder where video calling and telemedicine would be today if not for Skype.

Recently, though, Skype has taken a couple of licks with regard to its basic architecture. Let me first explain how this program works so that I can better describe what has been happening. Skype works by creating “virtual servers” through your computer when you sign up for Skype and download the program. In essence, you are not only sending your video, audio and files through your computer when you use Skype, you are in fact sending that data through other users' computers as you connect with your colleague, patient or family. The same is happening on your computer for other users when they connect to their friends or clients. It really is an ingenious platform. Because you share bandwidth and processing power with other users, Skype is able to give you the quality and speed you expect at a much lower cost. This in turn decreases your cost. Now, the data is encrypted and we are assured by Skype (now Microsoft) that your data is secure. So what are the potential pitfalls?

In 2010, we found out about one of the problems with using users' computers as server nodes. If you remember, similar to Blackberry this year, there was a large outage worldwide just before Christmas last year and it took over 24 hours to fix. Evidently, a Windows software update may have been the culprit as millions of Windows users updated their computer’s software. Since that time, Skype has added more of its own "supernodes" to handle increased traffic if part of its users' servers fail.

Since that time, Microsoft approached and purchased Skype to add it to its software services. This was a strategic move and not at all related to the outage. Shortly after the purchase, Microsoft applied for a patent that many found disturbing and is our second potential pitfall. Essentially, the Microsoft patent demonstrates their ability to listen, view and record conversations over the Skype network. Users were told, "Legal Intercept appears similar to tools used by telecommunication companies and equipment makers to comply with government wiretap and surveillance requests.” While perhaps unnerving, it seems understandable until you begin to think about populations trying to escape dictatorships that use Skype and Twitter to get their messages out. Then that same article points out that Skype "aims to incorporate tracking technologies for its Skype services, as it aggressively expands its mobile advertising system across the world. Skype will likely soon have ad targeting and user profiling digit strings attached.” Essentially they will also have the ability to know your location and when you are online as well as being able to see the data you are transmitting.

This security problem leads into the final pitfall. A study released last week found that an average programmer with minimal resources could find and track users' locations and find any files they shared through Skype. Essentially, you could find and get information regarding a particular individual or large groups of individuals. And, it can be done without the user knowing that they had been compromised or without downloading any malicious files to get things going. Essentially, if you have Skype software, or other Peer to Peer (P2P) video conferencing software that you have downloaded on your computer, you are vulnerable.

According to the researchers these security problems can be fixed and they reached out to Microsoft prior to publishing but Microsoft has yet to respond or resolve the issues. I am disturbed by this, especially considering that I am in the telemedicine business and can see how patient data could be compromised. A disgruntled employee could find out information on co-workers or their boss for blackmail. Someone could find data on celebrities and compromise their HIPAA rights.

Obviously when calling family or friends this is of little consequence but if you are seeing patients using their video calling feature, sending files or using Skype as a VOIP service, you need to think carefully about when you are using it.

Video Demo: Standard Dictations App

2011-11-09T17:00:00Z

The Standard Dictations App is available for free on the Android platform. It offers standard dictation guidelines for histories, physicals, procedures and counseling. Some procedures listed include arterial line placement, bilateral plantar fascia steroid injection, biopsy or chest tube. Exams include hospital admissions, labor and delivery, and discharge notes.

See a demonstration of how this useful, free app works in the video below.

AHRQ ePSS App for Primary Care Providers

2011-10-26T17:00:00Z

The Electronic Preventive Services Selector (ePSS) mobile app tool was developed by the US Department of Health and Human Services Agency for Healthcare Research and Quality for primary care clinicians to use when recommending preventive services for their patients. The interactive app is designed for use on a personal digital assistant (PDA) or desktop computer to allow clinicians to access the latest recommendations from the AHRQ-sponsored U.S. Preventive Services Task Force (USPSTF). The tool can be viewed and is available for download from the AHRQ Web site at http://www.epss.ahrq.gov/. You can also download the AHRQ ePSS app on iTunes.

The ePSS contains 110 recommendations for specific populations, covering 59 separate preventive services topics. The provider enters patient information such as gender, age, and smoking status, and the software cross-references the patient characteristics with the applicable USPSTF recommendations and generates a report specifically tailored for that patient. The associated database includes information on screening tests ranging from mammograms to ultrasound tests to detect abdominal aortic aneurysms, as well as counseling topics and information on preventive medications. There is also a desktop computer version that allows providers to print reports to give patients.

The AHRQ ePSS App is an incredibly useful tool for providers for its ability to facilitate the practice of optimal preventive care, an increasingly vital element of good medicine. Watch the video below to see a demonstration of the app as you might use it in practice.

Smart Skin Collects Healthcare Data

2011-08-23T19:04:00Z

When you have ordered a sleep test, EEG or other study that requires your patients to go to a sterile, uncomfortable clinic or hospital, have you ever wondered how they can get accurate results? I usually think about the accuracy of sleep studies, considering that even if they sleep in their own bed at home, the patients are still hooked up to a bunch of electrodes and wires. The basic problem with sensors is that they represent the hard, inflexible world of electronics while patients' skin is soft and elastic. To compensate for this incongruity, we use gels, wires, and/or pins to marry the two worlds. This is uncomfortable and naturally alters the data. For those of you familiar with hard circuit boards (think of the circuit boards you see when you have accidently dropped and shattered your phone or other personal electronic device), imagine taking one of these and attaching it to your skin! What if you could take that hard, inflexible surface and make it as stretchable as skin and thinner than saran wrap. You could then easily apply it to the skin like a temporary tattoo. That is what a group of researchers have done at the University of Illinois, in China and in Europe.

Smart Skin looks more like a circuit tattoo than a sensor and applies with nothing more than a little water on the skin; almost exactly like a temporary tattoo. No more messy glues, Velcro straps or tape to attach critical sensors to patients. It is evidently comfortable, easily forgotten once applied and can last for up to 4 days (the usual time it takes for enough of the body's skin cells to slough off to make the sensor ineffective).

The technology is incredibly cool for a couple of reasons. Because computer circuits are electronic connections, they need a stable way of transmitting electrical impulses between points. Well on a surface as elastic as the skin, those connections are either broken or altered as movement occurs. Just imagine the way an ECG changes when patients move. What the researchers have done is essentially developed a circuit that maintains its connections as the circuit is contracted and stretched. For the first time, this technology really marries two entirely different worlds; biology and hardware. Secondly, the product is so thin and comfortable that patients forget they are even wearing the technology. You can even place it on a temporary tattoo and apply it to the skin!

The sensors also have the potential to generate their own power from solar cells or even stray electromagnetic radiation. Even considering the product's small size and flexibility, the data received is good enough to give high-quality electroencephalography data. For those of you interested in other applications, the sensors are so precise, there is the ability to interface with computer systems. Essentially, you might be able to control gaming without the need for a controller or electronic eye. Very cool stuff indeed!