Medical Smartphones:“We all know that the AT&T network is having difficulty keeping up with the data load caused by a multitude of iPhone users. What will happen when the iPad becomes available? Will the networks get more congested? Will AT&T have the necessary infrastructure to provide adequate 3G services for all these new iPads that will be floating around?†– Joseph goes on to ponder how long it will take Versizon to get the iPhone as his wife is eagerly waiting for it. I too have been waiting for the iPhone to drop into Verizon hands. Even though I’m satisfied with my Droid, I will convert to the iPhone once available through my carrier. Unless, of course, something better comes along in the meantime. The reason why I would switch is simple; the iPhone is so widely used among healthcare professionals that application development for the device is on the forefront of technology. If you can’t find it for the iPhone, then it probably doesn’t exist.
So, what will happen when the iPad hits AT&T? I have no idea because I don’t plan to buy one with 3G. I will use the device like I use my iPod touch now; inside the walls of my house, the hospital and Starbucks.
As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting. (more…)
To continue with the radiology theme from yesterday: Toomey RJ, Ryan JT, McEntee MF, et al. Diagnostic Efficacy of Handheld Devices for Emergency Radiologic Consultation. Am. J. Roentgenol. 2010;194(2):469-474.
Abstract: Diagnostic Efficacy of Handheld Devices for Emergency Radiologic Consultation
OBJECTIVE. Orthopedic injury and intracranial hemorrhage are commonly encountered in emergency radiology, and accurate and timely diagnosis is important. The purpose of this study was to determine whether the diagnostic accuracy of handheld computing devices is comparable to that of monitors that might be used in emergency teleconsultation. SUBJECTS AND METHODS. Two handheld devices, a Dell Axim personal digital assistant (PDA) and an Apple iPod Touch device, were studied. The diagnostic efficacy of each device was tested against that of secondary-class monitors (primary class being clinical workstation display) for each of two image types—posteroanterior wrist radiographs and slices from CT of the brain—yielding four separate observer performance studies. Participants read a bank of 30 wrist or brain images searching for a specific abnormality (distal radial fracture, fresh intracranial bleed) and rated their confidence in their decisions. A total of 168 readings by examining radiologists of the American Board of Radiology were gathered, and the results were subjected to receiver operating characteristics analysis.
RESULTS. In the PDA brain CT study, the scores of PDA readings were significantly higher than those of monitor readings for all observers (p 0.01) and for radiologists who were not neuroradiology specialists (p 0.05). No statistically significant differences between handheld device and monitor findings were found for the PDA wrist images or in the iPod Touch device studies, although some comparisons approached significance.
CONCLUSION. Handheld devices show promise in the field of emergency teleconsultation for detection of basic orthopedic injuries and intracranial hemorrhage. Further investigation is warranted.
I’m not as sharp as many of you so I had to actually look up the word roentenology, which means “Radiology, the science of radiation and, specifically, the use of both ionizing (like X-ray) and nonionizing (like ultrasound) modalities for the diagnosis and treatment of disease.”
According to the article “the scores of PDA readings were significantly higher than those of monitor readings when all observers’ readings are taken into account†and “no statistically significant differences between handheld device and monitor findings were found for the PDA wrist images or in the iPod Touch devices studies, although some comparisons did approach significance.â€
An interesting follow-up to this study would be to insert an iPad into the same scenario against the iPod touch. I would be very interested to see how radiologists would react to that. The iPad would offer similar functionality to the iPod touch with the advantage of a larger screen. I can only speculate that more screen real estate would be preferred over less screen real estate for radiologists if given a choice. Just a thought.
Unless you’ve been comatose for a while, you’ve certainly heard about the Apple iPad. The device has already been crowned the de facto device for everything from e-reading to creating a new wave in healthcare unlike anything we’ve ever seen. Of course this is all speculation as the device hasn’t been officially released yet.
Many people have speculated that the iPad will be a great device for healthcare. Whether or not that will be the case remains to be seen. One thing is for certain: everyone is banking on the iPad being a big hit in healthcare. Based on the success of the iPhone as a favorite among physicians and nurses, this certainly isn’t a wild prediction. Will this success translate to the pharmacy? Good question. (more…)
As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
– What’s that? Oh, Avatar is still #1 at the box office. It’s now #2 on the list of top grossing movies of all time with its crosshairs squarely set on #1.
– KevinMD: “But when this health-care reform package passes, and if it does to the economy and to medical practice what many of us fear, will anyone be accountable? Will they step up and say, ‘yep, that was me! Sorry, I’ll try to fix it!’ It’s unlikely. That’s not how politics are conducted.†– Scary thought
– The Apple iPad was announced this week. It’s basically a giant iPod Touch. It isn’t available for purchase yet, but is already creating quite a buzz in heath care. Every card carrying clinician is claiming the iPad is going to revolutionize how they practice health care. I’m looking forward to getting my hands on one and spending some quality time figuring out how best to use it, but I’m a little gun shy about making claims like that.
– You can find positive blog posts on the iPad everywhere, so here a couple of negatives to help balance it out: interesting view from a 16-year old boy and another from VentureBeat and one final one from GottaBeMobile.
– Hitler responds to the iPad. I find these “Hitler†videos very funny. Be warned, however, they contain some offensive language.
– Here’s a tablet PC survey aimed at health care spurred on by the arrival of the iPad.
– Healthcare IT Consultant Blog: “Medical records for about 4,400 UCSF patients are at risk after thieves stole a laptop from a medical school employee in November, UCSF officials said Wednesday. The laptop … stolen on or about Nov. 30 … was found in Southern California on Jan. 8. There is no indication that unauthorized access to the files or the laptop actually took place, UCSF officials said, but patients’ names, medical record numbers, ages and clinical information were potentially exposed.†– This is why you never, ever store patient information on any type of physical media be it hard drive, CD, flash drive, etc. This is also why storage of patient information on the cloud should be considered.
– Pharmcotherapy : “The genetic study of disease states can be the stepping stones for thoroughly understanding the genetic basis of ADEs. Gene polymorphisms are implicated in the development of diseases and corresponding disease-like ADEs.†– Pharmacogenetics, the study of genetic variation on the effects of drug, has been around for several years now, but has never really taken hold like many thought it would. The idea behind genetic testing to determine how you will respond to medications makes sense, but I don’t see it in practice. I wonder why?
– The Palmdoc Chronicles: “VisualDx Mobile for the iPhone and iPod Touch aids physicians in their decision making efforts by increasing diagnostic accuracy, helping to reduce health care costs associated with unnecessary return visits, referrals, and tests– all of which increase patient satisfaction.†– Clinical decision support for the iPhone/iPod touch.
Endgadget: “Researchers aim to give surgeons 3D maps, directions of human body – the group’s TLEMsafe system does provide surgeons with a complete 3D map of the lower body, which can actually be personalized for each individual patient, giving surgeons a reference and means to practice before any actual surgery takes place — and, yes, even an “automated navigation system” during surgery.†– Pretty cool stuff.
– LiveScience: “Researchers have built a new super-small “nanodragster” that improves on prior nanocar designs and could speed up efforts to craft molecular machines.†– This is amazing, The nanodragster is built using a combination of phyenylene-ethynylene molecules for the chassis and buckyball wheels. Cool!
– medGadget: “To see if clinical measurements can be performed using a cheaper solution, researchers at University of Melbourne tested Nintendo’s Wii Balance Board (WBB) against a laboratory-grade force platform (FP), and concluded that the cheaper option can provide results “suitable for the clinical setting” – So having a Wii is totally worth it, right?
– ASHP: “Health care facilities can expect the Environmental Protection Agency (EPA) by October to release a set of best practices for managing excess, expired, and unwanted pharmaceuticals.†– What to do with these medications has always been an issue.
– LA Times: “Unfortunately, even great stories have their endings, and the chapter on Warner’s NFL career closed today when the 38-year-old quarterback announced his retirement.” – I’m disappointed for my team, but happy for Warner. The man is a class act and a lock for the Hall of Fame. Check out his stats sometime. They are impressive. Kurt Warner is one of the few professional football players that I would like to meet in person. Perhaps I’ll get the opportunity some day. Good luck Kurt.
– I went 1-1 last weekend, bringing my playoff record to 7-3. The Vikings game was one of those rare moments in the NFL where the better team lost. Even with all the Vikings turnovers and bad penalty calls, they were only one play away from a trip to Miami for the Super Bowl. I was really hoping the Vikings could pull it off, but it wasn’t meant to be. My hat goes off to the Saints for hanging staying in the game. Now I hope Favre retires and enjoys being one of the greatest quarterbacks to have ever played the game.
I spent some time yesterday talking with some good people over at Pharmacy OneSource about pharmacy technology, clinical decision support, data mining, and a whole bunch of other interesting items. During one point of a conversations the history of Pharmacy OneSource came up. Part of that history includes the merger of Pharmacy OneSource with HealthProLink (HPL) sometime in late 2005.
The mention of HealthProLink (HPL) brought back fond memories of a time when pharmacy informatics was really starting to take off and I was infatuated with the Palm Pilot <insert flashback sequence here>. HPL was a set of software tools for collecting and quantifying pharmacist intervention data as well as ADR/ADE information. In addition, the application offered access to several clinical calculators and a fairly robust reporting system. I was part of the implementation team for HPL when I worked at Community Medical Centers – Fresno and used it daily for a couple of years.
This was also a time when Palm Pilots were all the rage and every pharmacist I knew carried one in their lab coat pocket. The Palm OS was a stroke of genius because of its minimalistic approach to the user interface. Anyone could pick up a device using the Palm OS and figure out how to use it in a matter of minutes. They were a model of simplicity and functionality. In addition, several development environments were available for application development as well as several “readers†and database applications. This led to the development of hundreds of medical references, medical calculators, free and commercial peripheral brains and countless ways to track patients, labs, and medications available for devices running the Palm OS. It is the only time in my career as a pharmacist that the entire profession embraced a new technology and used it to their advantage. The literature was full of “studies†using handheld devices for documenting clinical interventions1-4, carrying individually created documents and “peripheral brainsâ€5,6 performing pharmacokinetic calculations, accessing drug information and performing drug interaction checking.7-12 The entire handheld movement was quite impressive to watch. (more…)
As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting. (more…)
BACKGROUND: Health information technology and electronic medical records (EMRs) are potentially powerful systems-based interventions to facilitate diagnosis and treatment because they ensure the delivery of key new findings and other health related information to the practitioner. However, effective communication involves more than just information transfer; despite a state of the art EMR system, communication breakdowns can still occur. 123 In this project, we will adapt a model developed by the Systems Engineering Initiative for Patient Safety (SEIPS) to understand and improve the relationship between work systems and processes of care involved with electronic communication in EMRs. We plan to study three communication activities in the Veterans Health Administration’s (VA) EMR: electronic communication of abnormal imaging and laboratory test results via automated notifications (i.e., alerts); electronic referral requests; and provider-to-pharmacy communication via computerized provider order entry (CPOE). AIM: Our specific aim is to propose a protocol to evaluate the systems and processes affecting outcomes of electronic communication in the computerized patient record system (related to diagnostic test results, electronic referral requests, and CPOE prescriptions) using a human factors engineering approach, and hence guide the development of interventions for work system redesign. DESIGN: This research will consist of multiple qualitative methods of task analysis to identify potential sources of error related to diagnostic test result alerts, electronic referral requests, and CPOE; this will be followed by a series of focus groups to identify barriers, facilitators, and suggestions for improving the electronic communication system. Transcripts from all task analyses and focus groups will be analyzed using methods adapted from grounded theory and content analysis.
Although the information in the article is only a design concept, it is still worth reading. Concepts like these could be useful for many outpatient as well as many inpatient alerts; labs that are outside normal parameters, results from blood tests, incorrect antibiotic choice following culture results, etc. With the advances in mobile technology, especially mobile communication devices, this is worth serious consideration.
The Palmdoc Chronicles:†I’ve had a Palm Pre for about 2 months now and I can declare that the device has seen tremendous improvement with firmware updates (pushed OTA) and a steadily increasing amount of useful applications in the Palm App Catalog and the unofficial Homebrew scene.
How usable is it as an smartphone for doctors? Well I can say it pretty much does replace your old PalmOS device as it is. One of the cool features of the old Palm PDAs is the ability to keep snippets of information in the Memos (Notes) in various categories for instant recall. These notes may be protocols, clinical pearls or practically any bits of information which you want to look up while rounding for instance.
WebOS’ builtin “post-it†type Memos is ok if you are keeping about 10-20 notes but pretty useless if you are talking about 300-500 notes or more. There are several solutions at hand which overcome this limitation.â€
The blog goes on to describe a few applications that can be used to create a peripheral brain out of the Palm Pre smartphone. One of these applications is the ever popular Evernote, which I use daily on my tablet PC as well as my Droid.
The information presented at the Palmdoc Chronicles isn’t restricted to the Palm WebOS. The iPhone, Motorola DROID, RIM BlackBerry devices, and a host of other smartphones are capable of storing memos, notes, PDFs and numerous other forms of information documentation.
The idea of using a PDA as a peripheral brain isn’t new. Felkey and Fox1 were talking about it back in 2002 when the precursor to the Palm WebOS was popular among healthcare professionals. It’s interesting how the idea is as good today as it was nearly a decade ago.
1. Felkey BG, Fox BI. PDA interface: Creating the Digital Peripheral Brain. Hosp Pharm. 2002; 37:1222-1224
“After three months of rumors, details surrounding Epic Systems’ partnership with Apple for a mobile phone-based electronic health record (EHR) application have come to light: Just a few days ago, Epic System’s iPhone application, called Haiku, became available on Apple’s AppStore. Haiku provides authorized clinical users of Epic’s Electronic Health Record with secure access to clinic schedules, hospital patient lists, health summaries, test results and notes. Haiku also supports dictation and In Basket access. Haiku works on both the iPhone and iPod touch,†according to the app’s description on the AppStore.â€
This is a very interesting turn of events as rumors regarding Apples new tablet entering the healthcare arena have been swirling around the internet. Could Haiku be the precursor to what we’ll see with the Apple tablet? I sure hope so.
SUBJECTS AND METHODS. Two handheld devices, a Dell Axim personal digital assistant (PDA) and an Apple iPod Touch device, were studied. The diagnostic efficacy of each device was tested against that of secondary-class monitors (primary class being clinical workstation display) for each of two image types—posteroanterior wrist radiographs and slices from CT of the brain—yielding four separate observer performance studies. Participants read a bank of 30 wrist or brain images searching for a specific abnormality (distal radial fracture, fresh intracranial bleed) and rated their confidence in their decisions. A total of 168 readings by examining radiologists of the American Board of Radiology were gathered, and the results were subjected to receiver operating characteristics analysis.
Unless you’ve been comatose for a while, you’ve certainly heard about the Apple 
I spent some time yesterday talking with some good people over at 
The Palmdoc Chronicles