No more medical CDs? We hope.

Many seniors likely have experienced the frustration—and fear—having radiological tests results that needed to be read by multiple doctors. The tests, downloaded to CD, may be transferred through the mails or hand-carried by the patient, but at its best the process can add days, even a week, to diagnostic time. At its worst, when the CD finally arrives, it may be unreadable for various reasons.

Not the pretty kind of cloud. Image courtesy: Getrems.com

Not the pretty kind of cloud. Image courtesy: Getrems.com

Distracted by whatever medical condition required all those tests, you may forget to consider the obvious: Why in these days when people can share photos on their phones are patients still schlepping around CDs?

Fortunately, medical institutions are beginning to catch up. According to a story in Modern Healthcare, there’s now a push for more centralized digital storage of medical images, so that the CD problem could be eliminated. Images and other records are kept “in the cloud,” which essentially means—despite all the hype around the term—a huge bank of computers that’s accessible over the Internet from any digital device. The advantage to you is that the test you took near your home can be read by a specialist thousands of miles away.

While several radiological cloud storage systems are already in place, the kicker is that there isn’t yet one national system. If you stay within one HMO or other medical network, your records may be easily accessed, but if you have to see an outside specialist, you may still be stuck with CDs and the subsequent delays. If you’re considering a new medical group, it’s worth asking if records can be electronically transferred both within—and without—their network. We’re guessing you may see some rolled eyes if you ask, “Will my records be kept in the cloud?”

 

AMA on EMRs

In 2009, the American Recovery and Reinvestment Act required that by this year, seventy percent of primary care providers should be using Electronic Medical Records (EMRs). Perhaps unsurprisingly then, the AMA has just issued a press release complaining about them.

ama-logoWhile it may be reassuring to discover that your doctor finds forms just as confusing as you do, the problems with EMRs or EHRs (for “health” records) can affect the care you receive.

Ideally, an EMR (sometimes known as an EHR, for “health” records) should be a complete computer file of all your doctor visits, conditions, complaints, and prescriptions. Everything you tell your primary care doctor should be easily readable by the specialist(s) she sends you to see, avoiding time-wasting repetition and the risk of contra-indicated medications.

The reality is that, alas, EMRs are currently provided by many competing vendors, leaving doctors with many different products to learn that don’t inter-operate as promised. When medical providers should be listening to you, they may instead be distracted by trying to figure out what field to fill in on the electronic form. Worse, many of the promises of mobile health—that you should be able to check your own records on your smart phone, for example—are also on hold while the technology evolves.

The AMA lists the following priorities for fixing the problem:

  • Enhance Physicians’ Ability to Provide High-Quality Patient Care
  • Support Team-Based Care
  • Promote Care Coordination
  • Offer Product Modularity and Configurability (make it customizable for particular specialties and institutions)
  • Reduce Cognitive Workload (in other words, make it less confusing!)
  • Promote Data Liquidity (make it easier for information to “flow” back and forth among providers by using common terms and other standards)
  • Facilitate Digital and Mobile Patient Engagement
  • Expedite User Input into Product Design and Post-Implementation Feedback

The importance of finding the right fix is explained by Steven Steinhubl of the AMA Advisory Committee on EHR Physician Usability: “Given the rapid growth of digital technology in health care, whether for health and wellness, or the management of chronic illness, a comprehensive health information technology strategy must include interoperability between a patient’s mobile technology, telehealth technology, and the electronic health record.”

A brief chat with Congressman Scott Peters (D-CA)

If you’re mad at somebody, don’t yell at the TV–call me.*

 

Scott Peters

*(that would be whoever your representative is.)

We promise we’ll avoid politics, except when it’s of note for seniors. Last night, at a local senior center, the 52nd District’s Congressman, Democrat Scott Peters, reminded the audience that for all of Congress’s notorious dysfunction, there’s one way it does work. It may not go forward on the big issue you care about, but if there’s a personal issue, say a problem with Medicare, you should call your representative and ask for Constituent Services. You may not always get satisfaction, but at least they will try to help you cut through the red-tape.

At least the traffic's moving.

At least the traffic’s moving.

As for the Medicare and technology issues of interest to seniors, Peters says that Congress is attempting to change Medicare reimbursements so that doctors will be compensated for consultations, not just procedures, which would give a boost to telemedicine.

In addition, they’re still working on trying to get compensation for in-home care, so that people aren’t forced into nursing homes. (Regarding nursing homes, the New York Times has an important article about how homes are gaming the Medicare rating system. Unfortunately, “five star” may not be as reassuring as it appears. We highly recommend you read the comments as well; they offer some good, albeit heartbreaking, advice.)

Whether you’re voting for Congress or trying to advocate for a favorite cause, you may want to check out OpenSecrets.org, a non-partisan website that tracks who’s getting money from whom in Washington.

Automated Medical Translation

Translate-Your-World, which enables both automated (machine) translation and simultaneous human translation over the Web, has announced that it is now making medical translation available in 78 languages.

But let’s let them explain in their own words:

Translate Your World, developers of linguistic and mobile marketing technologies, announced today the release of its TYWI-Hospital, an online speech translation software specifically designed for hospitals, medical offices, caregivers, and institutions for the aged. This futuristic software mystically creates real-time voice translation as people speak, plus text translation in 78 languages, then further offers support for the hearing- and vision-impaired.

Er, we believe the “mysticism” consists of a fairly standard approach. As explained by David Bellos, Director of the Program in Translation and Intercultural Communication at Princeton, the current way such translation is accomplished is a series of back-and-forth steps. First, using speech recognition, the human voice is translated into text, then the text is run through an automated translation program, which then may be spoken aloud by an automated text-to-speech program.

Undoubtedly, you’ve noticed such a process could yield several points of failure. Nevertheless, it surely beats trying to mime to a medical profession who doesn’t speak your language.

[youtube http://www.youtube.com/watch?v=k_bb6ZVutc0]

JIBO: A new world of robot apps?

Despite its record-breaking crowd-sourced funding, it’s hard not to see social robot JIBO as anything but a novelty appliance without a long-term impact. With its retro-future resemblance to a Videosphere, it just feels like something that will be an upscale must have for a year or two and then, along with ice cream makers and rowing machines, become part of the garage sale circuit.

But there is one aspect that could save it from trend oblivion. JIBO isn’t simply a piece of pre-programmed hardware, but a robot with a full-fledged operating system. Developers are invited to create programs for it—and it is in this respect, as perhaps the first device to allow for the popular creation of robot apps, that JIBO may radically change the adoption of robots. In other words, don’t think of it as a more fully featured Roomba, but as an Android or iOS phone in a more responsive form.

Still, that opens another question: Most of the suggested uses for JIBO, such as delivering messages or giving reminders, could be performed by a phone app. There are, however, some unique features that could increase its usefulness and adoption. Its facial recognition software allows it to tell people apart, while its swiveling head allows it to track individuals as they move about a room. While we remain skeptical about its value as a digital companion, these features could allow it to become an excellent telepresence bot for families concerned about relatives who are aging-in-place.

In addition, it can be trained to recognize voices as well as faces. Given that certain conditions, such as Parkinson’s Disease, are initially indicated by changes in voice, we can also foresee custom diagnostic apps that could make JIBO a valuable health-monitoring device.

[youtube http://www.youtube.com/watch?v=3N1Q8oFpX1Y]

“We’re sorry for the inconvenience.”

In the middle of evangelizing technology for seniors comes a reality check: an Internet outage.

Any outage is proportional of course. If you were planning on spending the afternoon shopping, it doesn’t matter that your cable stops working on Super Bowl Sunday. If you were planning to spend it, say, watching one of the biggest sporting events of the year, it gets a little annoying.

Thus, we’re forced to consider that no matter all the claims for the efficiency of storing medical records in the cloud, Mom was right: It’s best to have a paper back-up at home that you can carry with you should there be an outage on the day of your medical appointment.

Report: Increase in e-Prescriptions

The Office of the National Coordinator Health Information Technology is out with a new data brief on changes in rates of physician e-prescribing, pharmacy capability to accept e-prescriptions, and the volume of e-prescriptions between December, 2008 and April, 2014.

Nationwide, there has been a rapid increase:

  • All states showed double-digit increases in the proportion of physicians e- prescribing using an EHR between December 2008 and April 2014. 
  • As of April 2014, 7 out of 10 physicians e-prescribe through an EHR, representing a ten- fold increase since December 2008. 
  • In 2013, more than half (57 percent) of new and renewal prescriptions were sent electronically. 
  • The volume of new and renewal prescriptions sent electronically has increased thirteen- fold from 2008 through 2013. 

Screen Shot 2014-07-17 at 7.10.42 PMNotably, however, “the four states with highest volume of prescriptions — California, Texas, New York, and Florida — are all below the national average” in new and renewed e-prescriptions.

 

 

 

 

Telepresence is Priority

The Wall Street Journal asked Marc Agronin, noted geriatric psychiatrist and the author of How We Age: A Doctor’s Journey into the Heart of Growing Old, what piece of technology he thought would be the biggest help to seniors.

His answer was telepresence, which is already implemented in hospitals and is being experimented with in homes. He rightly cautions that the technology must be adapted to those with “sensory deficits. Such adaptations should include voice activation, easily navigated menus, interactive operators, remote troubleshooting, simple keyboards, sophisticated volume controls and projection, and extra large high definition screens.”

Telepresence is a strange little buzzword. When it comes right down to it, we’re talking about a two-way video monitor mounted on a remote-controlled base, and many of the elements Agronin cites already exist. How hard would it be to download Skype onto a tablet, mount it on a toy car controllable over the Net, and create a reasonably useful telepresence bot for under a grand?

Electrical engineer Jon Bennett is half-way there. He’s long had a website that gives detailed instructions for how to build aR remote-controlled car. He agrees it would be possible to, “hack something inexpensive together,” but cautions,  “It wouldn’t get FDA approval and you wouldn’t be able to sell it to anyone.”

5233_1

Way cheaper than a (real) one of these.

Foregoing the commercial medical market, if you have a background in EE or robotics, and would like to check on elderly relatives and their living conditions, it’s something to think about. As Agronin says, “An entire industry of telepresence volunteers and services could be created to serve the exploding population of aging individuals.” 

 

 

 

 

 

 

 

Streamlining Regulations to fit Reality

In an editorial in Health Affairs, Amy Comstock Rick, CEO of the Parkinson’s Action Network, details the benefits of the Tele-Med Act (HR 3077), a bipartisan measure that would allow Medicare providers to remotely treat patients in other states without first having to obtain licenses in those states.

Telemedicine, the ability to remotely diagnose conditions and deliver care over the Internet and wireless networks, has long since stopped being the subject of Wired articles and become part of the day-to-day working lives of medical providers. For just one example, Neil Martin, Chair of Neurosurgery at Ronald Reagan UCLA Medical Center, can examine fMRI images of stroke victims on his iPhone and give life-saving instructions to surgeons in rural hospitals or to his UCLA colleagues while he’s stuck in LA traffic.

Unfortunately, often such consultations can only be conducted within states, because of outmoded licensing requirements. A change in the law is vital to correct imbalances in medical supply and demand, warns Comstock Rick. In Delaware, there are approximately 2,000 people living with Parkinson’s Disease, yet there are no doctors in the state who specialize in its treatment.

Her rallying cry must resonate for anyone concerned with advancing medicine: “The concept of only seeing doctors within your own state lines is an archaic remnant of a former time in America before computers, smartphones, and widespread broadband connectivity.”