Category Archives: Health Technology

Do Online Medical Results Do More Harm Than Good?

Sandra G. Boodman
March 29, 2018

As she herded her two young sons into bed one evening late last Google logo with stethoscope for article, Do Online Medical Results Do More Harm Than Good?December, Laura Devitt flipped through her phone to check on the routine blood tests that had been performed as part of her annual physical. She logged onto the patient portal link on her electronic medical record, scanned the results and felt her stomach clench with fear.

Devitt’s white blood cell count and several other tests were flagged as abnormal. Beyond the raw numbers, there was no explanation.

“I got really tense and concerned,” said Devitt, 39, a manager of data analysis who lives in New Orleans. She immediately began searching online and discovered that possible causes ranged from a trivial infection to cancer.

“I was able to calm myself down,” said Devitt, who waited anxiously for her doctor to call. Two days later, after hearing nothing, she called the office. Her doctor telephoned the next day. She reassured Devitt that the probable cause was her 5-year-old’s recent case of pinkeye and advised her to get tested again. She did, and the results were normal.

“I think getting [test results] online is great,” said Devitt, who says she wishes she had been spared days of needless worry waiting for her doctor’s explanation. “But if it’s concerning, there should be some sort of note from a doctor.”

Devitt’s experience illustrates both the promise and the perils of a largely unexamined transformation in the way growing numbers of Americans receive sensitive — sometimes life-changing — medical information. A decade ago, most patients were informed over the phone or in person by the doctor who had ordered testing and could explain the results.

But in the past few years, hospitals and medical practices have urged patients to sign up for portals, which allow them rapid, round-the-clock access to their records. Lab tests (with few exceptions) are now released directly to patients. Studies estimate that between 15 and 30 percent of patients use portals.Bottom of Form.


Blue Shield of California Commits to Work with Providers to Bring Health Care into the Digital Age

LAS VEGAS–(BUSINESS WIRE)–Blue Shield of California today announced an important step to bring health care into the digital age. Beginning this year, it will require network providers, including those participating in the nonprofit health plan’s nationally recognized Accountable Care Organization (ACO) program, to agree to participate in Manifest MedEx, the largest nonprofit health information network that is creating comprehensive, real-time digital health records for all Californians.

Blue Shield logo for article, Blue Shield of California Commits to Work with Providers to Bring Health Care into the Digital AgeManifest MedEx facilitates the secure exchange of 11 million patient claims records and 5 million patient clinical records for over 200 participating partners. Manifest MedEx supports physicians, nurses, hospitals and health plans in sharing critical health information to ensure that patients receive safe, high-quality care.

Blue Shield’s decision aligns with the Centers for Medicare & Medicaid Services’ announcement today that outlines steps to increase the interoperability, portability and availability of medical data. These efforts should empower patients, improve care and lower health care costs.

“Manifest MedEx delivers real-time, comprehensive health care data to providers and payers on a secure, open platform. It is a crucial prerequisite to transforming our fragmented health care system,” said Paul Markovich, Blue Shield of California’s president and CEO. “This is part of our commitment to provide health care that is worthy of our family and friends and sustainably affordable. We encourage others to get on board.”

“Providers have made enormous investments in technology and infrastructure,” Markovich added. “These investments will be even more valuable when the data they collect is shared and combined with other health information to create a comprehensive patient record that helps improve the quality of care.”

Blue Shield is asking its ACO providers to sign a participation agreement with Manifest MedEx by Aug. 31, 2018 and other network providers to do so as a part of their next contract renewal. It plans to work closely with all its providers to complete the implementation in the optimal time and manner.

“Manifest MedEx delivers the information that helps hospitals, medical groups and ACOs do the hard work of improving care coordination, reducing inefficiencies, addressing gaps in care and enhancing the patient experience,” said Claudia Williams, CEO of Manifest MedEx. “Manifest MedEx gets you the information you need, in the formats you need, when you need it. We break down silos, so California providers can focus on what they do best: improving health care, not assembling data.”

Created through collaboration among California’s leading providers and health plans, Manifest MedEx makes it easier for doctors, hospitals and other care providers to securely review, analyze and share medical information across the health care system.


Eric Topol’s Top 10 Tech Advances Shaping Medicine


January 11, 2018

Each year, I look back at the top 10 tech advances that made headlines the previous year, and these technologies promise to revolutionize medicine in the coming year. Here they are, not in any particular rank order.

1 and 2. Gene Therapy and Gene Editing

These two biotechnologies are being used in clinical trials for diseases that once were deemed untreatable but now are believed to be curable someday, largely due to these important new tools. First, let me differentiate the two because there is considerable conflation and confusion about what they mean.

Gene therapy scored some rapid-fire successes this past fall[1,2,3] after a 20-year “winter” during which things looked pretty bleak and even some advocates feared that there might never be a comeback. On December 19, 2017, the US Food and Drug Administration (FDA) approved the first gene therapy that targets a disease caused by mutations in a specific gene. The treatment, voretigene neparvovec-rzyl (Luxturna™; Spark Therapeutics), is delivered surgically via subretinal injection to treat a rare form of inherited vision loss that can lead to blindness.

As for genome editing, ex vivo manipulation of T cells for leukemia[4] and HIV[5] has been used for several years, but the first case of in vivo editing was performed just this past November in a 44-year-old man with Hunter syndrome. We do not yet know the outcome.

3. Deep Learning of Skin Cancers

Esteva and colleagues at Stanford University created a deep-learning algorithm to diagnose skin cancer, and then tested it against 21 board-certified dermatologists. As they reported in Nature ,[6] the algorithm matched the clinicians’ ability to correctly identify malignant and benign lesions.

This represents an “in silico” demonstration or computer modeling of a biological process; a prospective real-world study in patients will be necessary to assure that the very high accuracy of the deep-learning algorithm is clinically validated. If it is, the developers hope that it can then be transitioned to mobile devices and that the visual diagnosis technology will be used in other fields as well.

4. “Panoromic” Cancer Evaluation

Last year I was able to visit Tempus Labs, a Chicago enterprise operated by Eric Lefkofsky, the co-founder of Groupon. He launched Tempus in 2015 after his wife developed breast cancer and they were unable to find a place for her to undergo a comprehensive evaluation.

Now, Tempus is collaborating with most of the National Cancer Institute’s comprehensive cancer centers in the United States and providing across-the-board cancer testing: sequencing of patients’ tumors and germline DNA; liquid biopsy of cell-free DNA; RNA sequencing of tumors; immune system characterization of tumors and patients; organoid cultures of tumor cells with drug testing; machine learning of all of these layers of information with the electronic medical record; pathology reports; and all medical imaging.

Previously, some companies offered isolated tests, but this is the first one to do them all. We await publications that spell out whether this rigorous, multilayered information approach will change patient outcomes.


Smartphone Apps Reduce Depression

September 22, 2017

New Australian-led research has confirmed that smartphone apps are an effective treatment option for depression, paving the way for safe and accessible interventions for the millions of people around the world diagnosed with this condition.

screen shot of smartphone app for treating drepression for article, Smartphone apps reduce depressionDepression is the most prevalent mental disorder and a leading cause of global disability, with mental health services worldwide struggling to meet the demand for treatment.

In an effort to tackle this rising challenge, researchers from Australia’s National Institute of Complementary Medicine (NICM), Harvard Medical School, The University of Manchester, and the Black Dog Institute in Australia examined the efficacy of smartphone-based treatments for depression.

The researchers systematically reviewed 18 randomised controlled trials which examined a total of 22 different smartphone-delivered mental health interventions.

The studies involved more than 3400 male and female participants between the ages of 18-59 with a range of mental health symptoms and conditions including major depression, mild to moderate depression, bipolar disorder, anxiety and insomnia.

The first of its kind research, published today in World Psychiatry found that overall smartphone apps significantly reduced people’s depressive symptoms, suggesting these new digital therapies can be useful for managing the condition.

Lead author of the paper, NICM postdoctoral research fellow Joseph Firth says this was an important finding which presented a new opportunity for providing accessible and affordable care for patients who might not otherwise have access to treatment.

“The majority of people in developed countries own smartphones, including younger people who are increasingly affected by depression,” said Mr Firth.

“Combined with the rapid technological advances in this area, these devices may ultimately be capable of providing instantly accessible and highly effective treatments for depression, reducing the societal and economic burden of this condition worldwide.”
Continue reading Smartphone Apps Reduce Depression

Internet of Things (IoT) and Your Healthcare

IoT for Healthcare — A $163 billion opportunity

Internet of Things Enabled Healthcare

Healthcare is a highly valuable albeit highly contentious industry. Soaring costs, complex insurance regulations used at times as much for political leverage as for ensuring patient care, overworked doctors and nurses, and ongoing public health issues all influence the way patients interact with medical professionals and other caregivers.

illustration of smartphones, computers, etc. used for healthcare IoTTo some extent all of these problems, along with many others that plague healthcare service delivery, could be streamlined, and outcomes improved, through better access to real-time information, innovative monitoring techniques and predictive diagnostics–all solutions the Internet of Things can enable.

IoT as a Healthcare Industry Disruptor

Based on research conducted by Accenture Consulting and published earlier this year, 73% of healthcare executives think IoT will be “disruptive” within three years. In keeping with a broader theme impacting enterprise IoT adoption, the research further finds that only 49% of healthcare executives say “their leaders completely understand what” the IoT means for the industry.

Despite an apparent hesitancy, digital research firm eMarketer projects an $163 billion value for IoT-related healthcare by 2020, representing a compound annual growth rate of more than 38% from a 2015 baseline.

An executive summary in the research report outlines a number of key use cases:

  • Internet-enabled devices and sensors seamlessly collect and analyze real-time health and fitness data.
  • Connect entire networks of medical devices.
  • Locate healthcare-related assets.
  • Streamline patient care and medical research.

It’s already tracking:

  • Pharmaceutical inventory
  • Helping elderly patients stay safe in their homes
  • Powering prescription bottles that remind people when to take their medications

Value From Data

IBM has tailored its cognitive data analysis platform Watson for healthcare, and has placed major emphasis on its health-related products and services. For Watson Health, IBM cites four primary benefits of data insight created by connected appliances:

  1. optimized organizational performance
  2. better customer engagement
  3. enhanced decision making
  4. management of patient experience while gaining cost efficiencies


What do Surgeons and Elevators Technicians Have in Common?

There is no excuse today for the surgeon to learn on the patient” — William J. Mayo, 1927.

For a long time, in medicine, this was the only way to learn.
Luckily for doctors and patients, we now have the ability to integrate visualization, computing, performance measures and simulated procedures.

AR can help surgeons become more efficient at surgeries, as well as train them safely without having to use actual humans.

For example, though AR an accurate 3-dimensional reconstruction of the body can be created, empowering surgeons with a sort of x-ray vision (in real time, and without radiation!)

One of the barriers to developing virtual and augmented reality surgical simulation has been the large amount of computing capacity required to remove delays in signal processing. Also fortunately for us, systems that break down tasks are addressing the issue, and as A.I. gets more and more intelligent, we are certainly heading towards a healthcare revolution. Imagine what will happen once quantum computing is here!

So, what do surgeons and elevator technicians have in common? They can both benefit enormously from AR.

ThyssenKrupp, the big elevator company, is trying out the HoloLens with its elevator maintenance teams. Techinicians can use AR to dig into the problems of thousands of different configurations and millions of parts that make the elevators they maintain. And they can do it more quickly and safely.

With AR, you are looking through the headset at the real thing, augmented with additional information. There’s no substitute for learning on the spot. AR puts the equipment in the hands of the person.

On-the-job training can be taken to a whole new level thanks to AR. Imagine a new hire faced with in real-world situations in which they must perform their job duties. Millions of new employees could be trained using these technologies. Seems like hyper-training, for good or bad, is here to stay.

VR at its best shouldn’t replace real life, just modify it, giving us access to so much just out of reach physically, economically. If you can dream it, VR can make it. — MATTHEW SCHNIPPER, “Seeing Is Believing: The State of Virtual Reality”

Augmented reality is truly revolutionizing the way we interact with information, with our history and the world around us. Its availability makes it the perfect tool for small-scale grandeur.


New Senate Bill Seeks To Reduce Telemedicine Restrictions

By Jeff Lagasse  |  July 31, 2017

photo of dcotor with laptop and medical icons floating in air for story on New Senate bill seeks to reduce restrictions on telemedicine useWhile the Senate’s efforts to repeal and replace the Affordable Care Act imploded last week, that hasn’t stopped lawmakers from introducing bills that would make tweaks to the healthcare system in smaller ways. One such bill, sponsored by Reps. Doris Matsui, (D-California), and Bill Johnson, (R-Ohio), would expand the use of telemedicine to reduce costs.

The bill, the Evidence-Based Telehealth Expansion Act of 2017, was introduced late last week and would give the Health and Human Services secretary the authority to waive Medicare restrictions on the kinds of telemedicine it covers — as long as the actuary at the Centers for Medicare and Medicaid Services concludes it would indeed save money.

Restrictions that would be lifted include any geographic limitations, as well as limitations on the use of store-and-forward technologies. Store-and-forward technologies are where patient healthcare data and digital images — such as radiologic images — are captured, packaged as a case file, and transferred via telecommunication services to a clinician who then responds with a diagnosis and any relevant therapeutic recommendations.

Additionally, the bill seeks to lift limitations on the types of healthcare providers who can offer these sorts of telemedicine services, with the caveat that they be a Medicare-enrolled provider. The bill would also remove limitations on on specific codes designated as telehealth services.

The waivers would come with certain telemedicine restrictions.
In addition to the CMS actuary rubber-stamping the waivers’ net reduction in spending, the HHS secretary would have to determine that the waivers reduce spending without reducing the quality of care; improve care quality without increasing spending; and wouldn’t deny or limit the coverage or provision of benefits for any given individual.


How an Air Purifier Can Boost Air Quality for Your Office Space

office workers wearing dust masks for article on improving inddor office air quality with air purifier

The air quality in your home is something you can control, but what if you spend 40 or more hours a week in an office building? The Environmental Protection Agency (EPA) notes that, “Most Americans spend up to 90% of their time indoors and many spend most of their working hours in an office environment.

Indoor environments sometimes can have levels of pollutants that are actually higher than levels found outside.” While the majority of the air quality in a large building is affected by the actions of building management, there are things you can do to improve air quality in your office, cubicle, or other workspace. One step you can take is to use a high-quality air purifier. But what air purifier is the best one for use in an office environment?

The Problem of Air Circulation in Office Buildings

The air quality in an office is important for several reasons beyond just the amount of time you spend there. We know from multiple studies that air flow and circulation — that is, the frequency with which the inside air is replaced by air from outside — is one of the most important factors affecting indoor air quality. In an enclosed space, whatever pollutants are present will tend to build and build and become more concentrated, and therefore become more harmful. Outdoor pollutants can be dispersed by the wind and diffused into the much greater air volume of the Earth’s atmosphere. That’s why circulating outdoor air through a house or office building generally increases the air quality in the building (this is not to say, of course, that outdoor air pollution is not harmful, but that in most cases outdoor air is cleaner than indoor air).

Continue reading How an Air Purifier Can Boost Air Quality for Your Office Space

New Study Highlights The Importance Of Telemedicine

A recent study from Canada Health Infoway adds to the mounting evidence that telemedicine, specifically virtual visits and consults via video conferencing actually offer value to both the patient and the provider.

Infoway, a Canadian federal non-profit whose mission it is to advance mobile hillustration of telemedicine for article about Canadian study shows value of telemedicine visits to patients, cliniciansealth, worked with researchers from the University of British Columbia to conduct surveys and interviews with clinicians and patients participating in virtual visits.

Lead author of the study Kimberlyn McGrail stated:

“The patient survey results clearly show that virtual visits can be a way to offer patient-centered care. Whether we realize that potential depends critically on how these services are integrated into existing care delivery.”

They found that virtual visits increased access to care for patients with most saving travel time and avoiding work absence. Many may have reservation about online security, but 91 percent of participants of the study said that they were confident their information was secure. And 57 % stated that they avoided a physical trip to the doctor altogether.

iMedicalApps has covered other recent studies that support these findings, like one that showed e-consults improved access to infectious disease care and high satisfaction ratings in pediatric care.

While the study comes from Canada where access to care in remote parts of the country is a problem, access to care even in urban areas around the world is a problem and a good reason for more investment in telemedicine.


Wearables Relatively Accurate On Heart Rate But Not Energy Expenditure

Using wearable devices to monitor physical activity, particularly step count, is not a new concept. Many wearable fitness trackers also have a heart rate monitor and we’ve previously talked about the accuracy of that data. And if you have one of these devices, you may have noticed that many track energy expenditure, or how many calories you’re burning.

Current wearable devices provide relatively accurate measurements on heart rate but not energy expenditureShcherbina et al from Stanford University developed a wearable sensor evaluation framework to test the accuracy of heart rate and energy expenditure estimates from seven commercially available wearable devices. The Apple Watch, Basis Peak, Fitbit Surge, Microsoft Band, Mio Alpha 2, PulseOn, and Samsung Gear S2 were tested against the clinical gold standards, continuous telemetry and indirect calorimetry, while sitting, walking, running, and cycling. The 60 volunteers included in the study were of diverse backgrounds.  The framework, protocol, and results are publicly accessible, and their three main conclusions are summarized below.

First, the tested devices can produce heart rate data with acceptable error for walking, running, and cycling. The lowest error rates were observed for cycling (median 1.8%, 95% CI 0.9%–2.7%) and the highest error rates were observed for walking (median 5.5%, 95% CI 3.9%–7.1%). Second, none of the tested devices could produce energy expenditure data with less than 20% error. Third, the Apple Watch had the best overall error profile, while the Samsung Gear S2 had the worst.  The Apple Watch had the lowest error in heart rate, 2.0% (95% CI 1.2%–2.8%), while the Samsung Gear S2 had the highest heart rate error, 6.8% (95% CI 4.6%–9.0%).