Blog: OrthoOnc.com
bone and soft tissue tumor surgeon, metro Washington DC
interested in health policy, technology and tumor research
co-founder, Touch Consult, web & mobile software for physician teams
twitter: @OrthoOnc
wodajo@orthoonc.com
practice: www.tumors.md
Link reblogged from Jay Parkinson + MD + MPH = a doctor in NYC
Long-term use of osteoporosis drugs linked to hip breaks →
I believe one day we’ll look back on chronic disease medications we’re supposed to take every day for decades and finally realize that reductionist medicine via a simple pill never really worked.
Agree with Jay here
These fractures were popping up individually in our practices and it was just a matter of time before somebody put them together.
It is so tempting when a fulcrum is found that moves a big rock. Unfortunately, biology is rarely so reductionist. Moving one rock usually causes a few others to move too…
Yet we still have this problem of people outliving the strength of their skeletons.
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Turning your iPhone into a Portable ICU Monitor – AirStrip Technologies is Revolutionizing Mobile Health Care [App Review]
(Reposted from iMedicalApps.com)
From HIMSS 2010, Atlanta
AirStrip Technologies was founded in 2003 by Dr. Cameron Powell, an ObGyn from San Antonio TX, and his partner Trey Moore, who is the software architect behind the products. Their first product, AirStrip OB was launched in 2005 and received FDA clearance in 2006. It allows for a physician to view the real-time fetal heart rate monitor of a woman in labor on an iPhone over a 3G connection. As Donna Morrow, RN, Vice President of Client Services told me, one of the least favorite parts of her job as a labor and delivery nurse was trying to describe a fetal monitor strip to a physician over the phone. When AirStrip OB came to her Houston hospital, she was an instant convert – enough in fact to leave her job of 15 years and join the company.
The real breakthrough for the AirStrip Technologies came when Dr. Cameron was one of the featured presenters during the keynote address during the 2009 Apple Worldwide Developers Conference. In between the usual cadre of developers, suddenly walks on a physician. I remember gasping when watching his demo of a real-time display of a wave form an ICU. While eventually being able to view lab and other static data on the iPhone seemed predictable enough, actually seeing a real live patient’s heart beating on your phone was obviously a turning point for the iPhone platform and medical technology in general.
The company is now announcing a suite of AirStrip Observer products, which will also include AirStrip Critical Care, Cardiology, Imaging and Laboratory. From their website, AirStrip describes the products as follows:
AirStrip CARDIOLOGY offers remote access to valuable data for the cardiologist including telemetry strips, EKG data, pulse oximetry, ventilator pressure measurements, end-tidal CO2 monitoring and arterial pressure monitoring.
AirStrip CRITICAL CARE delivers ventilator flow tracings, patient vital signs data and rhythm strips. Practitioners can access virtual real-time and historical data.
AirStrip IMAGING is a mobile PACS solution that can be accessed from virtually anywhere, providing practitioners with access to data previously accessible only at the bedside or on a hospital workstation.
AirStrip LABORATORY provides on-demand access to lab results and readings via an HL-7 feed. Users can refer to current or historical results through the patient medical file by simply selecting the required results view.
Ms. Morrow demonstrated the Critical Care product in the accompanying video and says FDA clearance is “imminent”. Even the quickest encounter will again show how amazing this will be to physicians. Multiple waveforms are displayed simultaneously, including ECG, blood pressure, pulse ox and temperature. Other screens will show laboratory data, I&Os. With a single tap, many of these parameters can be graphed over time, quickly showing trends over time. The interface is so fluid and accessible, I predict physicians will be standing at the bedside with all the hospital provided computers and monitors next to them and be looking down at their iPhones since it will be so much quicker and easier.
Another key feature is that data is not stored on the iPhone, helping reduce security concerns. Physicians are able to review up to 4 hours of previous data. Worth noting, there is currently no capacity to enter documentation into the iPhone.
AirStrip recently won a nationwide contract with HCA hospitals and is planning installation in 70 of their 110 hospitals. The OB and future Observer products are provided as a service, with the hospital paying a regular subscription fee. The pricing model for Critical Care will also be a strategic asset. The OB product is priced by the number of physicians. However, since several physicians can be involved in the care of a single ICU patient, the company is planning on pricing the Critical Care product on a per-ICU bed basis. What this will mean is that suddenly large cadres of physicians the in the hospital, across multiple specialties, will be using AirStrip Critical Care. It will not be long before they will be demanding the rest of the Observer suite of products for their own departments. Going forward, it will be cheaper anyway for hospitals to deploy software that individual physicians and nurses can use on their handhelds rather than trying vainly to keep up with with ever increasing numbers of dedicated fixed and portable computers, each needing maintenance and upkeep. And thus, the next era of patient monitors may well be beginning.
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Low Back Pain Clinical Management Guidelines App: Evidence-Based Guidelines for a Common Problem [App Review]
(as published in iMedicalApps.com)
Low back pain is virtually an epidemic in the United States. In many surveys, it is listed in the top 3 most frequent patient complaints resulting in a visit to a physician. It also appears to be more prevalent in the United States than in other industrialized societies, with only a muddle of theories available explain this costly difference. For this reason, a systematic methodology of evaluating the patient with back pain is clearly important. This would help the primary care physician, usually the first evaluate the patient, who is quietly worried that she or he might miss an ominous but uncommon etiology such as metastatic cancer. Also from the public health perspective, this methodology would help prevent multiple, unnecessary and costly imaging studies. And, in fact, many detailed evidence-based recommendations have been published over the years, going as far back as 1994.
While the availability of many evidence-based practice guidelines is of great benefit, the multiplicity also becomes a burden for the practicing physician who needs a quick and handy way to answer the question of what to do for a particular patient. Thus, the birth of a category of desktop and mobile applications named clinical decision support systems (CDSS). This growing and important sector bridges the gap between evidence based guidelines and clinical computer applications. Some of the larger players in this sector, such as Zynx Health, aim to integrate directly into the electronic health records (EHRs) used at hospitals. Others have opted for convenient, free-standing applications quickly available to the physician. The iPhone app Low Back Pain Clinical Management Guidelines is an example of the latter.
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HIMSS 2010 Coverage: Visual Dx Mobile - An iPhone Medical App That Supercharges a Clinician’s Most Basic Tool – Our Eyes
(as published in iMedicalApps.com)
Although an unimaginable array of technology was demonstrated in the hangar-like exhibition spaces at HIMSS, one of the most impressive uses of technology from a physician’s perspective was in a small booth in far off corner. In it, the voluble and passionate co-founder and Chief Scientific Officer of Logical Images (www.logicalimages.com), Dr. Art Papier demonstrated a web and mobile based application that magically produces a sequence of high quality diagnostic images in response to user queries. Since Dr. Papier is Associate Professor of Dermatology at the
University of Rochester School of Medicine, the application was originally dedicated to presenting high-quality images of dermatologic conditions. This is fortunate in two respects. First, the most important findings in dermatology are visible to the naked eye and thus to a camera, second few clinicians (except for dermatologists) have more than the slightest familiarity with dermatologic conditions whereas skin conditions, according to Dr. Papier, account for 15% of visits to PCPs. The application has since also expanded to include radiology. An iPhone and iPod Touch version was announced at HIMSS this week.
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HIMSS 2010 Coverage: Nuance Brings Medical Dictation to your iPhone – Video of Dragon Medical Mobile Apps in Action →
Nuance, the makers of Dragon Medical Dictation, a favorite dictation service among many physicians, announced at HIMSS they are bringing the same medical transcription service to the iPhone.
Many readers may have noticed the recent arrival of a free Nuance “Dragon” app in the App store. This simple app allows the user to speak directly into the iPhone and receive a nicely transcribed text document 15-30 seconds later, ready for email or for copy and paste.
At that time, Nuance did not specify their future intentions, but many speculated a medical version would be forthcoming. Indeed, at HIMSS, Nuance announced three new iPhone medical apps: Mobile Dictation, Mobile Search, and Mobile Recorder, all named with the prefix Dragon Medical (i.e. “Dragon Medical Mobile Dictation”, etc).
Dragon Medical Mobile Dictate
The medical app of immediate interest to physicians is the Mobile Dictation one, which is similar to the free Nuance application, except for the very important distinction that the back end is now connected to the very reputable Dragon medical transcription engine – highly optimized to transcribe doctor speak. Like the most recent version of the desktop Dragon Dictation application, the specific “training” time is required, although the application does learn the user’s voice over time.
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HIMSS 2010 Coverage: Zynx Health Condenses Vast Amounts of Evidence Based Guidelines into Computerized Order Sets →
Zynx Health was founded in 1994 by three physicians at Cedars-Sinai Medical Center in Los Angeles. Their original mission, unchanged from that time, says Carina Edward, Vice President of Marketing and Product Management, is to improve patient care and decrease costs. 
The challenge for physicians, then as now, is utilizing evidence based medicine in day-to-day patient care. While physicians can always search the primary literature or use a database of evidence-based clinical guidelines such as Up-To-Date or Cochrane’s, having recommendations at the critical moment of writing orders is invaluable.
This is how Zynx was created. The company was originally funded by Cedars-Sinai Hospital and now has grown to have partnerships with every major EHR vendor. The point of integration is at computerized physician order entry (CPOE) interface where the Zynx product is strategically placed. Institutions then have available to them more than 100,000 order sets, organized hierarchically. However, Zynx will simplify the process of selection by helping to choose the most popular or relevant order sets for each hospital.
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HIMSS 2010 Coverage: Epocrates’s recently announced Electronic Health Record will utilize many iPhone features →
Yes, that is correct. Epocrates, the mobile medical app that nearly has the distinction of being the one “indispensable” application for every physician’s smart phone, is going to have a big brother soon.
The ten year old company, based in San Mateo CA, believes that its installed base of more than 900,000 clinicians worldwide and experience with mobile development gives it the basis for understanding what physicians need and expect from a mobile EHR. They are targeting solo and small physician practices and presumably will have a price-point that will be competitive. “This was a logical next step for Epocrates,” said Rose Crane, chief executive officer of Epocrates, in their press release.
I had the opportunity to speak Robert Quinn, Senior Vice President of Engineering and Chief Technical Officer about the forthcoming product. They are planning a shipping target of Fall 2010. The product will have both a mobile iPhone and web interface. They plan on integrating the features of the phone, such as the camera, into the product as well as dictation directly into the iPhone, an interesting feature especially in light of the announcement today by Nuance that they will be shipping a medical transcription application for the iPhone.
Continue readingLink
HIMSS 2010 Coverage: Microsoft and Google Have Grand Plans to Change How Medical Information is Shared and have Data to Show it →
One very commonly understood pain point for patients is filling out the same forms over and over again. While just about every adult has experienced this annoying issue, the deeper problem is that a single patient will almost always has more than one physician or caregiver. This means that the repetitive form filling is really the tip of a much more serious problem of data in silos, with each physician and hospital treating the patient from scratch, exchanging information via faxed notes or (mostly missed) phone calls.
Take the simple example of a middle aged patient who suddenly experiences chest pain after dinner one night. Most she would go to the nearest emergency room and have a rapid and extensive evaluation. Let us say the results did not point to a heart attack but there were indeed some abnormalities on the EKG. The patient would be discharged home and instructed to follow up with a cardiologist and their own primary care physician. The next morning the patient would call the cardiologist and show up in his office that afternoon. In their hand is … nothing. They have no records from the hospital. They seem to remember something about an abnormal EKG but, unfortunately, do not have the PCP’s EKG from last year which showed the same abnormality. The cardiologist gets a new EKG, puts them on a beta blocker and aspirin. The next day the patient goes to their PCP carrying … nothing. The PCP sees the pill bottles and assumes they must have had a heart attack and orders more labs and sends them for a cardiac CT. All this for gastroesophageal reflux.
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HIMSS 2010 Coverage: What is CCHIT and how does it affect doctors ? →
One of the numerous sessions today was a lunch hour “town hall” on the current status of CCHIT certification. This is one of many acronyms that seem to populate the language of health IT of recent and stands for Certification Commission for Health Information Technology. This organization is a nonprofit, 501(c)3 organization with “the public mission of accelerating the adoption of health IT”.
Today’s presentation was headed by Mark Leavitt, MD, PhD the chair of the commission and covered a large amount of ground and was followed by some pointed questions from a very educated audience, many of whom were CIOs (Chief Information Officer) or CMIOs (Chief Medical Information Officer) of hospitals.
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Amazing amount of information at #HIMSS10, best part is conversations with fascinating people like @drjosephkim and @drval
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