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Digital Doctoring
ssajous writes "This is an interesting article in the NY times which talks about PDAs quickly finding their place in the world of medical billing and keeping track of patient's care, there is a lot of money in the medical field, but also currently a lot of unnecessary paper work. I like what I see!!!" I don't think Palm makes a tricorder card yet, but it's only a matter of time. The last time I saw a doctor, he was doing things the old-fashioned way - I would guess it will take a while before this sort of technology is widely used.
believe it or not the Newton had made a lot of inroads into this before Steve killed it. A lot of the apps for the Newton were specifically medical/hospital.
Security concerns aside, this is a really great idea because it allows multiple people to at least read a record (i believe they have a check-out mechanism to prevent more than one person from writing to the chart at a time).
Of course, there's the ambulance chasers, who whip out their PDAs and start taking names for litigation. However, the PDA is the number 2 favorite of the ambulance chaser; number 1 is the instantly inflating balloon for putting under women's shirts to feign the third trimester.
"Ancillary does not mean you get to rule the world." --U.S. Circuit Judge Harry Edwards, speaking to the FCC's lawyer
Maybe when they have good voice recognition for the Palm, then it might really look like a sexy alternative to pad and pen. But not yet.
my brother is a doctor and he uses his Visor regularly. Mostly it helps him explain to people whats wrong, without having to get out a big text book and show them the pictures. he loves it.
There are a number of problems with the concept of digital assistants in medicine. I worked in the field for some time and ran into all of them...
o Resistance
But I've *always* done it this way
o Portability
How do you move from patient to patient and
get data into a centralized database reliably?
o Reliability & Security
Medical data must be valid, authenticated, and
readily available. Having a system crash when
you're evaluating someone's heart condition is
unacceptable.
o Legal considerations
Doctors' notes are considered as legal
documents when looking at medical malpractice
and other legal-medical collisions. How do you
verify that the electronic format is the same
as the paper one when there *is* no paper one?
There are more, of course, but these are the big ones I ran into time and again. The bottom line is that while Hippocrates and other PDA software packages are useful, the likelihood of the medical profession accepting the widespread use of portable technology for medical data entry and retrieval is slim anytime soon.
Do the PDAs need some sort of jacket to prevent them from gathering/transferring germs/deseases in cracks and crevices? What do health regulations say about electronic equipment in hospitals? Does each electronic product have to be certified or something by a governing body as safe for use in a medical facility?
To a new everything, so that now there is a complete PC (Windows) in every office that brings up your history, the works...and even sends prescriptions over to the pharmacy for pickup. Of course, when they implemented it at first there were tremendous problems (like 3 hour lines for drugs) but they seem to have worked it out now. I'm just afraid that I'm going to go in there for something serious one day and his machine is going to crash in the middle of something important, thus giving Blue Screen of Death a whole new meaning. (Ok, I bet I'm not the first one to say that. :))
www.HearMySoulSpeak.com
The books published by Franklin for all the hand top OSs. It's just that the hot swap HandSprings allow people to carry several around.
A small piece not mentioned in a good article.
Profit motivates invention.
My friend is a doctor in large hospital in NYC, and she uses her Palm all the time. It has replaced a least a half dozen heavy manuals she used to keep in her pockets. Many companies now sell e-text versions of their reference works. She got it to reduce the number of reference works she had to use, but I think it is better in that it facilitates better searching and indexing. She is young, and young doctors liker her use them all the time, it is the older ones in power that are technologically resistant.
I think that it is unfortunate the medical field has been so slow to adopt technology like this. If anyone knows the history of MYCIN, it is amazing to me that the medical field has ignored such powerful diagonostic tools. In the end I think it is the public that suffers.
"Politics is for the moment, an equation lasts eternity" -A. Einstein
I havnt seen a need for PDAs in my own life. They have always been neat little toys as far as my life was concerned. Some people really need them, but I think for the most part, they are status symbols and/or toys. My thinking changed after I saw my brother in law's Visor at Christmas. He is a medical doctor and he had a great database stored in his PDA. He had diseases and different conditions loaded in the prepackaged database that he could update as well. It seemed as if he found it very useful at work. Reading about Doctors and PDAs just reminded my of this minor enlightenment of my own.
Anyway, he was one of the first people in Lewiston to buy a PDA, and he's still got one now (Handspring 8MB model). He carries it everywhere with him, keeps all of his stuff in it, and uses it for everything. And oddly enough, this has become typical in that hospital. If there's a market to be had for PDAs, it's probably indeed with anyone who collects data - and doctors fit snugly into that category.
CAP THAT KARMA!
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SIG: HUP
But as a software platform, I think they are not all that good. They have megabytes of memory now, but they suffer from 64k limits somewhat analogous to what DOS used to impose on programs. And while PalmOS is conducive to letting experienced PalmOS programmers write tight, simple applications in C, for many custom applications, you want something like Java, Smalltalk, or even VisualBasic.
Palm has made steps to offer Java and to upgrade the processor and OS. Let's hope those will happen soon.
I've learned about this first-hand: Last year, My wife was diagnosed with Type II diabetes in the aftermath of a failed pregnancy.
People diagnosed with Type II diabetes often have to test their blood seven (7!) times a day (or more!) in the first few years, and record the results, time/date, and diet info for their doctors. Manually, this can be a pain in the ass, especially when full records for 2 months need to be given to a doctor.
Right after being diagnosed, my wife found out about Glucopilot (see http://www.healthetech.com/), an award-winning program for the palm OS, which prompted her to buy a Palm V and a hard case. It does a wonderful job of recording, handling, and outputting & graphing the data. With the purchase of a small cable (made one myself, ha!) it can read the output of some blood sugar testers directly and eliminate the manual entry of numbers all together.
Her doctors, both of whom where unfamiliar with the program, were astounded by it and the detailed data it provided when she show it to them, and they began mentioning it to their other patients.
It's not just the Glucopilot software though, My wife found several other programs for the Palm that she uses to track diet, and other medical info like details on her menstral cycle, sudden sickenesses, and anything else.
Where this really makes the impact is on the day-to-day lifestyle front. She has a tiny case that she carries with her eveywhere she goes because it is so compact and totable. It holds her Palm V, and her blood testing gear. Because the form factor is so friendly, and the software provides such immediate feedback on blood-level trends, etc, she has displayed incredible dicipline in taking readings and entering data as it occurs. And that dicipline has seriously impressed me and her doctors, and is probably why they are saying she will be able to control the condition without needing insulin shots, etc.
The palm has been great for collecting all my loose data in one place, and I see specialized, easy-to-use medical tracking and info software as providing great benefit to people who have problems that are ongoing and have to shared with their doctors.
The Healthy Palm
and others...
Thing is, though, I'm not sure I'd trust, for example, a pregnancy-safe drug list I just got off some guy's home page...
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Many of the current meters have the ability to download the readings. My First Step records 50 readings internally and keeps date and time information and even logs averages and trends. Upload to the PC once a week and send in.
I work in a large hospital, in the ER, and currently we are trying to phase in handheld, and small 'touch-screen' patient-charts, called 'echarts.'The problem lies not in the fact that they're bulky, that they use a pseudo-windows UI, and that they use stubborn LCD displays. It probably has nothing to do with the fact that their login is the last name and the first initial of any employee. Most likely nobody knows that they communicate via RF so that they can connect to the network. I doubt they remember when the backup power generator turned on, and scrambled that RF connection. The REAL reason that nobody wants to use them is because they're different,bulky,and difficult if not downright impossible to navigate. At least the paper forms are color-coded, and all look pretty, with the cute nurses' curly little handwriting. These chunky boxes look cinder-blocks wrapped in rubbery plastic. I'd bet that when someone comes up with a more ergonomic, eye-pleasing design, the doctors, nurses, and techs will be more willing to convert to the Paperless Way. But for now, the things sit in the corner, collecting dust along with the dot-matrix printers, almost totally unused. Not until these devices are used from the beginning, i.e. in the nursing and medical schools, will doctors et al be willing to trust life-or-death info to them!
After I got my m100, I was lookign at memory upgrades. One of the sites I found is by an MD.
For that matter, are there any PDAs that work with the current 802.11b standard for PC base stations?
- I don't care if they globalize against free speech. All my best free thoughts are done in my head.
Oh, yes. It's scary the way drug companies court doctors and hospitals. (Even veternarians, too, to a lesser extent.) For example, for one new allergy drug the makers sponsored a seminar: "the invitation included round-trip airfare to California, accommodations at a luxury hotel, and a participation fee of $1,000..."
My doctor just got a Visor (I think); it wasn't a pharm. company comp, she bought it herself. She's like a kid with a new toy; got a bunch of medical references on it, including the PDR. (That's the Physicians Desk Reference, a honking big book that lists every drug on the market, its actions and contraindications. Worth consulting whenever you are prescribed a new medication.)Tom Swiss | the infamous tms | http://www.infamous.net/
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
o Portability - use Symbol 802.11 enabled Palm and have spread spectrum radio coverage throughout and either a telnet or html client.
o Reliability & Security - NEVER USE MICROSOFT!!! Use AS/400 if you want absolute reliability, or Unix if you want high reliability with ease/cheapness of coding/updating.
o Legal considerations - there are many ways to sign/legally encode a file...discussed elsewhere.
This only leaves the "We've always done it this way" brigade - work on them:)
Frog51
Electronic devices per se are fine in hospitals, and I tend to spend a lot of my time setting up rf networks in hospitals (802.11 kit in UK is limited to 100mW output power) with no problems - in fact we often hook heart monitors to mobile bridges so patients can be moved without having to take a trolleyload of hardware with them, or drug trolleys with a laptop and rf network card to make patient record updates easier and more accurate. Its devices with the output power of mobile phones (1/2 a watt and up) which can interfere with sensitive heart monitors.
Although I have seen a Vodafone antenna siuated on the top of the Royal Infirmary in Edinburgh!!?!
Frog51
My husband and I were in the ante-something area at the hospital (the pre-delivery room), and the staff OB had just confirmed that I was really in labor. My husband whips out his Palm to get our OB's home phone number, and the next thing I know, here's the doc pulling his slightly-different-model out and they're doing compare-and-contrast.
Now, while I like techtoys as much as the next geek, at that particular point (contractions every two minutes) I felt it was more important to yell "HEY, CAN I GET SOME DRUGS HERE?"
Slashdot's token middle-aged housewife
I'm a doc and can attest that our handwriting is indeed bad, but curiously enough most do grafitti just fine - even the old farts are catching on.
I thought the Newton had a lot of potential and even hacked up a few things in Newton script to help with rounds, but the thing was too slow until the 2000 came along. A doc acquaintence started a successful software company with it though.
I guess we're cheap if you're talking about charging me $20,000 for software that I can put together for free with existing GNU/open source/free tools such as Linux/BSD/Apache/gcc/perl/interbase/postgres.... Free software is a great idea for medical applications that will catch on. You're right about the antique software that's still used by a lot of hospitals and clinics.
As a busy doc who has thought a lot about these things, I would have to respectfully disagree. The vast majority of docs do not refer to "practice guidelines" in their daily routines. No more than the average programmer refers to Dijkstra in his daily activities. And it is all too easy to forget that medicine is still much more of an art than a science - and as such, it is not easily encapsulated in a set of rules or guidelines. Science has its place and is desireable in many ways, but there are precious few prospective randomized clinical trials. And there are serious flaws in treating specific patients as if they were the average case.
Experience and intuition (together with a basic medical fund of knowledge) are still much more effective in diagnosis and treatment than automated systems. There are so many important visual and nonverbal clues that come into play - and this is where "automated decision making" falls flat. This kind of problem requires serious AI that is nowhere near fruition. Perhaps one day we will have a medical "Deep Blue", but not any time soon. The heuristics are much more complicated in medicine than in chess.
The real potential lies not in aids to decision making. After all, it is only the rare & unusual case that forces a trained doc to hit the journals & books anyway. But there is big potential in saving time, since docs are incredibly busy and time pressured. Palms are very helpful in this respect.
The other areas where software and computers are going to be helpful is in pattern recognizion. Reading EKG's is commonplace (though still pretty bad). Automated reading of EEGs, XRAYs, and pathology slides will be common soon enough. Docs are also very interested in robots since they are potentially more precise and do not fatigue during surgery.
But I must agree wholeheartedly with you about the darker side of your type of software - it will be used as a tool for insurance companies to cut as many corners as possible and exert more control over medical decisions for their shareholders under the pretense of the computer software "knowing what's best for the patient". Like it or not, the vast majority of important advances in medicine are not based on quantitative scientific studies, but are instead the result of a experience-based darwinian process resulting from reasonable practice variability. Once the insurance companies (armed with your software) impose widespread mediocre (but cost effective) "practice guidelines", then I fear that medical progress will be slowed and medicine will lose its heart and soul.