Raja Jasti’s Blog - Renaissance Thinking

March 2, 2010

Message from your medicine

Filed under: Mobile, Technology, Trends — Tags: — Raja @ 8:43 am

WSJ has a feature story on growing trend of medicine reminders and its benefits in increasing the medication adherence.

[PILLS]

Vitality

The GlowCap gives electronic reminders and collects data on habits.

Much of the medicine prescribed to treat chronic conditions like high blood pressure and diabetes doesn’t work—because patients neglect to take it.

But what if someone, or something, called to remind them every time they were due for a dose?

Express Scripts Inc., the big St. Louis pharmacy-benefit manager, is about to test an electronic pill container that issues a series of increasingly insistent reminders, in a national study among patient members.

The container—actually a high-tech top for a standard pill bottle called a “GlowCap”—is equipped with a wireless transmitter that plugs into the wall. When it is time for a dose of medicine, the GlowCap emits a pulsing orange light; after an hour, the gadget starts beeping every five minutes, in arpeggios that become more complicated and insistent. After that, the device can set off an automated telephone or text message reminder to patients who fail to take their pills. It also can generate email or letters reporting to a family member or doctor how often the medication is taken.

It is one of the high-tech ways companies are grappling with medicine noncompliance. Only about half of patients who are prescribed a medication for a chronic condition are still taking the drug regularly after a year, says Daniel Touchette, assistant professor of pharmacy practice at the University of Illinois at Chicago.

Mobile technologies are going to play an important role in healthcare. Our company MDava provides technology that enables healthcare organizations to send such reminders and alerts to their patients.

October 17, 2009

Heathcare communications in the digital age

Filed under: Internet, Mobile, Technology, Trends — Tags: — Raja @ 2:20 pm

NYT writes about the startups that are aiming to change the way doctors and patients interact.

The doctor’s office seems to be one of the last places not yet transformed by Web technology, but a handful of tech start-ups are trying to change that.

Most patients still call to make an appointment and wait on hold to speak with a receptionist. When they arrive at the office, they fill out their medical history and contact information on paper that is filed away in a folder. Many doctors still take handwritten notes on charts that are difficult to share with the patient and other physicians, and write paper prescriptions that patients must carry to the pharmacy.

This year, the pace of technological change has accelerated as start-ups try to change the way doctors and patients interact. American Well, which we covered last year, enables doctor visits via Webcam. Another example is Keas, a new service that Steve Lohr wrote about in The Times on Tuesday. It helps patients by providing personalized reminders, advice and wellness plans based on their health information.

At the Health 2.0 Conference in San Francisco on Tuesday, a few other start-ups talked about what they were doing to improve the ways in which doctors and patients interact.

One is called Hello Health. Primary care practices use this service to communicate with patients, and the company says it can cut overhead costs in half by decreasing the need for receptionists and nurses. It enables patients to use instant messaging tools to talk with their doctors. The conversations are stored in the patient’s file, and the doctor can charge the patient on the spot and provide a receipt for the insurance filing.

Another is VisionTree. It aims to replace paper in a lot of the doctor-patient interactions that one would think would have been digitized a long time ago. For example, patients fill out their medical histories online instead of on a clipboard and can use the service to request prescription refills or make appointments over the Web.

ReachMyDoctor gathers a patient’s health history in one place so the doctor and patient can quickly see which procedures or screenings the patient needs. It also enables several doctors who care for a patient to communicate about that patient in a group chat. Patients can send questions directly to their doctor and make appointments online.

RelayHealth also enables doctors and patients to communicate online. It lets both doctors and patients enter health information, like vaccinations or allergies, and enables doctors to write electronic prescriptions and share information with other doctors.

Doctors and patients will probably encounter hurdles when they try to use these. For one, they will eventually need a single platform that they all use instead of a variety of different applications, said David Kibbe, senior adviser to the American Academy of Family Physicians and a proponent of doctors’ adopting health care technology. There are also legal obstacles with online records, patient privacy and telemedicine, he said.

Still, Mr. Kibbe said, “part of the problem with the health care system is physicians only have a small amount of time to see patients face-to-face,” and these new tools increase their interaction.

Mobile is going be the key enabler of this trend. 

October 10, 2009

Health2.0 startups

Filed under: Mobile, Technology, Trends — Tags: — Raja @ 12:16 pm

Mike Yuan has a review of the most promising startups from the Health2.0 conference.

Perhaps the most important aspect of Health 2.0 is for consumers to take responsibility for their own health, and take proactive actions to live a more healthy life style. Tools that help consumers to change their behavior in this way were featured prominently at the conference. One launch in this category that got quite a bit of fanfare was the beta launch of Keas. Started by Adam Bosworth, who used to run Google Health and of the BEA fame, Keas is a web site that provides personalized wellness/healthcare action plans based on a user’s personal health information, including both self-report questionnaires and medical records. Users can also share information about what treatment works and what doesn’t in self-organized online communities. You can read more about Keas here. While Keas is focused on bringing web 2.0-style health programs to the general public, US Prevention Medicine (USPM) has been selling web-based wellness, disease prevention, and disease management programs to employers for several years. Companies like Keas and USPM provide a clear case for ROI for Health 2.0 — it saves money to motivate consumers to take better care of themselves.

The online platform is arguably not the best tool for gathering the kind of detailed life stream data that truly drives behavior change. After all, few of us would check out our weight/blood glucose/cholesterol trends on a PC before we eat a big meal, and few would log the calories on a PC after that meal. The mobile platform is much better suited for both data gathering and trending. TheCarrot is an iPhone app that tracks a large number of activities in daily life, and they have a sleek web site that will let you plot any two matrix against each other to discover, say, whether exercise triggers your headaches. Polka is another cool iPhone app that manages a mini-PHR right on the iPhone, with the capability to record data streams on the phone and manage the data with a variety of interesting tools they have integrated into their web site.

Mobile is the right platform for health2.0. There no question that health2.0 technologies can provide tremendous benefits to consumers and transform the healthcare landscape. The biggest hurdle is not technical but instituational. Most of the healthcare information is controled by healthcare providers and they are not opening it up anytime soon.

October 6, 2009

personalized health advice and counseling

Filed under: Technology — Tags: — Raja @ 10:16 am

Keas, a new healthcare startup, wants to provide personalized health programs to consumers based on their personal health records (PHR).

A New Web Tool Devoted to Your Health
 

 The national health care debate right now is all about giving more people affordable access to doctors and hospitals. Yet the vast majority of health care decisions — 80 percent or more, experts say — are really made by individuals, instead of medical professionals, whether choices are about diet and exercise or ways of managing chronic conditions like diabetes and heart disease.

The national health care debate right now is all about giving more people affordable access to doctors and hospitals. Yet the vast majority of health care decisions — 80 percent or more, experts say — are really made by individuals, instead of medical professionals, whether choices are about diet and exercise or ways of managing chronic conditions like diabetes and heart disease.

The long-term answer to improving the health of the nation’s population and curbing costs, experts agree, is to help people make smarter decisions day in and day out about their own health. And the most powerful potential tool in the march toward intelligent consumerism in health care may be the Web.

That is why on Tuesday, a start-up company led by Adam Bosworth, former head of the Google Health team, plans to become the newest entrant to the online consumer health business.

Already, surveys show that a majority of adults in America routinely scour the Internet for health information. Doctors joke that the standard second opinion of diagnosis and treatment has become a patient’s Google search, with the results printed out and brought to the doctor’s office.

But the Web is still mainly a vast trove of generalized health information. The ideal, health experts say, would be to combine personal data with health information to deliver tailored health plans for individuals. That is what Mr. Bosworth and his San Francisco-based company, Keas (pronounced KEE-ahs) Inc., mean to do.

Using the Keas system, for example, a person with Type 2 diabetes might receive reminders, advice on diet and exercise, questions and prompts presented on the Web site or delivered by e-mail or text messages — all personalized for the person’s age, gender, weight and other health conditions.

Although success is far from certain, Keas has some big partners, including Google Health and Microsoft HealthVault.

Health technology experts say Keas is at the forefront of the effort to combine advanced Web and database technologies so it can personalize health education. The promise, they say, is a big step forward for online health tools, and could help accelerate their adoption — much as the spreadsheet program helped kick-start the personal computer industry back in the early 1980s.

“This is the next generation of applications for online health care,” said Dr. David C. Kibbe, a health technology expert and senior adviser to the American Academy of Family Physicians, who is also a member of the Keas advisory board.

This idea has tremendous potential particularly in countries like India where the doctor to patient ratios are very low. If this technology can be used to bring personalized healthcare to people that do not have easy access to doctors it can make a huge difference in people’s lives.

October 3, 2009

Telemedicine

Filed under: Internet, Mobile, Technology, Trends — Tags: — Raja @ 6:00 pm

Yahoo has a nice article on telemedicine.

SATURDAY, Oct. 3 (HealthDay News) — Imagine that you see a new mole and don’t like the looks of it so you take a picture of it using your cell phone and e-mail it to your family doctor for an opinion.

Or perhaps you have heart disease and take your blood pressure using a cuff that automatically uploads the data to your cardiologist’s computer for review.

Using electronic communications equipment to transmit medical information for consultation or examination — known as telemedicine — has come a long way from its beginnings as a means for rural areas to have access via teleconferencing to top-flight specialists.

In fact, technology has advanced to the point that telemedicine is beginning to blur into the normal daily routine of a doctor, said Dr. Jason Mitchell, assistant director for the Center for Health Information Technology of the American Academy of Family Physicians.

“Someday we won’t even consider it telemedicine anymore,” Mitchell said. “It’ll just be part of the way we practice medicine.”

And evidence is mounting that telemedicine can play a positive role in health care. A study in the journal Stroke found that the use of teleconferencing and the transmission of CT brain scans is beneficial to the initial treatment of stroke victims, later assessment of the amount of brain damage they’ve received and the rehabilitation they will go through during their long-term recuperation.

Some new ways of practicing medicine already taking place that could be considered telemedicine include:

  • Ambulances transmitting EKG data to the hospital they’re en route to
  • Automated pill counters that transmit data that lets doctors know whether medications are being taken as prescribed
  • Teleconferences to bring in specialists for consultation in such fields as dermatology, neonatal care, surgery and psychotherapists
  • Electronic scales for heart patients that trigger an alert to a nurse if the patient’s weight increases dramatically

“One of the best early indicators for impending hospitalization for patients with congestive heart failure is an increase in body weight,” said Dr. Lee H. Schwamm, vice chairman of the neurology department and director of TeleStroke & Acute Stroke Services at Massachusetts General Hospital in Boston and an associate professor of neurology at Harvard Medical School.

Schwamm describes such examples of telemedicine as “low-hanging fruit,” easily done to great advantage for both the patient and the doctors involved.

Telemedicine could be a boon to preventative medicine, Mitchell and Schwamm said, giving doctors access to detailed data that would allow them to diagnose problems early. For example, data from the scales or the blood pressure cuff could give doctors a chance to get someone in for treatment before a heart attack or stroke occurs.

“It would identify for us when a patient should be seen rather than relying on the patient for that judgment,” Schwamm said. “In my mind, that’s the real promise.”

Telemedicine also could provide tremendous cost savings. People might not have to take time off from work and drive to see their doctor to have a question or concern addressed. And people with serious illnesses might not have to travel hundreds or thousands of miles for a consultant’s opinion. “It’s expensive and inefficient to move people around when many visits require minimal care,” Schwamm said.

I agree that telemedicine will just be medicine as the use of mobile and electronic technoligies becomes integrated into healthcare.

May 19, 2009

Doctor’s new best friend: iphone

Filed under: Mobile, Technology, Trends — Tags: — Raja @ 9:01 am

Dcotors and medical students are embracing mobile technologies such as iphone apps. This is only the tip of the iceberg as mobile technologies will truly transform the healthcare as we know it.

"We saw that a lot of the physicians were using [iPhones] in the clinic," said Georgetown student Joseph Murray.

To his frustration, Steven Schwartz often encounters patients who have no idea what each of the pills they’ve been popping is called.

“But usually they can tell you what it looks like,” the Georgetown University Medical Center family practitioner said. “They might say it’s a blue, triangular pill for hypertension.”

Armed with an iPhone, Schwartz is able to play detective.

He uses an application called Epocrates to input pill characteristics, such as color, shape and clarity. The software replies with a list of medications and images that match those criteria, allowing him to deduce what the patient is taking.

Schwartz says his iPhone has become indispensable: He uses it to pull up instructional diagrams and videos for patients, write electronic prescriptions and check basic information, with the patient beside him.

” ‘This is how often you need a colonoscopy,’ I’ll say to a patient,” Schwartz said. “I’m just double-checking on my phone to make sure I don’t make a mistake.”

Doctors are also using smartphones to look up drug-to-drug interactions, to view X-rays and MRI scans, and even to stream music from the Internet during surgery.

The power and versatility of smartphones, Schwartz said, is leading more doctors to abandon their pagers and PDAs. Of the various smartphones on the market, such as the ones made by BlackBerry and T-Mobile, the iPhone’s graphic, audio, video and memory capabilities are helping it take the lead in the medical field.

Schwartz’s use of his iPhone speaks to a larger trend: Nationally, about 64 percent of doctors are now using smartphones, according to a recent report by the market research company Manhattan Research.

At George Washington University Hospital and the Johns Hopkins Health System, BlackBerrys are more popular than iPhones among physicians, according to officials at both institutions. Of the 700-plus smartphones in use by doctors, nurses and other hospital staff members at Johns Hopkins, only about 5 percent are iPhones, said Mike McCarty, the chief network officer at Hopkins; the rest are BlackBerrys. Although there are many applications being developed for the iPhone (the iTunes app store lists 674 applications related to medicine available), a lot of medical software used at Hopkins runs on the Windows operating system, which is what the BlackBerry uses, McCarty said.

McCarty believes that smartphones will soon assume a permanent place in medicine. “I think over time we will be replacing pagers with these devices,” he said. “Every clinician I meet says they want to be carrying one device, rather than two or three.”  

May 9, 2009

Healthcare innovation: Lessons from India

Filed under: India, Technology, Trends — Tags: — Raja @ 10:20 am

From Economist:

ENTER the main cardiac operating-room at Bangalore’s Wockhardt hospital on a typical morning, and you will find a patient on the operating table with a screen hanging between his head and chest. On a recent visit the table was occupied by a middle-aged Indian man whose serene look suggested that he was ready for the operation to come. Asked how he was, he smiled and answered in Kannada that he felt fine. Only when you stand on a stool to look over the screen do you realise that his chest cavity has already been cut open.

As the patient was chatting away, Vivek Jawali and his team had nearly completed his complex heart bypass. Because such “beating heart” surgery causes little pain and does not require general anaesthesia or blood thinners, patients are back on their feet much faster than usual. This approach, pioneered by Wockhardt, an Indian hospital chain, has proved so safe and successful that medical tourists come to Bangalore from all over the world.

Unlike the hidebound health systems of the rich world, he says, “in our country’s patient-centric health system you must innovate.” This does not mean adopting every fancy new piece of equipment. Over the years he has rejected surgical robots and “keyhole surgery” kit because the costs did not justify the benefits. Instead, he has looked for tools and techniques that spare resources and improve outcomes.

Shivinder Singh, head of Fortis, a rival hospital chain based in New Delhi, says that most of the new, expensive imaging machines are only a little better than older models. Meanwhile, vast markets for poorer patients go unserved. “We got out of this arms race a few years ago,” he says. Fortis now promises only that its scanners are “world class”, not the newest.

Mr Singh is not alone in thinking that many firms in the rich world are looking at innovation the wrong way. Paul Yock, head of the bio-design laboratory at Stanford University, which develops medical devices, argues that medical-technology giants have “looked at need, but been blind to cost.” Amid growing concern about runaway health spending, he thinks the industry can find inspiration in India.

Digital Medicine

Filed under: Internet, Mobile, Technology, Trends — Tags: , — Raja @ 9:52 am

I think digital and mobile technologies are going to change healthcare and medicine as we know them. Economist had a special report on this topic.

THE advances in digital medicine described in this special report have already started to move patients from the margins of the medical system to its centre. Some think there are bigger things to come. “The key is patient-driven research,” explains Gregory Simon, head of Faster Cures, an advocacy group in Washington, DC. Most of the push for adopting electronic health records has come from institutions anxious to cut costs and reduce medical errors, but he thinks the biggest gains will come in the shape of better treatments for difficult diseases. He sees patients increasingly getting together online and sharing medical data and treatment histories.

On a website called PatientsLikeMe, members from around the world swap stories about their ailments and discuss subjects like adverse drug interactions, dosing strategies, new drugs and trials for more than a dozen diseases. A report by the California HealthCare Foundation, a think-tank, argues that in dealing with multiple sclerosis, a neurological disorder for which there is as yet no cure, “the collective wisdom on this website may rival the body of information that any single medical school or pharmaceutical company has assembled in the field.”

Mr Brown of Ideo argues that until recently the flow of information in medicine has tended to be one way. In future, he thinks, medical knowledge will increasingly flow in many directions. Mr Brown points to a proliferation of health blogs, online groups and peer-to-peer portals as a sign that the age of social networking in medicine has arrived. Google already has a feature that allows users of its EHRs to share their health information with others.

It is easy to be sceptical about such online communities. A fatal illness will not be cured by Twittering about it. And for many people nothing will replace the personal relationship between a patient and his doctor. But it seems clear that patients are going online to get more information on their illness, to see what other consumers think of new medications and to get emotional support from fellow sufferers.

Good for them, good for us

Even doctors, who may seem to have the most to lose from patient-centred digital medicine, increasingly support the move online. Many of them are themselves keen users of secure medical chat rooms. Thomas Lee of Partners Community Healthcare thinks such social networking helps make up for the “water-cooler chats” of yesteryear that allowed doctors to exchange knowledge across specialisations.

How far could all this go? Neil Seeman, who runs a health-strategy innovation group at the University of Toronto’s Massey College, thinks that “Health 2.0” is important “because it reinvents how we identify opinion leaders and exploit disruptive innovation.” His research has shown that the most active communities on social networks such as MySpace concentrate not on celebrity gossip or sport but on chronic illness—especially stigmatised conditions like depression.

The most influential health blogs on the web, he finds, are those that offer people with chronic illnesses medically relevant and accurate information. One post from a trusted surgeon blogger, he says, now has a far more immediate impact on improving surgical care globally than a peer-reviewed trial published in a prestigious journal. WebMD and America’s Centres for Disease Control (CDC), standard-bearers of the old model of one-way information flow online, are now offering social networking tools like blogs and wikis. CDC even has a presence on Second Life, an online virtual-reality game.

One man who has seen all this before is Steven Case. He founded America Online, a pioneering internet firm, and made a fortune selling it to Time Warner just before the technology-stock bubble burst. A few years ago he became convinced that the next big thing on the internet was health, so he launched Revolution Health, which after recent acquisitions has become the biggest online health firm. The firm’s early efforts were slow to develop, he concedes, in part because health care is a conservative business and the financial-reimbursement models in health care are extremely convoluted.

But Mr Case remains convinced that digital medicine will take off. As people live longer and spend an ever larger proportion of their income on health, he says, “the consumer will demand to know and will want to be empowered.” He likens the current state of digital medicine to the heady days of the late 1970s when Apple ushered in the age of personal computing.

Doctors are quick to point out that transistors are not the same as transplants. Medicine is more complex than electronics or even the internet. And there are a number of things about established medical practice that are to be cherished and not recklessly cast aside in the name of change.

April 21, 2009

Mayo Clinic targets Google Health

Filed under: Internet — Tags: — Raja @ 8:54 am

I love Mayo Clinic website. I find it to be the best source for medical information on the web. It seems to be expanding its vision of online health as it opens a private medical data website similar to Google Health.

Mayo Clinic is the latest to offer a free, secure, online website for anyone — whether a patient or not — to store and organize medical information.

Such sites, also offered by Google Health and Revolution Health (started by former AOL Time Warner chairman Steve Case) are designed to replace the proverbial shoebox of medical documents kept at home.

Unlike some of its competitors, Mayo Clinic Health Manager will offer more than a place to organize medical data. It will also push out customized information, such as reminders for checkups, from one of the most respected brands in health care.

“In every family, there seems to be one person who keeps track of health info and figures out what to do,” said Dr. Sidna Tulledge-Scheitel, medical director for Mayo Clinic Global Products and Services Division.

On Mayo’s site, she said, “The more you enter, the more personalized the health care reminders and guidance there will be for each family member.”

Mayo Clinic is using Microsoft’s HealthVault software for the site.

April 17, 2009

Digital Medicine

Filed under: Mobile, Technology, Trends — Tags: — Raja @ 5:33 pm

Economist has special report (hat tip to Rajesh Jain) on how the convergence of biology and engineering is turning healthcare into an IT industry.

Illustration by Otto Steininger

INNOVATION and medicine go together. The ancient Egyptians are thought to have performed surgery back in 2750BC, and the Romans developed medical tools such as forceps and surgical needles. In modern times medicine has been transformed by waves of discovery that have brought marvels like antibiotics, vaccines and heart stents.

Given its history of innovation, the health-care sector has been surprisingly reluctant to embrace information technology (IT). Whereas every other big industry has computerised with gusto since the 1980s, doctors in most parts of the world still work mainly with pen and paper.

But now, in fits and starts, medicine is at long last catching up. As this special report will explain, it is likely to be transformed by the introduction of electronic health records that can be turned into searchable medical databases, providing a “smart grid” for medicine that will not only improve clinical practice but also help to revive drugs research. Developing countries are already using mobile phones to put a doctor into patients’ pockets. Devices and diagnostics are also going digital, advancing such long-heralded ideas as telemedicine, personal medical devices for the home and smart pills.

Technology in general and mobile technology in particular will revolutionize medicine and heatlhcare. I am betting on that as an entrepreneur.

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