Excerpts from a recent article in PC World merit your attention, I believe. The key players are IBM, the University of Florida's Department of Computer and Information Science and Engineering, a spin off company called Pervasa and the Eclipse Foundation, an open source development tool sponsor. Dr Sumi Helal leads the initiative at the University. During the past several years, Dr Helal and his colleagues developed smart devices for the elderly in a model home known as the Gator Tech Smart House in Gainesville.
I recently had a brief chat with Bob Sutor, Vice President for Standards and Open Source at IBM. He noted that the collection of patient information from smart devices could help build an electronic medical record, a perspective I can now appreciate. Security issues seemed of import, and in his view, IBM was involved in this venture for both commercial and social purposes.
Be sure and view the multi-purpose video referenced below. It is well done!
IBM Corp. and the University of Florida believe they've come up with middleware that will allow doctors to remotely monitor the health of their patients. The technology makes it possible for standard wired or wireless devices like blood-pressure and glucose monitors to be reconfigured so that when used by patients at home the devices can automatically send the collected readings to health-care professionals.
IBM and the university have been working on the smart device project for the past 12 to 15 months and have produced a short video to illustrate its possible use. In the video, an elderly man called Charley requires twice weekly visits to his doctor to check his blood pressure. He's able to cut down on the number of those visits by taking his readings at home using a monitor that's been reconfigured with the middleware.
The value of the technology is what could be achieved with it by any device manufacturer, said Sumi Helal, professor of computer and information science and engineering at the University of Florida, who headed up the project. The technology is a combination of middleware software and sensor hardware called Atlas from University of Florida spin-off Pervasa Inc. Should the technology be adopted, Helal would expect to see smart devices on the market within the next one to two years. It would then be possible to buy a device off the shelf and by dialing a 1-800 phone number establish a connection between the device and one's doctor. "The device itself becomes a service," he said.
Much of the work on developing Web services around a SOA (service-oriented architecture) has been looking at how to exchange information between people when neither party is familiar with how the other's IT system was built. There's been plenty of SOA work to Web-enable legacy mainframe systems. "What's the ultimate legacy system for us? The human body," said Bob Sutor, vice president of standards and open source at IBM.
The security governing the devices would be the same as that used in online banking, Helal said. It's possible to make that security very finely grained, Sutor added, to encrypt particularly sensitive fields. It will be up to device manufacturers to ensure that their products are tamper-proof to avoid the possibility of false readings, Helal said.
As a way to start building momentum behind the technology, IBM has contributed components of the project to the Open Healthcare Framework of the open-source development tools Eclipse Foundation community.
"You could look at this as something very nice for IBM," Sutor said, in terms of the vendor being a provider of all the necessary back-end technologies including middleware, databases, servers and storage. "But because it's standards-based, anyone can play," he added. "There's nothing we're doing here that gives us a product advantage."
Wednesday, July 25, 2007
Thursday, July 19, 2007
International Conference on Aging, Disability, and Independence (ICADI)
I want to draw your attention to the 4th annual ICADI conference which will be held in St Petersburg, FL on February 20-23, 2008. Early registration ends by November 30th, and details can be found at the ICADI website. A conference summary follows.
"The International Conference on Aging, Disability and Independence (ICADI) will focus on approaches to support people as they age in maintaining independence in daily living at home, at work and in the community.
As people age, independence can be maintained by use of assistive technology, by modifying homes, workplaces and environments and by selecting products that follow universal design principles. As people remain in the workforce into advanced years or return to work, knowledge and technologies are developing to adapt workplaces to meet their needs. Aging in the workplace is a new and significant area of focus for ICADI this year. Livable communities is another new focus, representing a broadening of the concepts of home modification and universal design to address design of communities so they are livable for all people. Mobility is another important component of independence as it relates to walking and wheeling, to driving and to using other methods of transportation. Prevention of injuries is essential to maintaining independence in advanced years. Current and future development in robotics will help and support individuals in everyday tasks; and, advances in telehealth approaches hold promise in monitoring and serving health and independence-related needs.
Each of these is important to aging well and will be addressed in eight ICADI tracks by an international cadre of presenters representing research and development, policy, practice and services, business, and consumer perspectives."
"The International Conference on Aging, Disability and Independence (ICADI) will focus on approaches to support people as they age in maintaining independence in daily living at home, at work and in the community.
As people age, independence can be maintained by use of assistive technology, by modifying homes, workplaces and environments and by selecting products that follow universal design principles. As people remain in the workforce into advanced years or return to work, knowledge and technologies are developing to adapt workplaces to meet their needs. Aging in the workplace is a new and significant area of focus for ICADI this year. Livable communities is another new focus, representing a broadening of the concepts of home modification and universal design to address design of communities so they are livable for all people. Mobility is another important component of independence as it relates to walking and wheeling, to driving and to using other methods of transportation. Prevention of injuries is essential to maintaining independence in advanced years. Current and future development in robotics will help and support individuals in everyday tasks; and, advances in telehealth approaches hold promise in monitoring and serving health and independence-related needs.
Each of these is important to aging well and will be addressed in eight ICADI tracks by an international cadre of presenters representing research and development, policy, practice and services, business, and consumer perspectives."
Monday, July 16, 2007
Remote Presence Robotic System
Today, we look to Yahoo News for an interesting story on robot use for hospital patients recovering from bariatric or weight loss surgery.
"Has it come to this? Robots standing in for doctors at the hospital patients' bedside?
Not exactly, but some doctors have found a way to use a videoconferencing robot to check on patients while they're miles from the hospital. One is at Baltimore's Sinai Hospital. Outfitted with cameras, a screen and microphone, the joystick-controlled robot is guided into the rooms of Dr. Alex Gandsas' patients where he speaks to them as if he were right there. "The system allows you to be anywhere in the hospital from anywhere in the world," said the surgeon, who specializes in weight-loss surgery.
Besides his normal morning and afternoon in-person rounds, Gandsas uses the $150,000 robot to visit patients at night or when problems arise. The robot can circle the bed and adjust the position of its two cameras, giving "the perception from the patient's standpoint that the doctor is there," the surgeon said. "They love it. They'd rather see me through the robot," he said of his patients' reaction to the machine.
Gandsas presented the idea to hospital administrators as a method to more closely monitor patients following weight-loss surgery. Gandsas, an unpaid member of an advisory board for the robot's manufacturer who has stock options in the company, added that since its introduction, the length of stay has been shorter for the patients visited by the robot. A chart-review study of 376 of the doctor's patients found that the 92 patients who had additional robotic visits had shorter hospital stays. Gandsas' study appears in the July issue of the Journal of the American College of Surgeons.
Nicknamed Bari for the bariatric surgery Gandsas practices, the RP-7 Remote Presence Robotic System by InTouch Technologies is one of a number of robotic devices finding their way into the medical world. Across town at Johns Hopkins, for example, a similar robot is used to teleconference with a translator for doctors who don't speak their patient's language. Robotic devices have also been used to guide stroke patients through therapy and help them play video games."
Let's try to get behind the information presented in the article. Our aim is to better understand such issues as patient privacy, consumer acceptance of "virtual services", and cost versus benefit assessments.
1. According to a January 2007 report published by the Agency for Healthcare Research and Quality, the total number of bariatric surgeries in the US increased nine-fold from 1998 to 2004. Across all age groups, the fastest growth in bariatric surgery occurred among adults aged 55-64. And, in 2004, 78% of these surgeries were covered by private insurance, with Medicare and Medicaid covering roughly 7% and 5% respectively.
2. The robot stands 5 1/2 feet tall and has a computer screen where a person's head would be. The screen broadcasts the face of a physician, who controls the device remotely. In addition to a screen, the device includes cameras and a microphone. According to the article, the device cost $150,000. About 120 of the robots are being used in hospitals worldwide.
3. The device was purchased by the Sinai Hospital in Baltimore. Patients using the device were discharged sooner than patients who didn't, yielding the hospital more than $200,000 in new admissions and saving some $14,000 in room and board costs, according to an article in the July 16, 2007 edition of Modern Healthcare.
4. The patients were hospital based, and not home based, and bore no added cost for the service. Apparently, they had positive reactions to the device, and there was no indication that privacy infringement was an issue. I'd like to see further studies of in-patient reactions, and also, am curious whether nursing home or home bound patients would have the same positive reactions.
5. The attending physician made normal morning and afternoon rounds, and used the device at night, or when problems arose and he was not immediately available. Thus, there was a mix of high touch and high tech.
6. The attending physician indicated that he was an unpaid advisory board member of the manufacturer and had stock options in the company.
7. A study by the attending physician in a peer reviewed journal cited a decrease in patient stay for patients who experienced robotic visits. If the results are replicated elsewhere, significant system cost savings could be achieved.
8. The robot was being used at Johns Hopkins Hospital to overcome language barriers with patients and for guiding stroke patients through therapy. It's hard to imagine there couldn't be a more cost effective way to deal with the former use, and the latter use would suggest a broader application to other patients with chronic conditions.
9. For the time being, the device would appear to be available for hospital inpatients only, less available to nursing home residents, and not a financially feasible alternative for the home bound.
"Has it come to this? Robots standing in for doctors at the hospital patients' bedside?
Not exactly, but some doctors have found a way to use a videoconferencing robot to check on patients while they're miles from the hospital. One is at Baltimore's Sinai Hospital. Outfitted with cameras, a screen and microphone, the joystick-controlled robot is guided into the rooms of Dr. Alex Gandsas' patients where he speaks to them as if he were right there. "The system allows you to be anywhere in the hospital from anywhere in the world," said the surgeon, who specializes in weight-loss surgery.
Besides his normal morning and afternoon in-person rounds, Gandsas uses the $150,000 robot to visit patients at night or when problems arise. The robot can circle the bed and adjust the position of its two cameras, giving "the perception from the patient's standpoint that the doctor is there," the surgeon said. "They love it. They'd rather see me through the robot," he said of his patients' reaction to the machine.
Gandsas presented the idea to hospital administrators as a method to more closely monitor patients following weight-loss surgery. Gandsas, an unpaid member of an advisory board for the robot's manufacturer who has stock options in the company, added that since its introduction, the length of stay has been shorter for the patients visited by the robot. A chart-review study of 376 of the doctor's patients found that the 92 patients who had additional robotic visits had shorter hospital stays. Gandsas' study appears in the July issue of the Journal of the American College of Surgeons.
Nicknamed Bari for the bariatric surgery Gandsas practices, the RP-7 Remote Presence Robotic System by InTouch Technologies is one of a number of robotic devices finding their way into the medical world. Across town at Johns Hopkins, for example, a similar robot is used to teleconference with a translator for doctors who don't speak their patient's language. Robotic devices have also been used to guide stroke patients through therapy and help them play video games."
Let's try to get behind the information presented in the article. Our aim is to better understand such issues as patient privacy, consumer acceptance of "virtual services", and cost versus benefit assessments.
1. According to a January 2007 report published by the Agency for Healthcare Research and Quality, the total number of bariatric surgeries in the US increased nine-fold from 1998 to 2004. Across all age groups, the fastest growth in bariatric surgery occurred among adults aged 55-64. And, in 2004, 78% of these surgeries were covered by private insurance, with Medicare and Medicaid covering roughly 7% and 5% respectively.
2. The robot stands 5 1/2 feet tall and has a computer screen where a person's head would be. The screen broadcasts the face of a physician, who controls the device remotely. In addition to a screen, the device includes cameras and a microphone. According to the article, the device cost $150,000. About 120 of the robots are being used in hospitals worldwide.
3. The device was purchased by the Sinai Hospital in Baltimore. Patients using the device were discharged sooner than patients who didn't, yielding the hospital more than $200,000 in new admissions and saving some $14,000 in room and board costs, according to an article in the July 16, 2007 edition of Modern Healthcare.
4. The patients were hospital based, and not home based, and bore no added cost for the service. Apparently, they had positive reactions to the device, and there was no indication that privacy infringement was an issue. I'd like to see further studies of in-patient reactions, and also, am curious whether nursing home or home bound patients would have the same positive reactions.
5. The attending physician made normal morning and afternoon rounds, and used the device at night, or when problems arose and he was not immediately available. Thus, there was a mix of high touch and high tech.
6. The attending physician indicated that he was an unpaid advisory board member of the manufacturer and had stock options in the company.
7. A study by the attending physician in a peer reviewed journal cited a decrease in patient stay for patients who experienced robotic visits. If the results are replicated elsewhere, significant system cost savings could be achieved.
8. The robot was being used at Johns Hopkins Hospital to overcome language barriers with patients and for guiding stroke patients through therapy. It's hard to imagine there couldn't be a more cost effective way to deal with the former use, and the latter use would suggest a broader application to other patients with chronic conditions.
9. For the time being, the device would appear to be available for hospital inpatients only, less available to nursing home residents, and not a financially feasible alternative for the home bound.
Friday, June 29, 2007
Talking Pill Bottles
In 2004, I ran across an news article which described the concept of a talking pill bottle, and it's utility for the visually impaired, handicapped, illiterate, and people with cataracts. Several firms were mentioned, and I thought I'd visit each firms website for a product overview. Each firm used a small electronic chip attached to the pill container, or a receptacle around it. But they had drawbacks, such as requiring a pharmacist or caregiver to read information into a recording device, needing patients to buy a $325 "reader" device, or using $10 disposable pill bottles. I did check with my local Walgreen's pharmacist, and he claimed they had no experience with such devices, though he agreed they'd be useful.
First, we have En-Vision America's Script Talk. The system acts in this fashion. When a patient using a ScripTalk reader submits a prescription, the pharmacy software prints and programs an auxiliary smart label using a dedicated, small-footprint printer. The smart label, which stores prescription information is placed onto the prescription container by the pharmacist. In the home, the patient uses a hand-held ScripTalk Reader that speaks out the label information using speech synthesis technology. By simply moving the prescription within an inch of the ScripTalk reader, pertinent information such as, the name of the patient; the name of the drug; the dosage; general instructions; warnings; prescription (Rx) Number; along with the doctor’s name and phone number are converted into speech.
The second vendor is MedivoxRx Technologies' Rex-The talking Prescription Bottle. Rex is fully automated through text-to-speech technology, allowing pharmacists to electronically record the label information to the pill bottle in a natural sounding computer generated voice using the pharmacy’s current software and data. As the pharmacist sends the label information to the printer, the label information is recorded into the base of the bottle. Features and benefits include ease of use (one push button), no special reader required, no usage training required, disposability, and low cost for patients.
The third vendor cited was Talking Rx. Talking Rx® is a simple, yet effective solution that provides audible guidance in taking medications. The device attaches to common-sized prescription bottles and contains a memo recorder that allows a physician, pharmacist, caregiver, family member or patient to record necessary information about the medication. Samples of the information that can be recorded include: name of the medication and the name of the person for whom it is prescribed, instructions for proper use, any special instructions or possible side effects, name and telephone numbers of physician and pharmacy, and expiration date and refill information, including the prescription reorder number.
First, we have En-Vision America's Script Talk. The system acts in this fashion. When a patient using a ScripTalk reader submits a prescription, the pharmacy software prints and programs an auxiliary smart label using a dedicated, small-footprint printer. The smart label, which stores prescription information is placed onto the prescription container by the pharmacist. In the home, the patient uses a hand-held ScripTalk Reader that speaks out the label information using speech synthesis technology. By simply moving the prescription within an inch of the ScripTalk reader, pertinent information such as, the name of the patient; the name of the drug; the dosage; general instructions; warnings; prescription (Rx) Number; along with the doctor’s name and phone number are converted into speech.
The second vendor is MedivoxRx Technologies' Rex-The talking Prescription Bottle. Rex is fully automated through text-to-speech technology, allowing pharmacists to electronically record the label information to the pill bottle in a natural sounding computer generated voice using the pharmacy’s current software and data. As the pharmacist sends the label information to the printer, the label information is recorded into the base of the bottle. Features and benefits include ease of use (one push button), no special reader required, no usage training required, disposability, and low cost for patients.
The third vendor cited was Talking Rx. Talking Rx® is a simple, yet effective solution that provides audible guidance in taking medications. The device attaches to common-sized prescription bottles and contains a memo recorder that allows a physician, pharmacist, caregiver, family member or patient to record necessary information about the medication. Samples of the information that can be recorded include: name of the medication and the name of the person for whom it is prescribed, instructions for proper use, any special instructions or possible side effects, name and telephone numbers of physician and pharmacy, and expiration date and refill information, including the prescription reorder number.
Thursday, June 28, 2007
Google's Health Council
I see both Google and Quicken as emerging players in the digital health arena (Please refer to my January 7, 2007 posting.). Today, Google announced the formation of it's Health Advisory Council. According to an article in the Health IT Strategist, the mission of the Council is to enable Google to better understand the problems consumers and providers face every day and offer feedback on product ideas and development. The Council is comprised of IT "movers and shakers" in the USA, including AARP's John Rother. It shall be interesting to follow their deliberations.
According to the news release, the panel will be chaired by Dean Ornish, the founder and president of the Preventive Medicine Research Institute and a clinical professor of medicine at the University of California at San Francisco. Other members of the panel are: RAND Health research scientist Douglas Bell; Cleveland Clinic Chief Executive Officer Toby Cosgrove; Health Technology Center CEO Molly Coye; Former Congressional Budget Office Director Dan Crippen; Wal-Mart Executive Vice President of Risk Management, Benefits and Sustainability Linda Dillman; Beth Israel Deaconess Medical Center and Harvard Medical School Chief Information Officer and Healthcare Information Technology Standards Panel Chairman John Halamka; U.S. News & World Report Health Editor and Columnist and a former head of the National Institutes of Health Bernadine Healy; American Medical Association Chief Operating Officer Bernie Hengesbaugh; AAFP Executive Vice President Douglas Henley; University of California at San Francisco Vice Chancellor of Medical Affairs and School of Medicine Dean and former Food and Drug Administration Commissioner David Kessler; Robert Wood Johnson Foundation Senior Vice President and Director of Health Care Group John Lumpkin; AARP Group Executive Officer of Policy and Strategy John Rother; Kaiser Permanente Vice President of Online Services Anna-Lisa Silvestre; FasterCures President Greg Simon; California HealthCare Foundation President and CEO Mark Smith; Palo Alto Medical Foundation Vice President and Chief Medical Information Officer and American Medical Informatics Association Board of Directors Chairman Paul Tang; Genetic Alliance President and CEO Sharon Terry; American College of Physicians Executive Vice President and CEO John Tooker; Lance Armstrong Foundation President Doug Ulman; UCSF Department of Medicine Associate Chairman and UCSF Medical Center Chief of Medical Service Robert Wachter; and I'm Too Young for This! Cancer Foundation for Young Adults Founder and Executive Director Matthew Zachary.
According to the news release, the panel will be chaired by Dean Ornish, the founder and president of the Preventive Medicine Research Institute and a clinical professor of medicine at the University of California at San Francisco. Other members of the panel are: RAND Health research scientist Douglas Bell; Cleveland Clinic Chief Executive Officer Toby Cosgrove; Health Technology Center CEO Molly Coye; Former Congressional Budget Office Director Dan Crippen; Wal-Mart Executive Vice President of Risk Management, Benefits and Sustainability Linda Dillman; Beth Israel Deaconess Medical Center and Harvard Medical School Chief Information Officer and Healthcare Information Technology Standards Panel Chairman John Halamka; U.S. News & World Report Health Editor and Columnist and a former head of the National Institutes of Health Bernadine Healy; American Medical Association Chief Operating Officer Bernie Hengesbaugh; AAFP Executive Vice President Douglas Henley; University of California at San Francisco Vice Chancellor of Medical Affairs and School of Medicine Dean and former Food and Drug Administration Commissioner David Kessler; Robert Wood Johnson Foundation Senior Vice President and Director of Health Care Group John Lumpkin; AARP Group Executive Officer of Policy and Strategy John Rother; Kaiser Permanente Vice President of Online Services Anna-Lisa Silvestre; FasterCures President Greg Simon; California HealthCare Foundation President and CEO Mark Smith; Palo Alto Medical Foundation Vice President and Chief Medical Information Officer and American Medical Informatics Association Board of Directors Chairman Paul Tang; Genetic Alliance President and CEO Sharon Terry; American College of Physicians Executive Vice President and CEO John Tooker; Lance Armstrong Foundation President Doug Ulman; UCSF Department of Medicine Associate Chairman and UCSF Medical Center Chief of Medical Service Robert Wachter; and I'm Too Young for This! Cancer Foundation for Young Adults Founder and Executive Director Matthew Zachary.
Wednesday, June 20, 2007
Andy Grove's Open Letter
Check out the June 11th issue of Fortune, where Andy Grove makes a pitch for using technology to keep parents at home as part of his "modest" proposal to fix the health care system. His comments follow.
"The cost of caring for the elderly is huge and will only grow as our population ages. Of the $440,000 the average American spends on health care in his lifetime, $280,000 will be spent after age 65.
Probably 50% of that post-65 outlay goes to assisted-living facilities and nursing homes. So it stands to reason that if there were a way to keep elderly patients in their own homes longer - without degrading quality of care - we'd have a cheaper and better system.
And we can do just that using technology. I'm talking everyday, low-cost technology - the sensors, microchips, small radios you'd find in today's PCs, in cellphones, and in Bluetooth earpieces. It's not too difficult to use this stuff as monitoring tools. Not to spy, but to detect trouble. For example, did the patient go outside to get the newspaper or did she wander away? Has the patient taken his meds? The same technology that brings us HBO can watch over the patient and trigger human intervention when needed.
A critical step to make this happen is to have it blessed - and reimbursed - by the dominant health-care supplier to the aged, Medicare. Candidates, I hope to see a phrase in your inauguration speech that starts like this: "I will have Medicare define specifications for electronic equipment that allows the average aging citizen to stay home two years longer than today."
As for affordability, Grove claims "As for the elder-care plan, the savings achieved by keeping just 10% of the aging population in their homes can amount to $30 billion a year."
"The cost of caring for the elderly is huge and will only grow as our population ages. Of the $440,000 the average American spends on health care in his lifetime, $280,000 will be spent after age 65.
Probably 50% of that post-65 outlay goes to assisted-living facilities and nursing homes. So it stands to reason that if there were a way to keep elderly patients in their own homes longer - without degrading quality of care - we'd have a cheaper and better system.
And we can do just that using technology. I'm talking everyday, low-cost technology - the sensors, microchips, small radios you'd find in today's PCs, in cellphones, and in Bluetooth earpieces. It's not too difficult to use this stuff as monitoring tools. Not to spy, but to detect trouble. For example, did the patient go outside to get the newspaper or did she wander away? Has the patient taken his meds? The same technology that brings us HBO can watch over the patient and trigger human intervention when needed.
A critical step to make this happen is to have it blessed - and reimbursed - by the dominant health-care supplier to the aged, Medicare. Candidates, I hope to see a phrase in your inauguration speech that starts like this: "I will have Medicare define specifications for electronic equipment that allows the average aging citizen to stay home two years longer than today."
As for affordability, Grove claims "As for the elder-care plan, the savings achieved by keeping just 10% of the aging population in their homes can amount to $30 billion a year."
Thursday, June 14, 2007
Consumers' Guide to Aging Services Technologies
Enhanced use of information technology in health is believed to lower costs, enhance
quality, and improve access to care for all Americans. Information technology
designed for the aging has similar promise, and we are only in the formative stages
in the design and installation of such products. Emerging technologies for the aging
include smart homes, monitoring robots, talking pill bottles, virtual communities, and on line medicine cabinets. Will consumers embrace these products? Will they be cost effective? Will they ensure personal privacy? Ultimately, will they lower costs and improve care quality? For answers to these and other issues, come join us and learn how to be a wise consumer of aging technologies.
quality, and improve access to care for all Americans. Information technology
designed for the aging has similar promise, and we are only in the formative stages
in the design and installation of such products. Emerging technologies for the aging
include smart homes, monitoring robots, talking pill bottles, virtual communities, and on line medicine cabinets. Will consumers embrace these products? Will they be cost effective? Will they ensure personal privacy? Ultimately, will they lower costs and improve care quality? For answers to these and other issues, come join us and learn how to be a wise consumer of aging technologies.
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