This is a fascinating development in the evolution of body sensors that are continuously updating and collecting all sorts of physiological data. As simple and non-threatening as a temporary tattoo, they appear to have the potential to be relatively inexpensive at scale and are applicable for critical care use as well as consumer health monitoring and even gaming.
It’s unclear if the power source and connectivity are part of the sensor. If not, I’m sure that someday soon those too will be integrated.
This would be fun to commercialize. Just think of all of the novel applications and benefits something like this could provide.
“FitBit too bulky? Why not glue a sensor array to your skin?
The quantified self goes nanoscale with a stick-on silicon electrode network that could not only change the way we measure health metrics, but could enable a new form of user interface. And the researchers behind it aim to have the device available in the next few weeks through a spinoff company, MC10.”
Terrific insight into the day-to-day frustrations of using healthcare information technology, from the perspective of a practicing U.S. anesthesiologist. Perhaps product managers and company executives for EMRs and other healthcare information systems already know of these issues and the “wish list” of requirements expressed by Dr. Leng. If so, it’s not evidenced by the user interfaces in these systems – most of which don’t (and can’t) talk to each other. One of the comments to this article suggested designing the user interface first and only then should the “back end” of the system be designed. I have a sneaking suspicion it’s usually the other way around.
“Today I’m doing anesthesia for colonoscopies and upper GI scopes. Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution. I’ll probably do 8 cases today. I will sign into a computer or electronically sign something 32 times. I have to type my user name and password into 3 different systems 24 times. I’m doing essentially the same thing with each case, but each case has to have the same information entered separately. I have to do these things, but my department also pays four full-time masters-level trained nurses to enter patient information and medical histories into the computer system, sometimes transcribed from a different computer system. Ironically, I will also generate about 50 pages of paper, since the computer record has to be printed out. Twice.”
A couple of interesting facts from this article and from my experience with a client:
Did you know that condoms are medical devices? (Class II = 510k)
We don’t hear or read much about it but there is a raging AIDS epidemic in sub-Saharan Africa. Millions of men, women, and children are afflicted. Among others, the World Health Organization, the Bill and Melinda Gates Foundation, and the U.S. Department of State are heavily involved in AIDS treatment and prevention in Africa.
One of the most effective HIV prevention methods is adult male circumcision, proven in several large randomized clinical trials in Africa. The substantial reduction in HIV susceptibility demonstrated in the clinical studies is described as providing the equivalent of vaccine-level protection, about a 60% reduction in HIV susceptibility.
The PEPFAR program (President’s Emergency Plan for AIDS Relief) was started by President George W. Bush and continued by President Obama. PEPFAR has spent more than $50 billion on AIDS and other infectious disease prevention and treatment to date. While not a panacea, PEPFAR estimates voluntary adult male circumcision will save $15 billion in HIV treatment and care expense, prevent more than 3 million HIV infections, and save hundreds of thousands of lives over the next 12 years.
This is an important trend in new healthcare technology. The convergence of mobile technology, ubiquitous wireless networks, ever-more sophisticated and accurate sensors on mobile devices, and innovative apps developed by physicians and medical device entrepreneurs will result in earlier detection and diagnosis, better treatment decisions, and improved communications between providers and patients.
A few examples from the article among probably hundreds in development: skin mole assessment, burn management, brain ventricle cannulation trainer (for surgical residents), neuroanatomy trainer, and an intelligent log/monitor for diabetes patients
“…mobile technology is on its way to innovate healthcare delivery and the quality of the patient’s experience. Modern advancements in mobile technology are helping with chronic disease management by reminding patients to take their medication at the proper time and generally extending service to various neglected areas, thereby improving overall health outcomes.”
A “Freakonomics” style look at how economic incentives can drive healthy behavior. Next step is to conduct some outcomes analyses. That should get the attention of top management!
The Salad Bar That Turned Around a Fortune 500 Company
By VIK KHANNA
“The Effect of Price Reduction on Salad Bar Purchases at a Corporate Cafeteria.” An excellent peek at the kind of steps that employers ought to take to improve eating habits in their work forces: subsidize the purchase of healthy foods. In this CDC study, reducing the price of salads drove up consumption by 300%. If this was a stock, we would all rush out to buy it.
Influencing behavior through both choice architecture and pricing differentials challenges many employers, however. There is a fear factor in play (“some of my people will be unhappy”), as well as financial issues, because the corporate managers responsible for food services often have their compensation linked to the division’s profitability. You make a lot more money selling soda than you do selling romaine. The same perverse financial conundrum appears when corporate food service companies run cafeterias. The on-site chef and managers typically operate on a tightly managed budget that leaves them little flexibility to seek out and provide healthier options.
A chef employed by one of the largest corporate food service providers in the country told me last year that he could not substitute higher protein Greek yogurt for the sugar-soaked, low-protein yogurt in his breakfast bar. When I asked why, he told me that Greek yogurt was not on his ordering guide, and he was not allowed to buy it from a local club warehouse and bring it in. In this same company, beverage coolers were stuffed to overflowing with sugar-sweetened drinks, all of which were front and center (and cheap), while waters and low-fat milk were shunted to the side coolers. In another scenario, health system leaders I met with last year all raised their hands when I asked if they had wellness programs and kept them up when I asked if they also sold sugar-sweetened beverages in their cafeterias at highly profitable prices. The irony was completely lost on them. They had to be walked through the inconsistency of telling their employees to take (worthless) HRAs and biometrics, but then facilitating access to $0.69 22 oz fountain sodas.
Continue reading “The Salad Bar That Turned Around a Fortune 500 Company …”
An interesting glimpse into the front lines of healthcare at the primary care clinic. I know that primary care physicians are the lowest paid and most overworked of all doctors. Looks like they are squeezing further down the line just to stay financially viable in these times of meager reimbursements and high operating costs. Will Obamacare make a difference? Check back in a few years…
The Extinction of the Primary Care Clinic Nurse
By JAAN SIDOROV, MD
The Passenger Pigeon. The Dodo bird. The primary care clinic nurse. All are extinct, driven out existence by a changing habitat, competition and over-hunting. Ask the average person when they’ve last seen these species and you’re likely to get the same baffled look that your columnist’s spouse gives when she’s asked about her compliant husband who does what he’s told.
Yet, this columnist wasn’t aware of the primary care nurses’ total absence until a recent conversation with a nurse-colleague who has been helping smaller physician-owned outpatient offices develop local care management programs. “There are no ‘nurses’” she said. “They’ve all been replaced by office assistants and the docs are trying to get them to do the patient education.”
Which makes sense. While articles like this have been lauding health care “teams” made up of physicians and non-physician professionals for years, the fact is that poor reimbursement, the allure of other specialties and lifestyle has long-hollowed out these clinics, often leaving a skeleton crew of part-time medical assistants shuttling patients in and out of the patient rooms. True, some of the larger health systems with a stake in primary care have kept nurses in the mix, your columnist thinks that’s merely part of a market-preserving loss-leader strategy.
This columnist looked for medical literature on the topic. He can’t find any surveys or other descriptions on how nurses have largely disappeared from the primary care landscape. If he’s wrong, he wants to hear from his readers.