Vol. 204 December 1, 2018 “Why Doctors Hate Computers”

December 2, 2018

 

Digitization promises to make medical care easier and more efficient. But are
screens coming between doctors and patients?
 – Atul Gawande

I wished I had thought of this title.
I wished I had written the article in the New Yorker that went with it. (1) But, it was written by a better writer, and a surgeon no less; a proceduralist, not a cognitive doctor like us pediatricians and internists. Atul Gawande nailed the reasons for the frustrations of most doctors in dealing with electronic medical records, including graphic points of special irritation with one specific computer behemoth, Epic.

Epic is the $100 million computer software system now in place in the Partners Health Care system serving 70,000 employees in 12 teaching hospitals with dozens of different medical/surgical specialities as well as thousands of office-based providers and their staff. In Epic I have learned the 6 different ways of using 13 different tabs or, worse still, those tiny little icons stuffed into the margin of the screen to get the information I need to see the next patient in a pediatric office. As I traverse the various and varied screens I usually am exposed to too much data and not enough information. It is clear to most of my colleagues and our staff that Epic is chiefly designed as an “optimizer of insurance reimbursement”; probably one reason that large hospital systems and their associated physician networks buy it. A recent Epic “upgrade” was so devoid of any upgrade in clinical relevance that it did nothing to dissuade our view of it as a “reimbursement optimization tool”.

One of Dr. Gawande’s insight as to why doctors have some much trouble liking the new way of computer documentation of everything is that computers do not handle “surprises” very well. In seeking a diagnosis and determining treatment, not all doctor’s questions and certainly not all patients’ answers can be accurately recorded with a simple click in a box. The computer thrives on all those clicks in all those boxes. Doctors do not. We often meander around in our conversations with a patient guided by chance comments or even subtle physical clues. If we elicit a “surprise” we can pursue it much more intelligently and enlightening than the computer can document it. In Gawande’s words computer programs are “brittle, bureaucratic, inflexible, designed for large data bases, rule-based, inflexible, and very difficult to adapt”; in short, unable to handle “surprises” easily. 

Defenders of Epic view their efforts as optimization of the medical care process – “reconfiguring various functions according to feedback from users.” An Epic VP labeled that as the “Revenge of the Ancillaries”. The “users” of an MRI or a X-ray request from a doctor are radiology techs or radiology department secretaries.  The questions they want answered may have little clinical importance but have multiplied within the computer screen requisition that now requires more data entry, more reading, and more in-the-box clicking by the doctor. Some computer programs allow the doctor to delegate ordering tasks, some don’t, and some, like Epic, allow delegating some tasks but not for others. Doctors who are now embracing the delegation of tasks by hiring nurse practitioners and physician assistants are confronting computer programs which are restricting delegation.

Studies have documented that doctors spend two hours in front of a computer for every one hour in front of a patient. In response a new “delegated person”, a medical scribe, has been hired by some doctors. A medical scribe is a non-physician that observes the doctor-patient visit and enters information into the computer freeing the doctor up to maximize the face-to-face patient interaction. (In Quality Management, aka Quality Assurance or Performance Improvement, we call this a “work around” – a human adaptation to bypass a problem in a operating system.)

The Clinical Director of the Partners Epic system defends its as being “for the patients, not the doctors.” Patients gain more access to their medical records like their lab test results, their medications, summary of their visits, and increased opportunity for communication with their physicians. Patient access to their medical record is via a “patient portal”; often touted as a successful way to build a practice and be a modern practitioner. Unfortunately the patient portal has not been the slam dunk it was expected to be. It certainly has not been in our pediatric practice. “Why Are Patient Portals Such Duds?” and other recent reviews describe some of both doctor and patient barriers to their adoption.

The Clinical Director of Partners Epic takes the long view that patients will eventually use the EMR as currently hoped and hyped. We shall see, and in the meantime I hope that fewer practicing primary care doctors experience “burn out” and that fewer new medical school graduates shun primary care practice.

References:
1. New Yorker Magazine, November 12, 2018, Atul Gawande


Vol. 195 July 1, 2018 BIG DATA and a whiff of AI in health care

July 1, 2018

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“When it comes to health data, Watson hasn’t been much help.”
-STATNEWS, Ross and Swetlitz. Bos Globe 6/18/18

This week all the newspapers (at least in Massachusetts) have been abuzz with the announcement that Atul Gawande, MD has been picked by three moneyed titans of innovation to head their new company to revolutionize health care. Optimism, promise, and hope is in the air! Kind of like when IBM presented Watson, its supercomputer, in 2015 as the tool to provide workable insights into the financial and clinical dilemmas of U.S. hospitals in 2015 via Watson Health.

How is that working out? Watson Health has access to data on tens of millions patients, in part by spending $9 billion to acquire other companies. It’s initial focus was on developing workable products in oncology, designed to help physicians individualize cancer treatments. “With these acquisitions, IBM will be one of the world’s leading health data, analytics, and insights companies, and the only one that can deliver the unique cognitive capabilities of the Watson platform”, said the general manager of Watson Health in 2015.

They (the newly merged companies) struggled with the basic step of learning about the different forms of cancer and the rapidly changing landscape of treatments. Last week Watson Health laid off people partly because, according to some, even Watson had difficulty in digesting all that data. “…They also don’t understand the generation of information, and how it is used, and whether they can do something different with it,” said Robert Burns, professor of health management at U Penn Wharton School. You can almost hear every primary care physician that is struggling to get their new EMR system to give him/her more information and less data cheering loudly in the background, “We couldn’t have said it better!”

The goal of a great deal of innovative technology in health care is “ “zero patient harm”. if Atul can’t do it all with his surgical checklists and Watson can’t do it all with data from tens of millions of patients , what/who can? How about Artificial Intelligence (AI), aka “machine learning”? AI and machine learning is the converting of data into information without the need for human programmers. For instance, if the computer views enough pictures of different dogs, it will learn to correctly identify a cocker spaniel. I think a real test of AI would be to see if it can recognize a Labradoodle,  or any other of the many poodle cross breeds. (Don’t you sometimes worry about the moral standards of poodles that seem to be eager to mate with any kind of passing breed?)

The building of knowledge from patterns in data, both visual and language, is labeled “computer vision”. In some medical studies “computer vision” is used to monitor actual bedside events and identify omissions or non-compliance in procedures. It has apparently improved rapidly beyond just identifying dogs or skin rashes because of “deep learning”: a type of machine learning that uses “multilayered neural networks whose hierarchical computational design is partly inspired by biologic neutron’s structure.” (1)  Got that? Think Google’s self-driving cars. “Computer vision may soon bring us closer to resolving a seemingly intractable mismatch between the growing complexity of intended clinician behavior and human vulnerability to error.” (2)

So, the effort to cut the Gordian knot of patient safety and cost-effective medicine continues. I suspect that the three titans of innovation have turned to Atul Gawande, a health care innovator who successfully uses clinical insight and re-education to effect change, because they recognize the limitations that are becoming more apparent in big data.

  1.  NEJM April 5, 2018 378:14; 1271-2
  2. Ibid.

Vol. 185 January 15, 2018 New High Tech, Now and in the Future

January 15, 2018

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The start of a new year is a great time to look at some new medical technology and speculate a bit about how it might evolve.  This blog space is too limited to cover the inundation of new medical apps, so we will largely ignore them.

DIGITAL ADHERENCE MONITORING –
The title alone has an ominous ring, and that is not altogether an inappropriate feeling. A pharmaceutical company is testing a pill with a built-in sensory that can track AND REPORT ON whether or not the patient is taking a medication. The sensor is called an Ingestible Event Marker (IEM), which I think is only a slightly less ominous label. The IEM is activated when gastric contents reach it as the capsule dissolves in the patient’s stomach. The activated IEM sends a signal to a patch worn on the patients abdominal skin. The patch, in turn, alerts a cell phone app that reports the event to monitoring physicians. If the patient doesn’t take his medicine, of course, there is no electronic beep from the cell phone to the monitors. This gives the prescribing physician real-time data on the patient’s “adherence” to the prescription (used to be called “compliance”, but that was declared politically incorrect during the peak of concern with patient’s rights and autonomy). The same app can also track patient-reported activity, mood, and quality of rest. This package of new technology is called Digital Health Feedback system (DHFS), and, as you might guess by these tracking elements, this clinical test involved patients with a mental illness, schizophrenia to be exact. As one reviewer commented, “”It is ironic that this technology is being piloted with a drug used for paranoia.” (NEJM, Jan. 11, 2018, pg.101)

We are assured that the use of this technology is completely voluntary, and the patient can remove the reporting patch anytime they wish. A preliminary study of 28 patients using the IEM pill found that 27 completed the study, 24 of them thought that the technology would be useful to them, and 21 said they would like to receive reminders on their own cell phone if they forgot to take the medicine. (Ibid)

Despite the apparent compliance with this adherence pilot test, I can imagine how this might evolve in association with other new technology:
Alexa at 8:00 AM – “Good morning Herbert. Today’s weather is going to be unseasonably warm, you have a 10:00 AM appointment in your office, and be sure to take your high blood pressure pill after you eat breakfast.”
Alexa at 12:30 PM – “Keep up the good work Herb. You have only one scheduled appointment this afternoon, and I notice that you haven’t taken your blood pressure pill yet.”
Alexa at 5:30 PM – “Now Herb, remember that this pill should not be taken with alcohol. I know it must have been a hard day, but you don’t want to make it any harder on your body.”
Alexa at 8:30 PM – “Hey Herb! Not only have you not taken your pill, but I noticed that you skipped your regular visit to the gym today. Wha’sup? By the way, congratulations on your Weight Watchers dinner tonight.”
Alexa at 11:45 PM – “HEY STUPID! You forget to take your pill ALL day. Take your pill NOW, turn off Colbert, and go to sleep. Your family is counting on you, … not that I care, of course.”

VIRTUAL ENCOUNTERS –
Kaiser Permanente, the large California-based health system, reported that last year a majority (52% actually) of their 100 million patient encounters were “virtual visits”. (NEJM, Jan. 11, 2018, pg.104)  Virtual visits involve secure email and video engagements. Patient portals into medical offices, use of Skype, and teledermatology programs are familiar virtual tools. Telemedicine that allows monitoring of blood pressure, weight, blood glucose, and even EKG for home-bound patients with chronic disease are commonplace now. Future innovations could include cell apps that monitor the “total hours spent in high-allergen zones” for an asthma patient, or that deliver “intensive behavioral counseling” to people with obesity-related disease (“HERBERT! Step away from that refrigerator!”), or that make assurances that the patient’s near-empty automated pill dispenser (remotely monitored by the pharmacy, of course) would be filled soon by a forth coming home visit.

One author suggests that in the future “a face-to-face, in-person encounter would be reserved for the patients with the most health care needs – the 5% that account for 50% of costs. In-person encounters would become Option B”. (Ibid)  Obstacles to such progress could be patient fears of getting trapped in endless “phone menus”, lengthy voice message instructions, or numerous, sequential mouse clicking. Physicians might fear being marginalized, and, of course, no one is currently paying for these virtual encounters. A future evolution to mostly virtual visits would require a significant reorganization of and changes in reimbursement of medical care delivery. Kaiser Permanente’s virtual visit capacity is supported by the 25% of its annual $3.8 billion capital budget it spends on information technology.

Though I am tempted, I won’t go into what might happen if a future patient portal, an automatic pill dispenser, and Alexa signals got all mixed up together by mistake. Might a patient request for a 10:00 AM home visit on Tuesday result in 1000 AMbien pills being delivered to the patient’s home by AMazon on two days?

 


Vol. 184 January 1, 2018 To the Dark Side of EMR

January 2, 2018

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“… a fundamental barrier [to successful EMR implementation] that has not received due attention is the disconnect between health IT developers and users.” (1)

I was a solid advocate of electronic medical records (EMRs). Now I am a skeptic.

Primary care physicians are currently paying a big price, in terms of both time and money for the elusive promises of EMRs. As a quality reviewer of hospital medical records, an experienced office-based pediatrician, and a medical director working with an excellent medical staff, I believed that EMRs would really help us to improve the delivery of quality care. I happily jumped on the “evidenced-based medicine” bandwagon and believed that EMR data would help us. After three years of working with two different EMRs in a primary care practice, I have now “gone over to the dark side.” I have slowly realized that EMR “data” does not equate with “useful information” for primary care providers.

I have never belonged to the AMA, for me a “too-conservative” medical organization that I considered primarily a bastion of physician resistance to positive change. A definite sign of my conversion from EMR advocate to EMR skeptic is my agreement with a recent AMA statement by the Executive Vice-President and CEO of the AMA:

“Harnessing the power of health data is an enormous and important challenge, and one that should be led by physicians. The solution must be useful for physicians, and it must allow us to spend more time with our patients and deliver better care.”

Of course, there are all kinds of physicians in all kinds of practice settings, and “one size fits all” does not seem to be working for primary care EMR.

Use of EMR in our office is slowing us down, is decreasing the time we spend with patients and their families, is increasing the chances of provider communication gaps or slips, and has increased the frequency of “work arounds” for the delivery of quality care. “Work arounds” is a traditional quality improvement term that describes the methods that workers in any setting develop to skirt the system problems that hinder them from doing their best job. The presence of “work arounds” is one of the cardinal signs of a dysfunctional system. “Work arounds” often serve as the first target of any effort to analyze quality performance.

So why have I “gone over to the dark side”.
EMR has become way too complicated – There are too many screens requiring too many clicks, too many switches from scrolling wheel to cursor pointer, too many inconsistent navigation routes using tiny icons or miniscule, barely-noticed arrows. To see the basic clinical information I need before entering an exam room with our EMR ,  I need to review 2 or 3 computer screens, make 4 or 5 clicks with the mouse, and both scroll and/or drag with a cursor for the information that I use to be able to read quickly on two facing pages in the paper record.

In the quest for the versatility that is necessary to serve thousands of different physicians in hundreds of different settings, the award-winning EMR we use is awkward and time-consuming for us in primary care. It is driven by the need for reimbursement documentation in specialized (expensive) care settings. Workaround? – I read the paper encounter forms completed by my patients and my staff before I start the patient encounter. It is faster, sometimes more reliable (because there is no absent entry), and is more focussed on today’s encounter than those multiple computer screens which are trying so hard not to “miss” any data, no matter how irrelevant to today’s tasks.

EMRs have too many ways to record information from multiple sources – Valuable patient encounter information from nurses, social workers, and medical assistants can be hard to find in the mass of data. It usually requires purposeful clicking on tiny icons or miniscule arrows (again) on multiple screens. Boiler plate checklists tend to make every patient’s chart read the same. Workaround? – I know how to type. The actual, and helpful, differentiation between my patient encounters is almost always found in my “free text” note. But, not all providers in my office know how to or like to type. When I have to track down another provider to find out the information I need, there are now two of us not seeing patients.

Safeguarding patient privacy in an EMR is more complex. Sensitive results or comments are sometomes consciously avoided in the EMR or are deeply buried underneath a number of more clicks, scrolls, and screens. Workaround? – See above about physically tracking down another provider or more likely, that valuable information is not available in the medical record at the time that you need it. The route(s) of clinical information coming in from outside our office like lab results, X-ray readings, and specialists’ consultations are multiple, varied , and often obscure in our EMR. The vigilance required to NOT miss such reports is INCREASED, not decreased, in EMR. Workaround? – I ask the nurse, medical assistant, or front desk staff to track down the information by telephone or fax just like “in the old days.”

Correction of recorded errors like dates, or names, or even diagnosis can be tedious in the EMR.  A simple single line cross-out and rewrite did it in the paper record. The EMR requires multiple cursor clicks and several screens to do the same. The timing of the clicks, or more nearly correct, the sequence of clicks can be important for success. Workaround? – Sometimes I will delete a whole section of generic computer-speak in an EMR section because I can’t easily change one or two lines  (2 screen colors, at least 3 clicks, and a small check box way down at the bottom of the screen are often involvedin making an EMR correction).

The EMR has reduced the delegation of accepted clinical tasks. Renewing or initially writing common prescriptions ordered by me is not permitted to be done by the nurse practitioners or nurses on our EMR. Instead of a verbal request to a trusted professional, my time and attention is required on at least three computer screens, up to half a dozen clicks, and my entry of my unique password to do that. True, the prescription is sent electronically to the correct (usually) pharmacy, but the nurse or office staff used to do that quite quickly via fax, and it took less of my time. Work around? – Perhaps patient safety clearly trumps convenience here, so I have not spent much time thinking about a work around for this, but it does continue to disrupt a previously smooth work flow.

My computer keyboard is in one room, and I use three other rooms as exam rooms, To complete a note, look up a growth chart,  check results, answer an unexpected question from a parent, or order a medication I often do a far amount of time-consuming walking back and forth between rooms. Workaround? – Why not just get a tablet?, you ask. Well for some mysterious reasons neither of our EMRs support that functionality in our office. After several frustration attempts we know that the tablet works beautifully at IT headquarters, but  not in our office.

What benefits most from EMR in the office setting?
Reimbursement and research.
Clinically the only useful information to know about an ear infection is whether it is “left” or “right”. Our EMR requires a half dozen more adjectives before the diagnosis is “recorded”. It has no effect on reimbursement now (what we are paid for that office visit) ,as far as I know, and I can only hope that such minutiae won’t affect reimbursement in the future.
There are also half a dozen adjectives required to record the diagnosis of “nose bleed”, and I can only imagine that somewhere out there exists a researcher just waiting to write the definitive article on “recurrent, non-injury, chronic, episodic nosebleed” which happen more often on the “right” than the “left”.

Both these R&R benefits of EMRs are quite removed from improving actual clinical care. That is another reason for my move to “the dark side”, and this current blog that deviates from my founding pledge to NOT publish personal rants.

If you chose to dismiss this particular rant as “just another doctor complaining about his poor lot in life”, you should read a more scholarly short treatise on the same subject: “Accelerating Innovation in Health IT”,  New England Journal O f Medicine, 375:9, September 1, 2016, 815-7 (1).

 


Vol. 144 March 15, 2016 Health Apps Are Not “Secure”

March 15, 2016

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Health apps are not subject to HIPAA rules designed to protect the confidentiality of health information.

The news media these recent weeks has been filled with the controversy between Apple and the FBI about the encryption of private information on smartphones. Apple’s argument is that EVERYONE who has a smartphone has a stake in this battle for access to their personal information. Since most of us are unlikely to become terrorists or gang leaders and have our smartphones seized by the FBI to crack them open, do we have any skin in this game?

“You betcha!”

For example, according to a recent Journal of American Medical Association article (1,2) some of our personal health and medical information is already widely shared by “health apps”. One out of five smartphones had health apps in 2012. Today that number is much higher.

Health apps are all those downloadable programs for your phone that can measure and record your number of steps, heart rate, calories consumed, medication schedules, etc. Newer ones can do the same with blood pressure, blood sugar level, sleep cycles, and soon-to-be-on- the-market gene testing and complete infectious disease history.  (See http://greatist.com/fitness/best-health-fitness-apps for the 49 greatest health apps of 2015; based on user’s ratings, user friendliness, relative drain on the phone’s battery. etc. without consideration of any data privacy protection.) 

Most health apps say they encrypt your data when it is sent from your phone over the internet to the Cloud to “safeguard your electronic data.”. That sounds great, and is essential to thwart any hacker who really wants to know what your blood sugar level is on Thursday at 3 PM. But, it is the “privacy policy” of the app that determines how your data AND OTHER PERSONAL DATA can be shared by the apps company.  Health app data is shared and it can be used for marketing new products and services, targeting you for specific infomercial activity or internet “push” ads, and potentially for assessing your “risk” by insurance companies.

This JAMA study of “private policies” revealed that 80% of the 211 diabetic apps did NOT have private policies. Further study of the 41 of 211 diabetic apps that had a policy revealed many opportunities for widely sharing your personal data:

86% used tracking cookies so that information about your use of the computer could be shared with other companies like marketing companies.
64% requested the ability to delete or modify information anywhere on your phone!
17% asked to track your location
11% sought to switch on your smartphone camera!
54% stated they could use your personal information in aggregated data reports (Use of personal information’ ie. like patient identification data, in aggregated data reports like published scientific articles has always been a big”No-No” since medical researchers started using computers. Only “de-identified” patient data has been the accepted standard for use. )

Most of this private policy information was in the fine print of the user’s agreement that no one ever reads which we just check off with “agree” rather than “decline”. If you read the fine print well enough or scroll down to the very bottom of the app screen some of the apps gave you a choice to opt out from three “sharing” elements:

31% allowed you to opt out of receiving cookies
22% allowed you to nix receive emails related to the app content
11% allowed you to block receiving marketing information and materials.

Scant “protection” to say the least.

Health apps are not subject to federal HIPAA rules designed to protect the confidentiality of health information. App sponsors are free to trade, sell, and use in any way the personal health data they collect from their apps on your smartphone. Health apps are completely unregulated. If you are at all nervous about sharing health and personal data, be careful about what you download.

References:
1.Boston Globe, March 14, 2016, p. 12, Eric Boodman
2. JAMA. March 8, 2016;315(10):1051-1052.


Vol. 142 February 15, 2016 Tech Update

February 15, 2016

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A drop of blood for 100+ tests!
A company called Theranos, founded by a Stanford University drop-out, has developed a nanotechnology system for testing a finger prick of blood for anything from standard cholesterol level to still-developing genetic analysis. It is being test marketed in California by Walgreens pharmacy. Theranos plans to charge 50% of the Medicare/Medicaid reimbursement for the tests.

HealthSpot Station : A walk-in kiosk in a mall or drugstore with high-def video conferencing, a stethoscope, a thermometer, and a blood pressure cuff for immediate evaluation of non-emergencies; they accept insurance, including Medicare.

A 3-D printer creates a bioresorbable airway splint for an infant
A two-month old infant with congenital anomalies of the trachea and surrounding blood vessels had a local collapse of his tracheobronchial tree which could not be kept open with conventional ventilation. A hose, similar to the design of a vacuum cleaner hose, but much smaller of course, was fabricated by a 3-D printer. Seven days after insertion, weaning from his artificial ventilation was started. He was discharged from the hospital 21 days later after corrective vascular surgery.

Wearable fitness monitors – a $2 billion business
The early ones only counted steps. In the rush to self-quantify ourselves more and more measurements have been added to these wrist bands that now talk to our smartphones. Three different wrist bands can give three different counts. Sleep scientists pooh-pooh the wrist-worn sleep monitors. But, people buy them … as motivational devices, not scientific ones. If you add on the seductive social networks to share your data with all your friends, you have entered into the realm of what some would call  “fitness by humiliation”. If you subscribe to conspiracy theories you might wonder where all that personal data ends up? Who looks at it? Who owns it? No one knows. No one does, … yet.  In the spirit of full disclosure I admit that last year’s Christmas present of a Fitbit bracelet sits on my bureau, not my wrist.  I discovered that I took about 3000 steps a day, every day. It never changed, and it didn’t count my Pilates exercises well, so I took it off.

Maybe my doctor should have texted me
A Johns Hopkins study showed that 81% of 48 men and women with risk factors for heart disease receiving an automated, “personalized” text message “from their doctor” successfully reached their 10,000 steps a day goal. Only 44% of those in the control group who received no messages met that goal. Sample message: “Jon, you are on track to have a VERY ACTIVE day! OUTSTANDING! We might as well call you LeBron James!” (I kid you not. You can’t make this stuff up.)

First to market telemedicine for profit- aka “Uber for Doctors”
FIRST OPINION – For $9 a month a patient can text health questions to a pre-matched physician any time of day and expect a response in 5 minutes.

TELADOC – Your insurance company offers you a video or phone consult with a physician 24/7.

DOCTOR ON DEMAND  – An app that connects doctors with patients who are sick to help them decide if they have to be seen by a health professional or just need to take an Advil. Medical histories are stored in an encrypted database.

FIRST LINE – For $25 up front and $15 a month you get unlimited consultations by video chat or messaging. New participants get 24 hours (total) of free texting with a doctor anytime between 8 a.m. and 10 p.m. A house call is available for $199. No insurance coverage…yet.

PCP iPhone cartoon

“There’s an app for it” – before you contact a doctor
ResApp – Determines the cause of a cough by listening to you cough into the phone. Has 90% accuracy in diagnosing pneumonia or asthma. (Ed. note: pediatricians have been making these diagnoses over the phone for years; plus croup of course)

Priori – Predicts bipolar episodes before they happen. It is always “on” and monitoring the speed and patterns of the patient’s speech when he/she is using the phone normally. Doctors will receive an alert based on the speech patterns when intervention is needed. In Beta testing this year.

ApneaApp – Diagnoses when the sleeping patient periodically stops breathing by bouncing inaudible sonar waves off the patient’s body back to the phone. The reflected waves are analyzed to determine if sleep apnea is occurring. It was correct in 32 out of 37 tests in a sleep lab, and is about to be tested in the home setting.

In honor of Valentine’s Day – a few random facts about sex (some from the Framingham Study)
Sexual intercourse burns only about 85-150 calories, though it can get your heart rate up there in the “aerobic” range.
Heart rate and blood pressure peak very early in the act.
Having sex is about the equivalent of walking up two flights of stairs.
Men who had intercourse twice a week had a lower risk of cardiovascular events then those who had less frequency.
Having a heart attack during sex is about a million to one risk if you are a non-smoker and non-diabetic.

HAPPY PRESIDENTS’ DAY
I probably should have written about a few Presidential medical fun facts … like Garfield’s death resulting from medical malpractice, etc. … Maybe next year.


Vol. 106 February 1, 2014 Do You Know Where Your Medical Data Is?

February 1, 2014

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The price of freedom is eternal vigilance.

                                                                                  –Thomas Jefferson…or Thomas Paine, Abraham Lincoln,
Dr. Thomas Sowell,  and John Philpot Curran.

The federal government is giving money to doctors and hospitals to computerize their medical records ( “EMR” = electronic medical records). To get paid the medical providers have to show “meaningful use” of EMR by, among other things, writing and sending a certain percentage of their prescriptions to pharmacies by computer , by creating interactive websites (“Patient Portals”) to improve patient access to their medical information , and by entering much more of their patient’s personal data into their computers. The improved coordination of care, collaboration of medical providers, and reduced costs of care through the meaningful use of EMR by Accountable Care Organizations (ACO) is a cherished hope of Obamacare (ACA) supporters.

Recently, another arm of the federal government (NSA = National Security Agency) has been shown to be collecting, and maybe analyzing, huge reams of personal data from our telephones, social network sites, and credit card companies. Facebook, Google, and Verizon have all been put on the defensive and are scrambling to show that they weren’t helping, at least “knowingly helping”, the government do this. Wired magazine recently reviewed how this conflict between the government’s promises of security and the internet giants’ promises of privacy is eroding the public trust in both.

So at a time that our government is aggressively incentivizing medical providers to put more and more patients’ personal data into cyberspace, the public’s faith and trust that such data will be safe and not be misused is weakening.

What’s the worry? How bad could it get? Since a picture is worth a thousand words, I direct you to this 3 minute video on how to order a pizza in 2015. Whether you find it believable or not,  or whether you think that 2025 is a more realistic date, you may rest assured that the NSA will know that you clicked on and viewed it.

Reference:
1. “How the NSA Almost Killed the Internet”, Wired, January 2014
2. http://www.youtube.com/watch?v=Q2DY6jWT2a4  “How to Order a Pizza in 2015”


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