Medical Futures Lab

Guest posting by Sonali Mahendran

CliniCloud, a company founded by two Australian doctors, is currently taking pre-orders for a wireless non-contact thermometer and a smartphone-enabled stethoscope.

These devices now take the concept of telemedicine to a new level. Technology is being used in implementing telemedicine and telehealth to improve patient care. Video visits are beneficial to patients who prefer to receive care from the comfort of their homes; travel time, parking, and wait times all complicate a patient’s hospital visit. On the other hand, doctors and nurses can attend to more patients’ needs in video visits as opposed to person-to-person visits. In fact, in an article in Health Affairs, Joseph Kvedar mentions that in a program at Partners HealthCare, more than 3,000 congestive heart failure patients received care via in-home monitoring of weight, blood pressure, heart rate, and pulse oximetry. In this study, three to four nurses care for a daily panel of 250 patients, whereas in a certified home care agency, these same nurses would only care for four to six patients daily. This strategy allows the hospital to cut down on costs, while allowing doctors and nurses to attend to patients with more demanding health care needs.

According to Dr. Andrew Lin, cofounder and CEO of CliniCloud, the stethoscope and thermometer are the two most important tools that are used in medicine for diagnosing common ailments. By providing patients with access to these tools, doctors empower patients; patients can engage in self-care. With these devices, patients can accurately record vital signs and can share this data with their primary care doctor or even a network of physicians. Also, this device serves as a means of tracking health between hospital visits.

The CliniCloud app, for both Android and Apple devices, guides users through correct use of the devices, allows them to store a history of readings, and create multiple profiles for different family members. Another feature provides baselines to help users determine whether or not their readings are normal. This feature lends itself to a significant concern. When I interviewed a nurse at Texas Children’s Hospital for a team project, she revealed a key point regarding patients’ knowledge. In hospitalizing infants diagnosed with a congenital heart disease, it is important to inform the family that data points that they find online for children with normal hearts will deviate from their child’s readings. In fact, she suggests providing the “normal” data points for a child with that specific heart disease.

This concept applies to every patient.  Every individual is different, and in fact, a true “normal” reading may not even exist. The world is transforming and technology is establishing its prevalence in all disciplines. There are definitely several positive aspects, but it is also important to become aware of and improve upon potential negative aspects. And sometimes, solutions may be nearly impossible. Consider, the concept of empathy, for example. How do you incorporate that into a fast-paced world? You can’t eliminate it, as patients prioritize empathy when evaluating their care experience. How do we remind doctors that the readings and data they see are not the complete narratives of each individual; how do we keep them from associating patients with a number or an ailment?

Inspiration: “CliniCloud Offers Consumers Smartphone-Enabled Stethoscope, Thermometer for Video Visits” – Jonah Comstock from Mobihealthnews

http://mobihealthnews.com/40642/clinicloud-offers-consumers-smartphone-enabled-stethoscope-thermometer-for-video-visits/#more-40642

Guest posting by Angelica Razo

You would think that a soldier’s return from war would be happy. A picture perfect scenario would include a tear-jerking moment as they embrace their family at the airport. However, we forget that scenario is only moments long.  Veterans return to suffer from PTSD and painful injuries. In order to cope with physical and emotional agony, they turn to pain-killers for relief. No one would want to deny a veteran pain-relief, so VA hospitals have prescribed them with a large amount of opiates with no hesitation. Unfortunately, this allows them to development opiate addiction. Now, we see an increase of opiate addiction and overdose cases among veterans. Veterans are being locked in a life-and-death situation.

What if we could change the way pain-relief was delivered? Recent research has shown the positive impact that acupuncture can have on veterans. Of course, too many people, this “alternative medicine” might sound too strange. After all, how can having large, yet almost invisible, needles stuck in your body help you forget the pain. Still, case studies have proven that veterans reduce the amount of opiates that they take when they are participating in acupuncture. Acupuncture has very low health risks and any possible side effects (eg. Headache and nausea) is minor compared to the side effects of opiates. This new method of PTSD and pain relief is beginning to gain ground in communities throughout the United States. For example, the positive response from the Wounded Warrior initiative in D.C. has provoked the opening several acupuncture clinics specifically for veterans in several states. Not only does acupuncture aid with pain relief, but it is a form a relaxation in which a patient can be release of mental stress and anxiety. For veterans, proper mental wellness is crucial to their reintegration into society.

Yet, the FDA refuses to recognize its use and continue to allow veterans to be prescribed opiates with little restrictions.  Communities have taken their own initiative in building up this type of treatment, but they lack the support from higher powers to reach their full potential. Clearly we have the resources to utilize this type of medicine on a larger scale, but the government claims that we should take caution with such “alternative medicine” since we do not know about to properly regulate it. Once regulation begins, acupuncture treatment could become just another form of medical prescription. Doctors could prescribe it, insurance companies would cover it. Yet, we know we are still a ways off from a world like that.

Who’s the real addict? The veteran, a victim of war? Or is it the health system? As veterans are dependent on drugs, our health system has become a dependent on pharmaceuticals for treating their patients- hesitant to try a different approach to medicine.  We revere our veterans as heroes, but we let them come back to their homeland to suffer in addiction. We claim that patients come first, but why don’t we prove it?

Guest posting by Bailey Flynn

This week, at our first design critique, we received an important question: what medium would we use for our solution—electronic or paper. Medicine, like most fields nowadays, is transitioning to become entirely paperless, so this is a crucial, but not simple, question. The hospital we are working with, Texas Children’s Hospital (TCH), is almost entirely paperless. All of their records, orders, and appointments are kept online, in a program made by Epic Systems. In 2006, TCH spent $60 million to begin switching to electronic medical records, and they’ve likely spent more since on upkeep for the system [1]. Indeed, the entire medical industry is making the switch, albeit somewhat slowly, to electronic medical records (EMR).

I do not wish to address here whether EMR are fundamentally a good or a bad thing. Either way, they are a reality. Instead, I’d like to focus on whether our solution specifically should be electronic or paper.

The logical answer to this question would seem to be electronic. Electronic records offer the potential to collaborate on a single document. They also allow for data logging and tracking over time. Since TCH is already paperless, our solution would better fit in with the environment if electronic. All hospital personnel use Epic, so integrating with an existing system could be a good thing.

However, developing an electronic solution may be difficult, especially given that we do not know how much ability we will have to modify Epic. Additionally, an electronic solution will likely have a slightly steeper learning curve than would a paper document. Finally, given that the electronic records are already so thorough, another electronic file may be viewed as a burden and could easily be forgotten.

I’m not ready to rule out paper as a viable medium. There are several disadvantages of paper, of course. Paper offers much less potential for collaboration. To view or edit it, one must be physically with it. It has the potential to get lost or ignored, as well. It’s also much less permanent than an electronic record.

However, paper is a tried-and-true method of communication. Paper offers several advantages—it’s user friendly, no one is uncomfortable using paper, it’s tangible and less easily forgotten (especially when it’s fluorescent pink). Currently, the checklist that is used for liver transplant patients is paper. I’d imagine it’s one of the few paper records left within the hospital. On the one hand, paper would stand out in a paperless hospital—but is that such a bad thing?

In the end, I think the critical point to consider is: what would doctors and nurses use more? Our solution, no matter how elegant, is entirely pointless if it isn’t used. In the coming weeks, I hope to dialogue with nurses and doctors about their preferences.

[1] http://www.bizjournals.com/houston/stories/2006/08/21/story2.html?page=all

Here are some related articles that I found interesting:

Forbes: Less Than Two Percent of Hospitals Are Paperless as Medicare Penalties Loom

NY Times: The Ups and Downs of Electronic Medical Records

Guest posting by Sierra Butler

Sierra Butler Film 381

Guest posting by Emile Gleeson

All of our readings about e-patients and patient engagement over the last month or so as well as the team presentations last Thursday have caused to me reflect a lot on my own recent experience as a surgical patient at Baylor/St. Luke’s Hospital. Just a few months ago, in December 2014, I received surgery to shorten my left anterior talofibular ligament (ATFL) and remove some excess scar tissue in the surrounding area. This surgery was necessary because, as a dancer, I snapped my ATFL in high school and didn’t stop dancing long enough to let it heal properly. As a result, my ligament inappropriately lengthened itself during the healing process and a large amount of scar tissue formed in the area. Eventually the pain had gotten so bad that I couldn’t walk without being in extreme pain (I was in a walking boot for three months pre-surgery, and even then I still had a lot of pain). As a pre-medical student, I was probably a prime example of an engaged patient, as I was always very aware of what exactly my medical issue was and what my best chances were of fixing it, and I had a great overall experience with my surgery. However, I think that my surgeon’s availability and willingness to answer questions both pre- and post-surgery was what really gave me this great experience.

When I first met with my surgeon, a few months before my actual surgery, he was able to email me a full report describing my condition and the exact surgical plan that he wanted to use to fix it. While many patients may have simply glossed over this email, or figured that they wouldn’t be able to understand the medical terminology, I took the time to really understand the entire procedure, looking up unfamiliar terms when necessary. As a result, I was extremely prepared for exactly what my post-surgical recovery would be like, and I was able to plan accordingly (For example, I scheduled my surgery right before winter break started so that I wouldn’t need to push myself to begin walking sooner than recommended in order to go to classes). Additionally, I thoroughly read through all of the post-surgery paperwork that I was provided with, and followed all instructions carefully, since, as a pre-medical student, I knew the importance of a good post-surgical recovery. This engagement of mine certainly played a big role in my successful (at least so far…) recovery, however, I still believe that my surgeon’s availability and willingness to explain everything on a level that I would understand is really what made the biggest difference in my experience. During both my pre- and post-surgery times, my surgeon made himself available for questions through email, which allowed me to clarify anything that I didn’t quite understand, and allowed me to work together with him to choose the best date for my surgery. Despite the prevalence of the “pre-surgical blackhole” which was mentioned in one of the other teams’ presentations on Thursday, I didn’t feel as though I was ever disconnected from my surgeon during this time. Perhaps if more doctors made themselves available to their patients in this way, more people would have positive surgical experiences such as mine.