Category Archives: Health

Increasing the Scope of mHealth: Telemedicine Behind Bars

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In designing mHealth solutions, one of the most important initial steps is identifying the target population. Asking “Who will benefit?” is one of the best ways to kick-off a successful, targeted mHealth campaign. To do this, we spend time gathering statistics about how many people own mobile phones, who owns smartphones, who texts, who tweets, and who talks. As we narrow down our target population to a specific subset, certain groups will inevitably be left out. One such population, is the incarcerated.

While inmates are not generally allowed access to mobile phones, mobile health, specifically telemedicine, holds a lot of promise in improving healthcare among this population. In December 2013, mHealth News reported that the Louisiana Department of Corrections (DOC) was planning to increase the use of telemedicine in their prisons three-fold as the primary healthcare delivery system for its inmates. By collaborating with AMD Global Telemedicine Inc—the leading Telemedicine Encounter Management Solutions supplier—the DOC hopes to serve over 50,000 inmates. Prior to this innovation, handcuffed prisoners had to be transported 150 miles by bus to reach the nearest healthcare facility, where all prisoners had to remain until everyone had been seen.

By establishing a telemedicine infrastructure—training doctors and healthcare professionals and purchasing video and medical equipment—inmates can be screened for the few that need face-to-face interaction, while the others can be seen virtually from the prison. With the technology provided by AMD, up to 15 patients can be seen by a single physician in just four hours. In addition to increasing productivity and tailoring care, the increased use of telemedicine is also cost-effective. Using telemedicine will greatly reduce transportation costs and payment for personnel who need to be transported from the prison. Additionally, the DOC is receiving additional funding from the state, which will allow it to pay for the aforementioned training and purchases.

Telemedicine is also especially valuable because it provides an opportunity for the consolidation of medical information through the digital interface. An article in PRWEb covering this telehealth development describes the program’s capacity to “deliver live medical images from connected medical devices and scopes, real-time video from an examination camera, and the ability to view patient documents and vital signs data all in the same online platform.” Furthermore, patients can use telemedicine to access physicians of 16 different medical specialties, including primary care, neurology, and endocrinology.

Telemedicine provides a very promising avenue for using media and digital technology to reach underserved populations. The incarcerated community is oftentimes overlooked for many medical innovations. However, this is one valuable opportunity in which such innovations can, and most likely will, be both highly useful and significantly impactful. While it is simple enough to design media solutions for educated professionals, the potential of mHealth is much more expansive, and should be utilized in as many ways as possible.

 

http://www.mhealthnews.com/news/telemedicine-behind-bars-prison-mobile-mHealth?page=0

http://www.prweb.com/releases/2014/02/prweb11575342.htm

Artificial Intelligence and Healthcare

I’m taking a philosophy class that touches a lot upon what cognition really means. Which led me to thinking – if we’re becoming closer and closer to developing artificial intelligence that rivals human intelligence, could we develop artificial intelligence to solve problems within healthcare?

Solutions are already in the works. A 2013 study from Indiana University showed that artificial intelligence machines were able to diagnose and reduce the cost of healthcare better than physicians by 50%! Using 500 randomly selected patients from that group for simulations, the two compared actual doctor performance and patient outcomes against sequential decision-making models, all using real patient data. They found great disparity in the cost per unit of outcome change when the artificial intelligence model’s cost of $189 was compared to the treatment-as-usual cost of $497.

However, one problem with replacing physicians with artificial intelligence may be the possibility of removing the doctor-patient relationship from the equation and undermines the importance of human relationship in the treatment process.

We are reaching a time in our society that we are slowly developing the tools needed to create intelligent beings that could solve problems. But a key distinction so far is that our goals in artificial intelligence have always been to create something as good or better than an average human.

But what if we switched that around? What if our goal was actually to create an artificial intelligence that had a problem itself? For example, could we develop an artificial intelligence that thinks like a patient in order to understand patient behavior?

There are plenty of virtual reality programs that exist for doctors to test their skills on surgery on specific parts of the human body, and now we know artificial intelligence could even replace doctors in diagnosis, but could there be one day be an artificial intelligence modeled after a sick person – an intelligent agent that may not be biologically (mainly because if it’s a robot it may not be made of biological parts) sick but we install a state of mind into it that would make it behave as it was sick? I’m talking about creating a robot patient who we would somehow program into thinking it has cancer, and doctors could be able to talk to the robot and it would respond and behave the same way as a cancer patient. It would be a great tool for doctors to understand patient behavior and how to meet their needs relationally, and I can see the uses it may have in studying psychology and philosophy as well.

As a Cognitive Science major, I can’t help but wonder since scientists, philosophers, and engineers have not been able to agree on an exact theory and replica of an artificial intelligence that represents a normal, healthy human, then how much harder would it be to create an accurate artificial intelligence that is a replica of someone who is sick.  After all, to model something that we might called defective, do you need to have a complete understanding of the original, non-defective object first?

Another complication would be distinguishing whether we could create a patient based on what is called “weak artificial intelligence” vs. “strong artificial intelligence”. Weak artificial intelligence is being able to create a machine that behaves intelligently, but strong artificial intelligence is creating a machine that can actually think. The current goal of researchers is to create strong artificial intelligence, which is why you have supercomputers like Watson who apparently can solve problems and answer questions by finding the information on its own. So if we even were able to create a machine that can behave like a patient, would it be because it has weak or strong artificial intelligence?

I believe there are many factors to consider both in philosophy and in technology before this possibility could ever be achieved. But for now, perhaps the best way to understand patient behavior is to communicate with the patient.

 

A New Approach to Treating Mental Illnesses

While we often think of new applications of medical technology as having vast implications for the treatment of many diseases, mental illnesses are often left out the discussion. This exists due to the deeply ingrained stigma in our culture that mental illnesses are not “real” diseases. However recent advances in technology have had a large influence on addressing the stigma of mental illness and providing new treatment approaches for mental illnesses.

One of the greatest impacts of new technology on mental illnesses is creating an online forum where people feel comfortable discussing their illness and can connect with others who are living with the same illness. While technology enables this for a variety of illnesses, it is especially important for mental illnesses because people with a mental illness can often feel isolated and feel pressure to hide their illness. Reading the stories of others, who are facing the same type of struggles, can encourage someone to seek treatment. The information available online creates an open dialogue in which we all can become better educated on mental illness, which will hopefully begin to break down the stigma ingrained in our culture.

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http://www.integration.samhsa.gov/

New advances in technology are also impacting the treatment for various mental illnesses. One particular multimedia program that is garnering attention is called Virtual Reality, and was developed for patients with Post Traumatic Stress Disorder. The program is based on exposure therapy, and uses specially programmed computers to create an artificial environment designed to be similar to scenarios a veteran experienced during combat. This program has also been shown to reduce a number of phobias, including arachnophobia, by having patients work their way through various scenarios that include their phobia, thus becoming more accustomed to their fear.

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www.medgadget.com

Future advances for the treatment of mental illnesses might involve applications that sense when a user’s mood is changing or if the user is in a high-risk situation. Mood could be tracked using physiological measures, and could signal a potential manic or depressed state. Location could be correlated to mood, and send a comforting or alerting message to the user if they are in an area where they normally experience high stress. For example, if a phone detects someone who has been diagnosed with depression with a predisposition towards alcoholism buying alcohol alone late at night, it could alert a family member to check on their loved one. While promising, these new features lead to many privacy and security concerns.  Although it might seem easier to limit the app to solely the patient, allowing the patient’s family and friends to be part of the treatment plan is essential, especially for mental illnesses.

While technological innovations for the treatment of mental illness are advancing rapidly, the technology out there lags behind many other “typical” diseases. Hopefully, even more innovative treatment approaches will soon be created, creating a brighter future for the treatment of mental illnesses.

Too Much of a Good Thing

A recent article published in the Argus Leader from Sioux Falls, SD highlights the difficulty that parents face in controlling their children’s internet usage. The article cites research by a distinguished pediatrician that determined social media can have a very negative impact on children. Heavy media use can be a detriment to a child’s health and social life. Therefore it is imperative that parents find a way to limit their child’s exposure to media on the internet and social media. Unfortunately many parents are not as savvy as their children when it comes to the internet so they do not understand the risks involved and potential consequences of excessive use. Nor do they know how to limit use or how much limitation is sufficient. Clearly children need to utilize the internet as a source of information and mental stimulation so it is crucial parents know where and when to cut down on internet use.

Some side effects associated with excessive exposure to the internet are lack of sleep and poor nutrition. Children need eight to ten hours of sleep a night and a balanced diet in order to develop properly and avoid health complications in the future. The internet acts as an escape and a distraction from normal life so kids these days spend more time indoors than ever before. They are also affected socially as interaction with others online hampers their face to face communication skills and ability to empathize. Substituting electronic for real life personal interaction leads to a poor understanding of facial expressions, tone and nuance in everyday conversation.

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Due to these mal-effects of the internet on a child’s life it is imperative that parents limit online usage. As the author of the article points out, unfortunately parents do not understand the internet and mobile applications very well, often less than their children. Therefore, parents need to establish communication with the children in order to further their understanding and protect their children. This necessary role reversal makes for an interesting modern family dynamic.

As we move through this class trying to increase the use of mobile technologies and the internet to better patient care it is important to remember that there are physical and mental side effects associated with it. Every solution no matter how beneficial contains inherent negative side effects. We also need to understand that the baby boomer generation is not as well versed in technology as our generation. Therefore when designing solutions to issues in healthcare that involve the internet and media we must teach rather than simply provide. Overall tech literacy must be increased or else our solutions will remedy little and confound many.

Argus Leader Article: http://www.argusleader.com/story/news/2014/04/08/children-face-health-risks-social-media-overload/7452213/

 

Guided Medicine or Big Brother: A Thought Experiment

Self-tracking devices have been lauded as the potential solution to filling in the gaps in traditional clinical data collection.  Oftentimes, measurements in the doctor’s office are not truly indicative of the patient’s everyday behavior and lifestyle; patients may experience white coat syndrome, or increased anxiety in the presence of the doctor.  Automatic self-tracking in everyday living may provide more accurate data because the data is collected in more natural settings.

One of the goals of self-tracking is to model and predict human behavior.  This sounds quite promising; however, how does this automated self-tracking actually come about?  Would we want our personal handheld devices to predict our next moves?  And what a fascinating thought experiment it would be to have our phones, these inanimate devices, give us life suggestions.  But oh wait, they do.

Google Now carefully watches its users’ every interaction to improve its efficacy.  It can predict where you will go judging by your past behavior.  It can detect that on Wednesdays, you like to get a Grande green tea frappe at Starbucks before your Russian literature class, and sometimes, when you’re having a particularly packed week, you treat yourself and venture into the bold Venti end of the spectrum.  While Google Now has the potential to notify you if there is a promotion on green tea frappes, it may suggest another drink perhaps, and as a subtle suggestion, a drink with fewer calories and a lower fat content.

Photo Credit: clipandfollow.com

Popular Science awarded Google Now as the 2012 “Innovation of the Year” for its potential to serve as an “intelligent personal assistant.”  It can infer your age bracket from your recent searches and tailor advertisements to your curated predilections.  For your mother, it can suggest her favorite hair dyes or jewelry boutiques, but what if one day following her sixtieth birthday, it begins suggesting cholesterol medicine and life insurance?  While this teeters on the edge of being mildly insensitive, it may regrettably be a sensible recommendation.

But it doesn’t stop there.  Google Now has a minute-by-minute map of your life.  Not only can it suggest nearby attractions and events, but it can also summarize your daily physical activity.  Given your latest late-night food adventures, it could now suggest restaurants with healthier vegetarian options.  It could also suggest a route that requires more physical exertion (to make up for that discreet donut run that you thought went undetected), and in your hurry, you wouldn’t notice that it was slightly more strenuous, with a steeper incline of about two degrees.

Photo Credit: geofffox.com

Physicians have the potential to produce mobile health applications that use the same tracking devices as Google Now.  While they have the promise of displaying customized content and advertisements, they can also subtly suggest healthier eats and longer walking routes.  With smartphones constantly linking accounts and contacts, mobile health applications will soon be connected to the information collected by Google Now.  And suddenly, without your conscious awareness, you will be forced to be utterly and irrevocably healthy.

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