Beyond Medical Informatics

Here’s 2 bits of news about texting in healthcare:

Text4baby receives high grades

Surveyed participants in text4baby, a health information text messaging service for pregnant women and mothers of newborn infants, reported high levels of user satisfaction, according to researchers from the University of California San Diego (UCSD) and the National Latino Research Center (NLRC).

…

Additionally, 63 percent of respondents reported that text4baby reminded them of an appointment or the need for an immunization; 75 percent reported that text4baby informed them of medical warning signs that they’d been unaware of; and 71 percent reported speaking to a physician about a topic they learned of through text4baby.

This is great use of texting for consumer health IT purposes. The text4baby site is here.

However…

Joint Commission- Doc ordering via text is unacceptable

Here’s the original post at the Joint Commission site.

Is it acceptable for physicians and licensed independent practitioners (and other practitioners allowed to write orders) to text orders for patients to the hospital or other healthcare setting?

No it is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting. This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record.

I know this practice is somewhat common here in the Philippines.

What do you think?

This Medscape article identifies 10 "exciting and important new tools" that will someday be "changing the practice of medicine." They are:

1. Video Consults on Your Smartphone
2. Tablet Computers
3. Speech Recognition Programs
4. Handheld Ultrasound Stethoscope
5. Smart Bandage
6. Unified Communications
7. Remote Medical Devices and Functions via Smartphone
8. Automated Medication Adherence
9. Electronic Reference Tools and Calculators
10. Social Networking

I especially like 1 (Video consults on your smartphone) and 10 (social networking). Some are old technologies getting new uses in healthcare, while others are emerging technologies.

I don’t completely agree with the article as I have to see whether the emerging technologies will prove value in patient care processes but the list shows great promise.

Here’s the juicy news:

The stethoscope – medical icon, lifesaver and doctor’s best friend – is disappearing from hospitals across the world as physicians increasingly use their smartphones to monitor patients’ heartbeats.

More than 3 million people have downloaded a 59p application – invented by Peter Bentley, a researcher from University College London – which turns an Apple iPhone into a stethoscope.

…

Bentleys iStethoscope application is not the only mobile phone programme lightening doctors bags and transforming their practices: there are nearly 6,000 applications related to health in the Apple App Store. The uptake has been rapid. In late 2009, two-thirds of doctors and 42% of the public were using smartphones – in effect inexpensive handheld computers – for personal and professional reasons. More than 80% of doctors said they expected to own a smartphone by 2012.The trend looks likely to gain pace as younger doctors enter the workplace. Some medical schools issue students with smartphones. In America, Georgetown University, the University of Louisville and Ohio State University are among those requiring undergraduates to use one.

via iPhone set to replace the stethoscope | Technology | The Guardian.

So, will the iPhone replace stethoscopes? I don’t think so.

No doubt it is still a cool technology but this is all hype, at this point. The steth has more uses than just hearing heartbeats. In extreme cases, it can even serve as a reflex hammer.

Now, smartphones are a different matter–and it is already making a difference. A recent article reports that mobile devices help in decision making.

Studying the positive trends in mobile healthcare is important, but sometimes the hype can get in the way.

Here’s an interesting article: Physician studying diagnoses from phone-generated photos – FierceMobileHealthcare.

In Tuesday’s edition, the Post features George Washington University emergency physician Dr. Neal Sikka, who, according to the story, has been using camera phones to help diagnose minor wounds for friends and family pretty much since he became a physician in 1999. (Did we really have camera phones back then?)

Now, Sikka is in the midst of a six-month study at GWU Hospital of the accuracy of diagnoses from phone-generated photos sent by patients. He calls this the largest mobile health study of acute wound care to date.

For the study, patients snap photos of their own injuries and send them to a secure email account at the hospital. They also fill out a medical history form. “We’ll look at their picture along with the questionnaire and make a diagnosis,” Sikka tells the Post. Study researchers–ED physicians and  physician assistants–then look at the photos on a computer and make a diagnosis. Another physician then will physically examine the patient to test the accuracy of the diagnosis by cell phone.

The original story is from The Washington Post.

In 2006, I was involved in a project started by Dr. Paul Fontelo, my NLM mentor. It was called MMSPix and was presented in AMIA 2007. It involved using MMS, camera phones and an online repository for submitted images.

Abstract:

Smartphones with cameras have added a new dimension to augmenting medical image collections for education and teleconsultation. It allows healthcare personnel to instantly capture and send images through the multimedia messaging service (MMS) protocol. We developed a searchable archive, a mobile images Weblog of camera phone images for medical education. Registered users can view and comment on uploaded images. The archive is compartmentalized to allow sharing images with all viewers and by clinical specialty groups.

Many Filipino doctors already use SMS/text messaging as one of their communication channels with patients. And I’m sure there are already groups in the Philippines doing similar trials and studies with phone-captured images. With the right infrastructure, application and safeguards, we can find ways to maximize the ubiquity of camera phones in the country and make teleconsultations work to improve care.

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Are you currently using SMS or MMS in your practice? Do you have an ongoing study, trial or implementation using camera phones? I’d like to hear about them.

The growing popularity of iPad is a boon for other touchscreen or tablet devices. These devices hold great potential for better mobility and portability in clinical settings.

Competing models from China and Taiwan should drive prices down in the Asian marketplace. Hopefully, this translates to penetration and adoption of these technologies.

Other articles about iPad alternatives:

• iPad Alternatives: The Main Contenders
• iPad alternatives
• Top 10 iPad Alternatives
• Seven alternatives to the Apple iPad
• Seven more iPad alternatives

Mobile healthcare has been waiting for this kind of technology to proliferate. I can’t wait to get my hands on any of them to test them out.