Ebola virus, Education & Telemedicine: a SmartER Combination

October 25, 2014 Leave a comment
Categories: Uncategorized

Holograms, Augmented Reality, Smart-Glasses and Beyond: The future has arrived

October 22, 2014 Leave a comment

I think that the future has arrived indeed!

Almost all that we learned in medical school, is now potentially outdated or obsolete. The way we now teach medicine, prevent disease and care for patients has radically changed in many forms. We have been living the evolution of healthcare, the revolution, the change of paradigm…

Last year, at the Games for Health Europe conference in the Netherlands  http://www.gamesforhealtheurope.org  ( Twitter @gfheu14 ). I had the chance to try the Oculus Rift.

It was a very early prototype, I thought, but immediately realized its future in medicine, visualizing “Virtual Telemedicine” consultations, in front of a 3D- digital provider in a virtual reality (VR) office. Imagine the potential of this use to extend the reach of over-sought, already in shortage, medical personnel. To be able to provide medical advise, immediately, remotely, no matter the physical location, as long as there’s connectivity. That’s the closest you can get to a physical interaction, when that form of interaction is not possible or necessary.

Then it came Google Glass. As a very early Explorer, I performed the first operation ever documented with this device

http://t.co/W0EJQy9U8s

Simple and simply, intuitively improving connectivity and communication between surgeon and an audience, to proof the point that this new gadget was really one of many wearables in the horizon, representing “The Natural Evolution” of the computing platform. 

In the matter of months, quicker than we can dream or assimilate, we are once again presented with exponential advancements in technology. Exponentially smart ideas about how to use technology to improve the way we provide healthcare or teach medicine.

In the video below, you can appreciate how medical education could certainly be delivered in “the future”.

The video was published in September, 2013, telling us about technology leaps to happen around the year 2033.

Well, nice video, but TOO LATE. It is only 2014, and that technology is HERE NOW.

Check out RealView Imaging. “Interactive Live Holography, from Science Fiction to Science Fact”.

This is a reality now, and has the potential to revolutionize medical education and medical care. Providing interactive, virtually Real, 3D images of anything, allowing physicians to SEE better, to learn better, plan better, to deliver better care.

Yesterday I spoke with the team behind the next generation of smart glasses. An amazing development, augmenting every aspect of what it is currently available.

Meet THEIA, Augmented Reality Glasses.   ( http://WWW.Theia-Glasses.com )

[

youtube=http://youtu.be/nn7XBmsQ5W4]

I can just see it  now: the RealView platform, embedded in the Theia- AR glasses, providing us with the closest-to-reality-possible vision the anyone can have… other than the real thing.

Embracing Technology for a Healthier Future

October 21, 2014 Leave a comment

Once again, I really want to send a public note of appreciation to Maine Magazine (@Themainemag), for their recent article about my work. I think that Sophie Nelson (writer) and Nicole Wolf (photography) are amazing professionals that really represent some of the incredible talents that Maine has to offer.

I humbly want to thank them for their comments and views, and for helping spread some of my vision and passion regarding the potential for innovation technology in healthcare and education.

This is the link to the article:

The Maine Mag/ October, 2014

Ebola virus, Education & Telemedicine: a SmartER Combination

October 18, 2014 2 comments

Ebolavirus infection. Education &  Technology can help, especially EDUCATION!

The recent news about the Ebola epidemic are really catching the world’s attention, and I feel that it is important to keep updating this post about this most important, life-threatening topic.

Ebola Glass2

I’m not an Infectologist. I’m not an Epidemiologist either. I’m just a Surgeon.

Like many healthcare professionals, I have been thinking about it for several weeks. In my particular case, I’m extremely alarmed and  do worry that this current epidemic, will spread fast and take an enormous toll on its way to be eventually defeated.

Some facts: Wikipedia/Ebolavirus

I don’t want to get too technical about this.

FACTS: It is a virus, basically (RNA) protein that infects a host (in our case, humans) and replicates quickly, overwhelming the bodies capabilities to fight it. It attacks, among several targets, the lining of blood vessels (endothelium) and organs like the liver and immune response cells. It likes neutrophils (cells in charge of alerting the body that there’s an infection going on), blunting their ability to evoke a defense response.

Transmission occurs by the way of (ANY) body fluid from an infected person (but only after that individual is having symptoms). Symptoms appear between a few days to 3 weeks.

The virus is A SURVIVOR. It can be killed or inactivated while on the surfaces, with 3% Acetic acid solution (vinegar, alcohol based products, bleach (1:10-1:100  for >10 minutes),  heat (heating at 60 degrees for 30-60 min, oiling for 5 minutes), UV  radiation (moderately sensitive), bleach powder, etc.

Outside the host, it can survive for WEEKS in blood or contaminated surfaces, especially at low temperatures  (4 degree Celsius)…winter is coming!. These facts are based on experimental findings and NOT BASED on observations in nature.

I think that the problem will be controlled only by the development of a VACCINE ( to provide immunity to people NOT INFECTED yet) and/or the development of a RAPID, mobile DIAGNOSTIC TOOL that allows detection of the virus, in a host, BEFORE the individual becomes SYMPTOMATIC and INFECTIOUS, hence CONTAGIOUS.

The current scenario: a lot of effort in screening symptomatic people in many places (affected areas, airports,etc), mainly to check whether they have symptoms (fever, pains, bleeding, etc). If they don’t have symptoms, THEY ARE RELEASED TO GO, and that’s it.

Imagine how many people might be infected with the virus, but when they were evaluated by the current protocol, they were found not to be symptomatic, so they got through the checkpoint.

I believe that the use of technology such as Telemedicine (m-Health), has a definite role in extending the reach of providers to patients thought to be at risk of becoming symptomatic.

Imagine, for instance,  the possibilities of REMOTE AND MOBILE VTAL SIGNS MONITORING using wearable technology to keep those patients in “the radar”, without exposing anyone to them and risking becoming infected, while the period of “quarantine” lasts.

Having potential carriers of the virus wear sensors that automatically track an objective parameter such as temperature, heart and respiratory rates,  so that abnormal elevations  (i.e. fever) are immediately detected, and appropriate measures taken right away. Mobile thermal imaging has a very relevant, potential role in the fight to contain the spread of this illness.

http://therm-app.com

http://www.psfk.com/2013/09/ultrathin-wearable-thermometer.htm

Sensor skin

Vitalconnect, a skin patch to that detects and wirelessly transmit your vital signs

Tinkė – A smart, portable monitor that detects vital parameters

The use of virtual reality presence (telemedicine) clinical interviews and follow-up of cases would make an ideal tool for extending the reach of providers without exposing them to infection.

Tele-mentoring of remotely located health personnel, guiding them with expertise and advice could prove an invaluable tool to optimize the treatment of patients and the development and deployment of strategies to fight this potentially lethal disease. Wearable computers (such as GoogleGlass) could potentially add to the armamentarium of healthcare workers.This particular device has the capability of being a “Touch-free” / voice activated-interface ( along with the current developments to integrate gesture commands, like the Myo platform). See “GoogleGlass on Steroids”.

http://rgrosssz.com/2014/08/11/googleglass-on-steroids/

SO, MY QUESTION IS, what happens with that infected patient afterward?

How many of these “FELL THRU THE CRACK”, and any time between that moment at the airport and 21 days later, developed symptoms-“GOT A COLD” (cold-like symptoms) and started spreading the Ebola-virus. And they might not have been in an area of risk for Ebola, but maybe they just became contaminated by someone else, maybe a few degrees of separation from the actual individual who came from the geographic risk  area.

I don’t want to BE ALARMIST but REALISTIC.

We have already seen three INFECTED, SYMPTOMATIC AND INFECTING, patients IN THE USA ( up to the latest report on October 22nd, 2014).

Unfortunately, my prediction is that we are only seeing the “tip of the iceberg” and that in he next several days, we would be finding out many more cases, since it takes at least 21 days for the symptoms to become evident.

I think that this is a problem that requires the most aggressive strategy and that the public needs to be educated (not alarmed BUT AGGRESSIVELY EDUCATED) about the potential of this epidemic to be disastrous, and of the many easy ways to prevent transmission.

ENCOURAGE PEOPLE NOT TO TOUCH ANYONE OR ANYTHING AS MUCH AS POSSIBLE.

ANY SEVERE “COLD” – LIKE SYMPTOMS SHOULD BE TREATED AS EBOLA INFECTION UNTIL PROVEN OTHERWISE, and those patients should be temporarily isolated.

Teach yourself and those around , to be “a little paranoid” about this issue.

Wash your hands and use alcohol-based sanitizer often.

If you come in contact with anyone, WASH YOUR HANDS , USE ALCOHOL BASED SOLUTIONS, DON’T TOUCH YOUR MOUTH, NOSE , EYES OR ANY OPEN SURFACES BEFORE “DISINFECTING” YOURSELF .

I think that this is the type of information that needs to be taught and spread in schools, in public spaces and in the media, as much as possible until this epidemic is under control.

To be informed, to remain healthy… is the right of every individual.

Go wash your hands please.

Be Scared of Telemedicine, Really Scared!

October 15, 2014 3 comments

I had been thinking of this title for a long time. Actually, I had been thinking about writing this post, for even longer.

The idea to get people’s attention to the reality and the future of virtual presence medicine has been going around, inside my head for many months.
I admit it and I apologize, the title was only meant to catch your attention. No matter in which “team” you are right now, patient or healthcare provider (by the way, there should be only one team !), know you have a real potential to switch sides in a “sneeze”, literally.

You should NOT be afraid, UNLESS you are a healthcare system or a hospital that haven’t realized that telemedicine or e-medicine, is already becoming a very popular way in which YOUR patients are doing healthcare transactions, or at least getting the initial medical advice; I don’t mean in a distant future, I mean today, I mean yesterday, I mean in the years to come!…And their options and choices are multiplying quickly, morphing, improving, adapting to their needs, like the free-market economy does.

You see, I’m a medical doctor, a full-time surgeon.I love technology and its potential to help us take better care of people, when used in a smart manner.

After giving a few TEDx talks in the subject ( “OK Glass: I need a surgeon http://youtu.be/fo3RsealvGI
“OK Glass”:Disrupt Healthcare Now”
http://youtu.be/DVzkw7y4_u4 ), attending ExponentialMedicine (a Singularity University program that injects its participants with the knowledge and the passion for how exponential technology can impact the future of healthcare delivery. http://exponential.singularityu.org/medicine/ ) and soon after that, performing the first ever documented surgical procedure with Google Glass
( http://t.co/W0EJQy9U8s ), I have become some sort of an “evangelist”, traveling the world as a keynote speaker, sharing the vision for e-medicine, of “how much better it could be” (or IT SHOULD BE!).
Preparing for the talks, I try to keep up with the most up-to-date information in the subject, curating the internet and healthcare social media, seeking inspiration and following brilliant colleagues and blogs like the ones of Bertalan Meskó/ @Berci, Christian Assad/ @Christianassad, John Nosta/@JohnNosta, Lucien Engelen/ @LucienEngelen, Daniel Kraft/ @Daniel_Kraft, Kevin MD, 33Charts, the 3GDoctor, etc.

Over the last year, one common trend has been the amount of new developments regarding the availability and variety of telemedicine options. I not only mean that hospitals are slowly adapting to the reality of e-visits, but that it seems that every couple of weeks there are news of a direct mobile option for a patient to get health advice in a very efficient way, over the internet; quickly, inexpensively, reliably and in most instances covered by insurance.

Who doesn’t want that? Why would you choose the less attractive option of making the appointment, waiting for the date, driving to the doctor’s office, waiting to be seen, being seen, getting a prescription (maybe), getting a follow-up appointment date, filling the prescription and then going back home (or back to work or school, which, by the way, you missed because all of the above routine) ?

This is just a brief, partial list of some of the available stand-alone telemedicine options that offer what I just described:

Curely (@CurelyMD -see http://medbonsai.wordpress.com/2014/10/08/the-future-of-healthcare-is-here-and-it-is-a-telehealth-marketplace/ ), Teledoc (Teladoc.com), Healthtap (www.healthtap.com), Memd ( http://www.memd.me ), ZocDoc (www.zocdoc.com), DoctorSpring (www.doctorspring.com) , DoctorOnDemand ( http://www.Doctorondemand.com), Better (http://recode.net/2014/04/16/better-puts-healthcare-in-your-pocket/ ) and even Google, who is rumored to be getting ready to offer a service in the Helpout platform, for patients to get medical advice in a mobile fashion thru the internet (http://www.zdnet.com/the-google-doctor-will-see-you-now-search-giant-trials-online-medical-consultations-7000034705/ ).

Imagine that you are a patient living in a rural area (or not so rural, even metropolitan), suffering from a non-emergent medical problem that does not merit a 911 call or a visit to the ED, and you are thinking  about calling your primary care provider (PCP) to get some advice on what to do. How easy would that be? How soon will you be seen? How much of a hassle will be involved? And what about if the office is really far away, or if you are home-bound because of disability or just because you don’t own a vehicle? I know you can get the picture!

The “legality of these interactions is becoming not an issue anymore, and HIPAA compliance is being addressed in all of these services, so…the argument of “privacy” concerns, is not such any more.
I truly believe, that health organizations that don’t confront this issue right now, will definitely suffer the consequences.

I think that it is imperative for them to make this modality, Telemedicine, a main pillar of their “survival” strategy (along with Finance, Community, Employees, Patients, etc.), in order to be able to keep their market share, to even increase it, but most importantly, to provide better, overall care to their patient population.

If they don’t do it NOW, they will for sure do it in a few years, BUT UNFORTUNATELY, right behind their competition!

So What I’m really telling them is: IF you want to survive,

DON’T BE SCARED OF TELEMEDICINE….EMBRACE IT!

 

PS. This link just came out, minutes after I published my post:

http://venturebeat.com/2014/10/15/plushcare-launches-telemedicine-service-with-stanford-ucsf-doctors-on-call/

These services will virally multiply!

Telemedicine ALSO MAY Cuts Costs and Improve Outcomes in THE ACUTE CARE Management

September 29, 2014 Leave a comment

I just finished reading a very interesting post by Nuviun Digital Health, from September 23rd, 2014. It was entitled “Telemedicine Cuts Costs and Improves Outcomes in Chronic Disease Management”

( http://nuviun.com/content/series/telemedicine-cuts-costs-and-improves-outcomes-in-chronic-disease-management)

I recommend reading it, to really get a quick overview of how remote presence medicine, or Telemedicine ( or mobile health, mHealth) is really having an impact in healthcare today. We are not talking so much about “potential”any longer, but about real progress and factual changes in outcomes BECAUSE of the use of this modalities.

As you all know, I’m a big proponent of the smart use and application of technology in Healthcare. I think that as communication technology exponentially evolves, and devices are becoming faster, smaller, less expensive and more user-friendly, they allow us to connect and communicate better in our daily lives. People use video-conference calls more commonly, rather that bringing their phones to their ears to just “hear’ someone, when instead they can “hear and see” the other person.

If this is the case in non-medical settings, it is just intuitive that professional disciplines like medicine, should make use of the same tools to improve the way we care for patients, the way we connect to providers, seek advice and provide expertise.

The device industry is barely waking up, and what we are seeing now is only the “tip of the iceberg”. Wearable devices like Google Glass, Epson Moverio, etc. are only examples of what is there to come, the first steps in the natural evolution of the platform of choice to connect and communicate ( Natural Evolution Up to GoogleGlass http://youtu.be/Psq-T2O0LDs )

Early developers, most of whom I had shared views and perspectives with, several months ago, such as Pristine (@PristineIO ), Augmedix (AugmedixINC ) and Droidres (@Droiders ), among others, are the true pioneers and visionaries of how this intuitive way to communicate could improve the interaction between providers-patients and the medical record, hence permitting a more fluid conversation which should allow for better care and outcomes.

http://venturebeat.com/2014/09/29/pristine-grabs-5-4m-to-cure-the-doctor-shortage-and-save-lives-with-google-glass/

It is well accepted that Telemedicine and mHealth have clear roles in the setting of chronic disease. I argue that it has a place as important  in the improvement of acute care issues. Back in 2009, we at EMMC showed that a telemedicine program was well accepted by patients, referring and consulting providers, and that the potential for dollar savings and improved outcomes was real.

( https://www.facs.org/~/media/files/publications/bulletin/2011/2011%20june%20bulletin.ashx )

Be it in the non-emergent situations, chronic diseases (COPD, HTN, Heart disease or stroke, to name a few) or in the life-threatening conditions and moments, when a provider needs an answer quickly, or when an expert wants to share his or her insights to improve the patient’s care and potentially save a life, the role of wearable HUD (head up displays) telecommunication devices to improve the process of communicating remotely is plainly obvious.

The way I see it, why use a written letter when you can use the phone? Why use a land-line telephone when you can use a smartphone? Why use a smartphone when you can use a video-phone? It just makes sense, despite the demands of proof, evidence, data or ROI.

This is just the beginning. Innovation in Healthcare is happening fast and it is unstoppable. Unstoppable because the current state of our system is unsustainable, due, among other factors, to exorbitant cost, lack of access, deficient communication and connectivity among key players (read provider-provider-patient-regulators-administrators and industry!) and shortage of expertise.

The smart application of technology can help us with this.

Medical Records were not meant to be “Sugarcoated”

September 27, 2014 Leave a comment

Originally posted on Medhacker:

I have spoken recently with several doctors that are changing the way they write their notes and thus relevant patient information. Why? Simple, a great thing is happening, patients are beginning to embrace digital health , learning more about their diseases/conditions and accessing, studying and understanding their medical records.

11

Here is the kicker…Sometimes in life we hear others addressing personal issues that even though they are true, they are uncomfortable to hear. Some can easily ignore them, others may  feel insulted and/or aggravated. This is extremely important to YOU, yes you who is reading this, since you now  have easy access to your Medical records.

Medical records are not meant to be a story. They were not made to be easy on our ears. They are scientific data used to capture facts. They are the mixture of years of training, medical knowledge, experience, and a patient-doctor relationship.

Alison-Brie

Why is this important?

View original 231 more words

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