Electronic Medical Record | Medical Futures Lab

Mar 08 2014

Communication, Electronic Medical Record, Medicine, Technology

Through the Looking Google Glass

As I was scanning my twitter feed this last week I came across an article discussing one of Google’s newest technology accessories, Google Glass. Google glass is essentially a lightweight pair of eyeglasses that works like a headset equipped with camera, GPS, Bluetooth, microphone, and viewfinder. This technology allows the wearer to connect to smartphones, allowing them to search for and access information online and to use the camera, GPS, etc. all hands-free.

Google Glass: What It Does

With all this information less than a click away and viewable without having to carry a physical device I wondered, what possibilities could this technology have in the world of medicine?

I decided to look at how Google Glass was currently being used in the medical field. I found that this technology provides a means to change the ways the doctors work and communicate both with each other and with patients.

In class we’ve discussed how the internet has come to change how information is spread throughout the medical community, from simple avenues like the increased access to information to more creative paths like the live tweeting of surgeries for the public to access. Technologies like Google Glass make these information sharing “innovations” of today look small in comparison.

A perfect example of this can be seen in an article that discusses a surgery performed by Dr. Pedro Guillen earlier this year. Dr. Guillen was able to perform a highly complex surgery while wearing Google Glass, allowing the surgery to be streamed around the world in real-time. This feature allowed him to serve as an interactive teaching tool to university students and physicians all over the world, opening non-traditional avenues to improve medical education around the globe. The technology, as reviewed by Guillen, also revolutionized the way he performed surgery. The split-screen display allowed him to maximize access to valuable information such as images of the knee, notes, or past surgery videos without having to lift his eyes from the table. While all of these features were impressive one that stood out the most was in the off chance that an error occurred, Dr. Guillen possessed the ability to rewind the tape to review the surgery while standing at the table. This feature can serve to drastically change the way we approach and view medical error in the future.

Video of Dr. Guillen’s Surgery

I also found an account of how Google Glass is working to improve doctor-patient interaction. One company, IOS Health Systems, has developed a native EHR app that can be used with Google Glass. This means that doctors could access patient information such as medical history, vitals, etc. and display it into the heads-up display while talking to the patient. This opens the possibility for doctors to reduce reference to a stationary screen and engage in more direct conversation with the patient, working to improve the doctor-patient interaction.

As I reviewed the literature I marveled at the possible impacts that technology like Google Glass could have on the practice of medicine and considered the role that Google Glass could play in our design setting. In the cardiovascular ICU physicians are required to both consolidate and communicate vast quantities of data into a simple and informative patient narrative and plan of care. In the current system often hand copy detailed data from the patient EHR onto sheets of paper. This practice, while necessary within the system, has created a sort of presentation “crutch,” where fellows will focus and rely on the data that they have spent so much time collecting rather than giving a cohesive patient narrative. Technology like Google Glass can work to eliminate this crutch. By allowing for the information to be readily available and accessible, physicians can focus more on preparing a patient narrative and care plan for presentation during rounds.

While Google Glass offers many positive aspects for the world of medicine it also holds many cautionary aspects. With the adoption of any new technology there come many unanswered questions. How will the ability to stream in real-time at any moment change privacy? Will the knowledge that your doctor is viewing information that you cant see change the way that doctors and patients interact? The positive impacts that utilizing revolutionary technology in medicine can have are great, but as always we must move carefully as we move towards the future.

Tagged EHR, medicine, technology

Feb 28 2014

Communication, Design, e-patient, Electronic Medical Record, Health, Prototyping, Technology

Ping. Have It Your Way.

Ping. That must be my daily reminder. How am I feeling now in terms of arousal and valence? Well, I just had my weekly meeting with my research advisor. He was really getting into the nitty-gritty and suggested that I should have been farther along with my project. I don’t even like this project. I wish I could just get it over with… Anyway, probably low valence. It was a pretty negative experience. Also high arousal… He really stresses me out, and I could feel my blood pressure rising.

Photo Credit: mzstatic.com

One of the greatest benefits of mood tracking is increased self-awareness. Mood tracking apps like Moodscope and Mobile Therapy remind users to take a step back and to reevaluate their life choices. They can reflect on what is bringing them happiness and what is bringing them down. By connecting their moods with other factors happening in their lives, users can develop a greater understanding of themselves with respect to their environment.

The beauty of mood trackers is that they also provide spatial and temporal information. Users can link their moods to their immediate spatial surroundings and to the time of recording. By randomly sending pings throughout the week, these apps can help users determine where and when they tend to feel upset or happy.

Additionally, mood trackers do not only take in information, they can also offer advice. Mobile Therapy offers therapeutic exercises, including breathing visualization and muscle relaxation. It also offers strategies to quit smoking, treat anxiety, and detect relapses in psychotic disorders. Ideally, these mood tracking apps could personalize therapeutic exercises to a user’s specific input. You could “have it your way” by inputting end goals, such as cultivating happiness or controlling the relaxation response.

Photo Credit: play.google.com

With most mood trackers, it is also possible to add information through texting—users can share paragraphs of information if they feel inclined to do so. Therapists and physicians could use these self-reflections to see how their patients are doing over time. Appointments with health professionals are short, and they are not necessarily indicative of how the patient normally acts. Some patients may experience white coat syndrome, so there is an additional benefit of having records of patients outside of the doctor’s office.

In the future, perhaps these apps could notify the patient’s physician directly. Jon Cousins describes the benefits of connecting his data to those close to him: “We leave traces of ourselves with our numbers, like insects putting down a trail of pheromones, and in times of crisis, these signals can lead us to others who share our concerns and care enough to help.”

If physicians have access to their patients’ personal information, they can individualize their treatments. While there would be a lot of information to handle, this issue could be alleviated with efficient organization and clean programming. It is possible to automatically assemble the relevant information in a visually aesthetic way, and these apps track not only the physical health of users, but also their mental and psychosocial health.

Feb 26 2014

Electronic Medical Record, History

History of Medical Records Systems from 19th to 21st century on Connexions

Guest post by Olivia Banner

I’ve just posted A History of Medical Records on Connexions (a Rice University-based repository for online learning modules). By showing medical record systems from the nineteenth century through the present, this project illustrates how the physician/patient encounter has been recorded, and the accompanying text begins to tease out what we can learn from the forms such records have taken.

When we teach about the history of medicine, students often take it for granted that medical records sit outside of history: that it is obvious what a hospital or a doctor would want to measure and record about their patients. Yet that information has changed over time, and what a hospital or a doctor selects as significant enough to record tells us much about the needs of medical institutions as well as what goes on within the physician-patient encounter. In addition, the format for those records has undergone constant transformations due to the introduction of new technologies, or changes in institutional needs, etc., and their format reveals much about medical practice.

The project is still in progress, and the materials I have been able to gather have been limited by what archives have saved (and medical records, seen as the stuff of bureaucracy, are often not considered important for the historical record) as well as by concerns about privacy. Materials from Los Angeles and Boston archives will be added in future months. Nevertheless, what is included here will help us all learn more about the history of medicine as it moved from the analog to the digital age.

Jul 12 2013

Art, Communication, Design, Education, Electronic Medical Record, Prototyping, Story

Transmedia Hackathon @ OEDK!

Earlier this week the Medical Futures Lab parachuted into Matthew Wettergreen’s class in the Oshman Engineering Design Kitchen at Rice University to run a two-day transmedia hackathon inside a summer engineering design course. Our goal: explore how the visual and narrative representation of problems shapes our ability to find solutions to those problems. Students engaged in a series of experiments using different communication and representational tools to develop their understanding of how the form of representation for a problem shapes the way we analyze and solve that problem. By exploring with different tools, students saw different dimensions of their problems, which included doctor-patient communication about a variety of complex subjects, including risks & benefits of genome sequencing, end-of-life conversations, and talking about socially uncomfortable topics.

Peter Killoran started things off with a narrative medicine + EMR re-design warm-up exercise, routed through two classics: IOM’s To Err is Human (1999) and Edward Tufte’s Visual Display of Quantitative Information (1992). We spent a lot of time talking about the role of storytelling in design, and then these incredible students went about prototyping (in about 90 minutes) consumer-facing EHRs that could also be useful to clinicians. The beauty of the non-expert approach was definitely on display, as these young creatives weren’t hampered by all the restrictive protocol (HIPPA, can you hear me?) and instead could concentrate on the core message: get the patient’s story into the EMR.

Later in the day, Allison Hunter ran the group through some eye-opening visual arts exercises in flow-charts and mood-boards. The next morning, I launched the group into a session on doing things with words. We did exercises on metaphor, simile, and analogy, both textual and visual. We also worked on point-of-view as a critical dimension of design. After a final session on storyboarding with Allison, students were tasked with a problem to solve using a set of tools (written, visual, moving image, audio), and at the end of the hackathon they presented their experience of experimenting and identifying which tool best helped them develop a solution to the problem.

This was a laboratory designed to generate ideas and strategy for the Medical Media Arts Hub, and my big take-homes included affirmation (again) that collaboration across difference is truly critical to engineering design, to medical problem-solving, and to tackling the wicked problems of the world; that art+engineering+storytelling is the answer to many problems; and that listening to future users’ needs is everything. Mind-expanding experience, and fun to boot. Next time, we’re taking it public, so stay tuned – we’ll be seeking local “wicked problems” to tackle soon!

Apr 22 2013

Culture, Design, Electronic Medical Record, History, Medicine

EMRs and the Problems of Diagnoses, Part 2

Guest post by Olivia Banner.

“Schematic Flow Chart for DIAGNO II Computer Program,” Robert Spitzer and Jean Endicott, American Journal of Psychiatry 125, 7 (1969): 15.

In a previous post, I wrote about Ted Gup’s critique of the current rush to organize human differences into diagnostic categories, which he published on the heels of the CDC’s recent report that 11% of U.S. children are currently diagnosed with ADHD (see “Diagnosis: Human”). It’s interesting to consider this critique in light of the DSM’s history, and in light of projects to automate diagnoses using computers, all of which produces some intriguing questions about the future of EMRs.

Some readers may already be familiar with the vagaries of how the DSM has treated “homosexuality” over the years: it wasn’t until 1986 that editors completely removed it from the DSM.

This is only one among many examples of how the DSM mirrors cultural attitudes toward the groups of “symptoms” it classifies as psychiatric disorders.

In the late 1960s, one of the DSM’s previous editors, Robert Spitzer, developed a computer program intended to automate diagnosis. Called DIAGNO, the program was envisioned for use during intake at psychiatric facilities. Spitzer’s basic premise was that, since clinicians employ a decision tree to arrive at a differential diagnosis, and software code also uses decision trees, a computer program could be equally if not more precise than humans at determining diagnoses. DIAGNO went through three versions as Spitzer fine-tuned it over the years, aiming for a program that could one day skip the clinical encounter altogether.

As far as I’ve been able to figure out, DIAGNO remained a dream that was never implemented; however, it’s interesting to note that Spitzer was building on other researchers’ programs to automate recommendations for which drugs to use to medicate specific disorders. One of these was used in the late sixties at the University of Texas Medical Branch in Galveston. (Please comment if you have any additional information on DIAGNO’s implementation!) The dream of automating diagnoses lives on, however, whether in technologies intended for use in the home such as SCANADU, which would diagnose medical conditions, or those for use in clinical settings. In the latter category we could include a fascinating project that attempts to integrate findings from cognitive science to help automate psychiatric diagnoses, so that diagnoses can be reached through a computer program analysis of a patient’s narrative (see Cohen et al., “Simulating Expert Comprehension”).

I wonder what Ted Gup would say about this latter effort. In this dream of a future where diagnoses are automated, his narrative about his suffering might, when analyzed by software, be diagnosed as a condition suitable for treatment. Do we want this future where computers can diagnose? What happens when EMRs are based on diagnostic categories that can’t reflect the particular exigencies of their historical moment that drive the diagnosis?

How does automating diagnoses occlude broader cultural debates about the diagnoses themselves? And how can we, as educators, best alert our students to these problems, even as we search for more efficient ways to implement new digital technologies into clinical practice?

Medical Futures Lab

Category Archives: Electronic Medical Record