Category Archives: Medicine

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

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.

EMR vs. EHR: What does it really mean?

One of the topics that we have discussed on varying occasions throughout the semester is electronic health records (EHR) and how they interact with and effect patient care. In my own groups work with our problem owner in the CV ICU, interaction with the EHR has been a large part of developing a solution. As I have continued to work with and research the present systems, I have noticed, both in the classroom and in the hospital environment, an inconsistency in terminology used to refer to the records. From what I observed, the terms electronic medical record (EMR) and electronic health record (EHR) are often used interchangeably. Curious, I looked to see if there was an actual difference between these two records and how they are involved in medicine.

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Google Trend Data Tabulating Searches for “EMR”and “EHR”

Though these terms are often used synonymously, there are marked differences between EHRs and EMRs and how they are used within the medical field. My research led me to discern that the term EMR refers to essentially a digital version of the paper charts that they replaced. These digitalized systems contain a patients medial and treatment history specific to a doctors practice and posses the ability to allow caretakers to track data over time, identify which patients are due for screenings or appointments, and monitor quality of care within the practice. The largest difficulty when using EMR is transfer of information out of a physicians practice, and in that sense does not improve significantly from a paper record.

So how do EHRs differ from what I have just described? The key difference between an EMR and EHR is the focus of use. As described by a variety of sources, an EHRs functional aim is to address the total health of the patient, going beyond the original health organization to encompass information from other health providers including laboratories, specialists, and most importantly the patients themselves. The ability to share information in a secureway throughout all aspects of patient care creates the possibility for interactive communication and the meaningful use of EHRs as a tool to improve patient care.

Overall, what I found is that while the terms EMR and EHR only differ by one word, that small change makes a world of difference. The engagement and commination opportunities that the EHR provides, makes a case for the use of these systems exclusively. A push for providers to engage patients through their access to the EHR system has occurred in recent years, but is this engagement really effectual and beneficial to patient care? With an estimated 77 million Americans that possess either basic or below basic health literacy, are EHR systems providing accessible and useable information to patients to improve their care or are many patients just getting lost in the process?

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To answer that question the Agency for Healthcare Research and Quality have examined health education materials delivered by EHRs and have determined that many do not often account for the poor health literacy possessed by a large amount of the population. So what can we do to make EHR systems more useable for patients and improve care outcomes?

A number of leaders of Health IT have begun address this disparity by suggesting a list of preliminary standards and key tools designed to be incorporated into the existing and new EHR systems. A number of simple changes to improve direct communication with patients include providing patients with the ability to identify their preferred language. Other functions including the ability of EHRs to filter quality measures by patient characteristics such as language, socioeconomic status, and education level, could work to reveal and address disparities in care, including those involving health literacy. In addition to providing better resources for patients, having EHRs include information such as disability status, sexual orientation, or gender identity can provide caregiver a greater context regarding a patient’s health recommendations and outcomes. While these changes serve as the initial push in addressing functional and health literacy changes to EHRs, there are still ways to improve the educational value of the interactive system.

What other innovations could be incorporated into EHR systems in improve health literacy?

Instant Access to Yourself

With our constant obsession with technological advancements and the fashionable desire to be the first owner of the newest products, we must remember what we already have.  And this isn’t just a banal platitude about being grateful for what we have.  Even though the answers to the world’s problems seem to lie in the continued miniaturization of sensors and further embedded systems, have we forgotten what is already available to us?  Perhaps we should shift the focus from finding the most sophisticated devices to becoming more proficient with what already exists.

In the summer of 2013, I took a psychiatry course at the Geffen School of Medicine at UCLA.  The course had the rather grandiose title: “Personal Brain Management,” yet that was exactly what the physician taught.  It turns out that by having a greater control of what we think and how we think can protect us from a wealth of illnesses.  The only technological advancement I needed to supplement my project was a thermometer, yet that was enough.

Photo Credit: stress-relief-tools.com

My independent project focused on utilizing biofeedback for Mindfulness-Based Stress Reduction (MBSR).  MBSR advocates that practicing mindfulness meditation can help reduce stress and promote greater mental and physical health.  By using a simple stress thermometer, I was able to increase my awareness of my body temperature.  While such a physiological marker may seem to be beyond our control, managing our internal thermostat is surprisingly possible. Roughly speaking, more relaxed states are correlated with increased body temperature, and the thermometer served as a means to quantify these changes.

With just a crude thermometer in hand, I was able to cultivate my relaxation response (in contrast to the familiar stress response).  At the end of a six-week trial, I found that I was better able to control my body temperature, and I scored significantly lower on a battery of stress measures.  For my project, I did not need a smartphone or the newest Nike product or the most sensitive sensors.  I needed myself and 30 minutes of my day.  And am I really so important that I cannot sacrifice the entirety of 30 minutes to myself?

Photo Credit: clintonpower.com.au

In our constant and desperate search for what is new, let’s not forget that we have instant access to ourselves.  While innovative electronic devices can help us organize data and take measurements, let’s not get carried away with their seemingly whimsical promises.  It is as much our duty to discover and invent as it is to make more effective use of what already exists.  By remembering that the first generation of iPhones was released in 2007, we become aware of the humbling reality that perhaps society can function without a supercomputer in hand.

While simple and sophisticated mobile health applications can encourage patients to become more empowered, decreased reliance on digital technology is in its own right just as empowering.  My project at UCLA showed me that I could become more self-sufficient and cultivate my body’s natural capacity to heal with a minimalist approach to technology use.

Taking Heart Transplants to the Next Level…But Should We?

This is so crazy how relevant this is to our project, but I saw this news story shared on my Facebook newsfeed: Link here because I can’t embed the video for some reason.

While we’re working on telling the story of artificial hearts in the Texas Medical Center, at the same time researchers in the Texas Heart Institute right here in Houston are taking heart transplants to the next level. Bypassing even a total artificial heart transplant, they are now using stem cells to manipulate pigs’ hearts into hearts that can work in humans. In the video, you can see so far they have successfully been able to transforms the cells the pig’s heart into a mold of a human heart and the next step is to insert cells inside the heart so that it will properly perform the pumping functions. It was crazy how the reporter was able to hold this modified heart (still white from being grown by stem cells) and squeeze it like it was a toy.

However, the meat of the piece started when the reporter started questioning Dr. Doris Taylor, the head researcher, on the ethical implications of conducting this stem cell research. I was surprised at how quickly Dr. Taylor defended her work, probably because this was a commonly asked and attacked question. Instead of thinking about the lives that may be lost by using stem cells, she reasoned that because she had the ability and the tools able to save lives, even if those tools were stem cells, it would be “morally wrong not to go forward using those tools”.

I noticed in this video how they utilized emotional (ethos) and moral (pathos) appeal to convince the viewer to support the stem cell research. The beginning of the news piece features a young woman who, suffering from a terminal heart disease, waited and eventually received a traditional heart transplant from a dying man. I was kind of confused at first because I thought the news piece was going to be more of this young woman’s story but instead turned into a news story about stem cell research. However, they brought her back at the end of the piece and asked her if she would support someone getting a heart made out of stem cells, and with tears in her eyes, the patient talked about how lucky she was to get a heart and how if it was possible in any way for others in need to get the same she was all for it. Now, I do have my own opinions about whether it’s morally right to conduct stem cell research and I won’t be sharing it here, but to me it was an obvious storytelling tactic to get viewers to sympathize and support stem cell research.

The concept of ethical conduct in research and treatment has been an ongoing issue for the physician. Dr. Akers faced similar concerns and backlash when he performed testing of artificial hearts on animals and in society today the hot topic is the consequences of using stem cells. I am not a medical student, but I have heard that when a student first enters medical school they must recite the Hippocratic Oath that states they will vow to take care of the patient as best they can and do no harm to them. But for the physician (and the government), is the best way possible a solution that involves stem cells and should stem cell research be considered unfairly taking a life from another to save someone else? Or is it indeed is morally wrong not to use whatever means possible to save a person’s life?

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