Thinking about Dementia

Thinking about Dementia

by | Dec 27, 2022 | Healthcare

Unfortunately thinking about dementia is not too difficult for most of us – having seen the impact in our families and/or close friends. Just listened to a series of three podcasts published by The Conversation.

I was familiar with the ideas about Alzheimers – build up of plaque/ tangles in brain (amyloids, tau). And had read recently about some exciting developments in terms of drugs which may slow down development of Alzheimers.

But found the podcasts very interesting on a number of fronts (as a layperson);

  • Potential relevance of education and socio economic background to onset of dementia
  • Possible relevance of untreated high blood pressure during peoples’ 30s and 40s
  • Research of Common Cold Sore Virus (HSV1) as a possible cause/ instigator of Alzheimers
  • Impact of sports injuries/ concussion – CTE (Chronic Traumatic Encephalopathy)
  • Typical clinical diagnoses for Alzheimers
  • Views of a range of researchers in US and UK

Unfortunately seems like we are going to have to live with Alzheimers and other forms of dementia for some time – and will be more prevalent as the population lives longer. But as one of the researchers reminds us – so little progress on cancer for so long and now we are seeing personalised medicine in cancer treatments. Hopefully we will also see breakthroughs of significance in field of dementia in next few years.

Thinking about metaverse for healthcare

Thinking about metaverse for healthcare

by | Dec 26, 2022 | Healthcare, Disruption

metaverse
Thinking about metaverse for healthcare 2

When I read Tom Coughlins’ thoughts on the metaverse, some of the challenges and opportunities, I can’t but compare this with hospitals operating a hybrid of paper based and electronic healthcare records – and what the metaverse for healthcare would mean. The world has move on – so far. Belated implementation of old fashioned software is not digital transformation – and is not positioning healthcare to move forward and leverage the opportunities presented by the metaverse.

In this discussion Coughlin considers some of the challenges in terms of access, connectivity e.g. if trying to accommodate 5,00 people from multiple devices in a concert type situation.

Clearly, from the bets being made by Meta, Mark Zuckerberg thinks we will solve many of these technical challenges.

Interesting comments also about the car industry – KPMG suggesting that >50% of the cost of electric cars is semiconductors. I have just finished reading ‘Chip War‘ – FT business book of the year. I think it should form part of basic courses in economics, social science, engineering. Amazing to see the role being played by this industry across the globe.

This piece from venturebeat well worth a read for anyone getting over excited about implementing an EHR solution in 2022. If we want to serve a public in the metaverse need to throw out some of the old thinking and reinvent ourselves.

Where is my electronic medical record?

by | Jun 19, 2022 | Healthcare

In the absence of an electronic medical record (of my own) where is my medical data?

Many doctors, dentists, physios, pharmacists and others

Thinking back over my life to date there have been many medical consults. Lots of diagnostics. How do I bring my doctor or physio up to date quickly on my medical history?

I would consider myself reasonably healthy. I’ve really only had 3 or 4 general practitioners over my life time. I have had consults with ortho, cardio, uro, neuro and general over the years. I have had multiple diagnostics – MRIs, Xrays, Ultrasound, barium meal, blood tests – perhaps others. Trips to ED as a result of skiing, car accident, rugby, cycling. Lots of physio (multiple practices) – back, hamstring, ankle, tennis elbow – massage, dry needling, acupuncture. Perhaps three dentists – fillings, extractions, cleaning. Multiple pharmacists for various prescriptions including anti-inflammatories, antibiotics, pain relief. Minor operations under general anesthetic. COVID vaccinations. Various vaccinations prior to visiting various international locations. And that leaves out being born, jaundice as a kid.

Sharing the data – my medical record

It just doesn’t really happen the way you would like. There are probably four physio practices with separate records with respect to my back condition. And at least two orthos and one neuro in different hospitals – with various data. And my current GP would have some of this data. To say nothing of what exists in the various hospitals or diagnostic clinics I may have visited re my back.

In other instances consultants have requested blood test results – which had previously been ordered by a GP. They may have been emailed to me and from me to the consultant or from the GP to the consultant. And, presumably, the various consultants also have notes with respect to my various ailments. And, if the system works, some or all of these notes may have made it to my GP (via post

Then there is the data I record myself e.g. daily blood pressure records or weight or sleep patterns. Or records I may maintain in apps such as ‘patientslikeme’.

What would good look like?

In the first instance I would have an electronic medical record – owned by me. And I would use this record in interacting with any medical provider.

Not going to happen retrospectively for me. But what about people being born now and going forward? What would be the benefits? What would be the challenges, obstructions, risks, down side? Who would pay for it?

The right data should enable more efficient medical care, more personalised medicine, improved diagnosis and treatment. But this would require consistent data capture, ease of access, security over access. And, of course, willingness (or legal requirement) of providers to provide data in acceptable electronic format.

In this scenario a 45 year old would have a very detailed personal medical record – detailing all interactions with medical providers over her lifetime. And this should serve to enable the 45 year to interact more effectively with future advisors. There should also be a method whereby the 45 year old can share anonymised data as she sees fits with various research entities.

Where next?

I think we have to accept that all of the providers will continue to have their own systems and processes – designed to enable them to run their provision of services optimally for them. In general, with some notable exceptions, there is an acceptance by providers that they require electronic records – that paper charts no longer ‘cut it’.

I have commented previously on the need for EHRs in hospitals (but the conflict as to who really owns the data). Individuals will require their own medical record. This will require specialist companies who will assemble these and maintain them on behalf of individuals. I think the likely scenario is a paid service that an individual subscribes to – whereby the provider will set up and manage the individual’s personal record. These entities will probably liaise directly on behalf of their customers with the providers of health services. On behalf of patients they will provide access to relevant data and receive back additional data from the providers.

Possible disruption

Were this model to succeed this may lead to significant disruption in the market place – with patients having much more influence in the market place through these companies. A comprehensive electronic medical record will change the game. But better data should ensure more efficient service delivery. And such systems should support improved research.

Consumer strategy in healthcare – easier and less expensive

Consumer strategy in healthcare – easier and less expensive

by | May 14, 2022 | Disruption, Healthcare

Great podcast recently on healthcare rap focused on consumer strategy in healthcare.

Thinking about a consumer strategy in healthcare

Was particularly interested in contributions of Craig Kartchner of HonorHealth and his thoughts in his role as AVP Marketing and customer experience.

Patients love their doctors and doctors – from their perspective – have been patient (read ‘patient’ for ‘customer’/ ‘consumer’) focused from the word go. Craig thinks of the patient as a customer (or potential customer) before and after the patient experience – and he wants them to be a repeat customer. The doctor may see a monogamous relationship – the customer will have multiple relationships.

Improving customer experience

Some ideas:

  • Research where we are failing – in the before and after experience (We need to accommodate their needs and wants for entire journey – not just sitting in front of physicians)
  • Streamline access to care – when, where, how, speed
  • Improve care navigation – multiple systems, multiple visits, multiple tests, different sets of instructions
  • Simplify patient communication – ability for patient to communicate with clinical, financial, administrative – too complex, too slow, too unpredictable
  • Don’t let the tech get in the way of humanity/ empathy – patients want to be there for their kids/ their grandkids – may need a shoulder to cry on

Where can tech help?

Lots of ideas – leverage what you have:

  • Online scheduling
  • online wait lists – automatically offer appointments as they become available
  • eCheckin – avoid queues/ delays
  • telemedicine/ telehealth – avoid the trip
  • asynchronous care – complete electronic form and provide initial diagnosis

Challenge/ opportunity

Consumers (patients) are not interested in our complexity – they want it to be easier and cost less. Do we really understand what drives consumer thinking and decision making – to select a particular service or no service at all?

If we are to move to a focus on keeping people well we will need to build out better relationships. Intelligent outreach to patients, better care plans, people are more likely to follow treatment plans and in turn this will keep people out of hospital.

Medical Extended Reality (‘MXR’)

by | May 3, 2022 | Healthcare, XR

Great podcast on Faces of Digital Health last December addressing VR and AR in Healthcare i.e. Medical Extended Reality

MXR per Rafael Grossman – ‘augmented reality where you have an interactive connection with the digital content over the real world for a medical application of some type’ – can be applied in surgery, training and other areas in medicine.

Now seeing Virtual Reality as another medical tool – not just diagnostics; opportunities to immerse yourself in the data more therapeutic uses for VR – impacting surgical procedures. Other applications in mental wellbeing, mental disorders, PTST, Depression, Anxiety

Jennifer Esposito

People now understand difference in VR and AR – and the use cases for both. Lots of use cases now in surgery. Training and education are ‘no-brainers’ – but more complex surgical applications likely to deliver real results.

Aaron Gani (BehaVR)

Great mission: ‘liberate the world from fear and pain’. Focused on VR. Demonstrated power of VR for Exposure (PTST, Anxiety), Movement, Focus with absence of distraction (e.g. mindfulness practice). Global market developing for non pharma therapies.

Thoughts on XR – listening to this podcast

What really caught my attention was: ‘How do we take things that are well understood and demonstrated to be effective in a live analog setting between therapist and patient or maybe have been digitised in a 2D manner. How do we translate to something where we are working in an immersive medium where we can get all the digital benefits of standardisation, repeatability, personalisation, lots of data collection, closed loop of your reaction driving the experience itself while we’re doing an immersive medium where movement in involved and the brain is engaged differently, literally’.

Yes – there are challenges: need mor clinical studies/ research, comparative assessment capabilities across the industry, additional education/ talent e.g. thinking about how to maximise use of 3D. Lots of smart people with no real understanding of why XR is transformative – thought this is probably true for lots of people who have not experienced the online games world.

New technologies are enabling advances in XR – AI and Edge computing. AR brings lots more data – how to integrate with other data and what does this mean?

MXR (VR/AR) is just a new way for medicine to interact with the digital world.

Like this comment ‘2D pane of glass is not the end game’. And if you watch this video on YouTube, to paraphrase the patient: ‘if my world is 3D why should medicine stop at 2D’?.

Medication Safety

by | Sep 29, 2021 | Healthcare

Recently listened to a ‘Faces of Digital Health‘ podcast from 11th August with Lea Davis (former Medication Safety Pharmacist at Perth Children’s Hospital – addressing medication safety. Interesting perspective on role of electronic health record and technology in medication safety. It is not difficult to see how electronic records and systems can assist healthcare staff in improving patient safety.

How do overdose errors happen?

Interesting observations by Lea Davis: All nurses, doctors, pharmacists busy – checking lots of charts, sometimes lack of knowledge, sometimes checking books, sometimes decimal point goes in the wrong place, sometime doses are transcribed from one sheet to another, if not checking back to references may not pick up the errors.

What is the role of technology in improving medication safety

Keys to success included a clear vision and strategy of the systems hospitals wanted to bring in, the problems they were tackling and the type of data they wanted to capture. Best practices related to vision, funding, implementation and not just technology, automation, robotics. Solutions include scheduling, management of systems, closed loop medication management (scan barcode on a package to verify that the does matched what was prescribed).

Integrity of information on medication management is related to the biggest clinical system (EHR/ EMR – including community medicine records) – with this you will have less errors. When you look at hospitals who do not have the budget for this – then major efforts required to integrate the patchwork of systems (a lot of work and time, interoperability challenges). More recently developments in HL7, FHIR, open systems are simplifying some of this integration/ interoperability. Benefit should be less burden on doctors and executives in safe patient care.

Future of patient safety and technology

Patients to have tools to better manage their own care. Reduce fear for patients. Able to be treated more often in their home environments. Patients to have more of a say in how the information looks as they transition through their care journey.