Singularity University Future Med 2013 Autodesk Innovation Lab & Demos

I am just copying and pasting the whole page - endlessly interesting:

FutureMed has an Innovation Lab and Demonstration Room for participants and faculty speakers to use during the entire FutureMed program.

FutureMed 2013 Demos

Make rounds with the latest mobile telepresence robots from 9th Sense and AnyBots
Visualize realistic 3D anatomy with Anatomage’s amazingly interactive Virtual Dissection Table
Achieve better understanding of oral care behavior with BeamBrush, the world’s first app-connected toothbrush.
Experience the latest in high tech robotic surgery using the da Vinci Surgical System by Intuitive Surgical
Learn how Bespoke Innovations 3D Scanning Technology is changing the world of custom tailored prosthetics.

From Star Trek to Future Med, check out the new “tricorder” prototypes by MedSensation and Scanadu  – futuristic  devices that accurately measure body metrics and allow data to be transferred wirelessly.
Make DNA analysis and interpretation more accessible and less expensive by using the new DNA Guide Genome Browser for iPAD.
Turn your smartphone into a digital first aid kit with CellScope.
Learn how Ekso Bionics Exoskeletons can be used to augment human mobility and capability.
Check out Esteem, the world’s first and only fully implantable hearing restoration device that doesn’t rely on a microphone or speaker.

Take a look at GE Healthcare’s amazing Vscan, a pocket-sized visualization tool with ultrasound technology.
Check out the technology behind the Genome Compiler, the next generation of computer-aided design tools for synthetic biology.
Meet the folks at Health Tech Hatch, a company providing platforms for start-up fundraising, and usability feedback on healthcare concepts and prototypes.
Use Intellisense’s innovative new technology to measure data, to video-document research, or to measure soft touch, pulse, and pressure metrics.Learn about the latest in Deep Infrared Thermography and its current use in the early diagnosis of breast cancer.
Try out “m3d”, an intuitive clinical and biomedical search engine, now being billed as the new “Google for Healthcare”
Monitor your fitness with Lark, Larklife, & Lark-Pro, three cutting edge wearable health and wellness tracking devices.
Be the first to view the next generation of Ultra-Thin Flexible Endoscopes created by Lightscan Technologies.
Sit up and take notice with LUMOback, the smart, wearable sensor and a mobile app that provides feedback on posture and movement.
Take a close look at CATRA, a low-cost, snap-on, mobile phone eyepiece that provides precise maps of cataracts in the eye. 

Make first response safer, more efficient, and cost-effective using the MEDIVIEW cloud-and-client platform
Use the BrainBot brainwave headset to literally read someone’s mind.Capture, compare, and share medical images for easy analysis using CaptureProof
Learn how CliniCast’s ARTO enables providers to improve outcomes and reduce costs through predictive analytics.
Manage your HR benefits more strategically using Benefitter Exchange 

Improve your health with Prevent  – an online program that uses digital tracking, personalized coaching, and social support to promote healthy behaviors.
Learn the many ways that Moxe Health aims to improve access to care for the underserved.
Learn how Neural ID’s Intelligent Waveform Service uses data pattern recognition to streamline and improve research.
Use OncoSec’s Medical Electroporation Device to specifically target cancer cells during chemo and immunotherapy
Size yourself up with Poikos, a smart-device technology that can quickly and accurately measure your body habitus. 

Think you have an idea that can change healthcare?  Meet the team of Rock Health, a business incubator company with a long, successful track record in nurturing Start-Up’s
Not sure that rash is serious?  Take a moment to consult Virtual Nurse, an interactive new age application that helps triage your need to see a doctor.
Check out the latest in remote vital signs monitoring using the  ViSi Mobile® System
Learn how researchers, providers, and payers use genomics to improve medical outcomes using the Discovery Biomedical Data Platform
Use Inside Tracker to identify the nutritional, supplemental, lifestyle, and exercise interventions most needed to improve your health
Give your patients a personalized medical video using Telesofia Medical, a platform aimed at increasing patient compliance and reducing health care costs
Sequence your microbiome using citizen science with uBiome.
Get the benefits of a two-hour workout in only 20 minutes with Vasper System’s SA-1Learn how the Due Date Plus mobile health platform is making pregnancy healthier, safer, and cheaper.

p value less than 0.05

I received an email about a Research Integrity conference and checked out the keynote speakers. One of them was Dr. John Ioannidis. This lead to me to what I discovered was one of the most cited research papers out there "Why Most Published Research Findings are False". This article touched off a nerve or two in me, and eventually I will try and read it to at least a level of comprehension, because it is very mathematical. What struck me was the hypothesis that:

Several methodologists have pointed out [9–11] that the high rate of nonreplication (lack of confirmation) of research discoveries is a consequence of the convenient, yet ill-founded strategy of claiming conclusive research findings solely on the basis of a single study assessed by formal statistical significance, typically for a p-value less than 0.05.

I took courses in health research methodology and was taught how to read medical literature and the p value inherent in most of the journal articles always confused me.  I still don't know the significance of the p value, but this I know: it is not good if family doctors, relying on evidence- based medicine to prescribe innovative therapeutic drugs, are relying on these articles' conclusions and p values for their predictive value to help me. They should be relying on the gold standards of medical evidence: systematic reviews and meta-analysis - the highest forms of "unbiased" research. Atlantic magazine has a great article "Lies, Damn Lies, and Medical Science" (in plain English) about Ioannidis and this medical dilemma.

If you want to check out why I might be confused by what a p value is, check out this definition in wikipedia:

In statistical hypothesis testing, the p-value is the probability of obtaining a test statistic at least as extreme as the one that was actually observed, assuming that the null hypothesis is true.^[1] One often "rejects the null hypothesis" when the p-value is less than the significance level α (Greek alpha), which is often 0.05 or 0.01.

Although there is often confusion, the p-value is not the probability of the null hypothesis being true, nor is the p-value the same as the Type I error rate.^[2] A Type I error in statistics is the incorrect rejection of the null hypothesis. In this case the hypothesis was correct but wrongly rejected. In a Type II error, however, the null hypothesis was not rejected despite being incorrect. This results in the failure of rejection of incorrect assumptions.

The best place to learn about all of this is in one of the classics of evidence-based medicine by one of the authors who coined the term "evidence-based medicine", Dr. Gordon Guyatt, who teaches and does research at McMaster University:

Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice, Second Edition (Jama & Archives Journals) by Gordon Guyatt, Drummond Rennie, Maureen Meade and Deborah Cook (May 21, 2008)

Another McMaster Study about Health IT: The Renaissance Version!

So, I enjoy reading posts on the Kevin Pho MD newsletter, and I am not even an MD. The ehealth stories are often very interesting, like the one I am posting here. Now this article has 3 main characters:

1. The article by James Salwitz entitled "Why IT is the core of the healthcare renaissance".
2. An article mentioned by Dr. Salwitz by Stephen Soumeri and Ross Koppel on the online Wall Street Journal called "A Major Glitch for Digitized Health-care Reform".
3. A paper by McMaster University researchers entitled "The economics of health information technology in medication management: a systematic review of economic evaluations".

Please draw your own conclusions! My conclusion would be that the McMaster researchers uncovered a need for better economic assessments of healthcare technology, in order to really make a realistic appraisal. And I agree with Dr. Salwitz that looking back 5 decades is too long.

And this isn't the only research that has cast aspersions on the benefits of eHealth technology. A study on PLOS last year, that was almost polemical in tone, blew the doors off of that "The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview"
"http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000387

Why IT is the core of the healthcare renaissance

JAMES C. SALWITZ, MD | TECH | DECEMBER 11, 2012

Warning!  I am a practicing doctor who sees real patients using an electronic medical record (EMR).  My sole agenda is to provide the best patient care.  I have no financial stake in information technology (IT).  However, unlike the editorial board at the Wall Street Journal, Mr. Stephen Soumerai of Harvard or Mr. Ross Koppel of the University of Pennsylvania, I have actually used digital patient records for over a decade and I have news for them;  EMRs work.

In a reactionary opinion in the WSJ entitled “A Major Glitch for Digitized Health-Care Records,” the authors expanded to the point of silliness the conclusions of a review of healthcare IT by McMaster University.  The McMaster analysis abstracts data from 36000 studies over five decades of healthcare IT and concludes that computerization has yet to save dollars nor improve health care.  WSJ editorialists proposed that the concept of a common medical database has “already failed” as is “common knowledge.”  While they portend to “fully share the hope” in the success of a computerized healthcare system they express doubt as to “why are we pushing ahead to digitalize.”

The question is so ridiculous as to barely require an answer.  We are pushing ahead to digitalize because the healthcare industry, which is 18% of our GDP, is the last major industry to go electronic.  Despite how critical medicine is to our citizen and nation’s vitality, health care is most often documented with paper and ink.  Can you imagine any other industry where this would be acceptable?  Would you go to a bank where they use a hand-written ledger?  Travel on an airplane without GPS, fly by wire technology or a minimum of three computers?  Do you yearn for rotary phones?  Credit cards left paper money behind decades ago and will soon move on to the next phase, pay by smart-phone. The world is digital and one of the core problems with medical care is its failure to follow.

The average doctor writes his notes on parchment and scribbles orders on contact paper.  He wastes time writing prescriptions by hand that cannot be read and will produce unneeded drug interactions and side effects.  The data on billions of health care events cannot be mined, monitored, analyzed or improved, because it is not digital.   Millions of hours are wasted, billions of dollars vanish and tens of thousands die because of preventable medical complications, the result of massive variation in quality and safety.  We are doomed because we cannot access or evaluate most medical care data; “If you can not measure it, you can not manage it.”

Taking health digital is key to fixing and affording care.  Standard, unified medical records will significantly decrease the risk of providing unneeded or dangerous medical care.  Massive efficiencies will result by reducing duplication, speeding communication and reduction in waste (and fraud).  Critical improvements will follow the use of guidelines to study clinical databases and drive quality. This means that whether one lives in Manhattan, in the mountains of Tennessee or potentially deep in Africa, the finest care will be possible.

How do I know this to be true?  Our practice of seven doctors and three nurse practitioners was an early EMR adapter.  We put in our first basic system in 2000, upgraded three times and have been fully electronic for four years.  This has resulted in marked efficiencies and obvious quality improvement. Encrypted electronic records cannot be lost, are unlikely to be stolen and are always available from anywhere.  Ordering tests is instantaneous, as is reviewing results, organizing treatments, scheduling appointments or communication with outside health providers. On the cost side we reduced non-clinical staff by more than 50% and in an account receivable analysis our billing cycle dropped more than 60% and bad debt fell to low single digits.

Today in the office, I saw four new patients.  Without assistance of clerical staff and without leaving my desk I reviewed their entire surgical, laboratory, pathological, and radiologic records.  By the time, I entered the room to meet each of them a significant part of their medical history was entered into our EMR, based on outside records, so that the care and observations of previous doctors was not forgotten. Half way through each visit documentation of their history and physical exam was complete, leaving more time to talk with each patient.  Tests were ordered, treatments scheduled, disability letters printed, medications e-scripted, instructions created and follow-up appointments setup.  The patients were given codes to electronically access their records from home.  Letters were sent online to referring doctors, as well as any clinicians we were consulting in that patient’s care.  Billing was complete before each patient got to the parking lot.  Such is the power, efficiency and quality of electronic medical records.

This is just the beginning.  Although EMRs now provide assistance with basic medical care, such as scheduling flu shots, identifying drug interactions, and health screening reminders, future systems will use academic information to assist the doctor in making diagnoses and planning treatments.   Seamless with the EMR will be computer augmentation to create differential diagnoses and recommend treatment alternatives.  In oncology alone there are almost 50,000 articles published each year; Artificial intelligence integration with the clinical EMR will help every doctor penetrate that massive database on a continuous basis as it applies to individual patients.

So, why does the McMaster study not show this obvious benefit? It comes to four factors. The first is the “five decades” of study reviewed by the Canadian authors.  Since most doctors did not start adapting EMRs until 3 years ago, that leaves 57 months of irrelevant data.  Second, we have not reached the critical mass to achieve broad system efficiencies, as hospitals and doctors are still figuring out how to incorporate the technology into their daily practice, and less than 50% of health care providers have converted to EMRs.   Third, we do not yet have a universal common database for medical records. This is a complex technological step, which has been achieved in major industries such as banking, but still must be assembled in medicine.  Finally, as was correctly stated in the WSJ op-ed piece, present EMRs are cumbersome, immature, and several generations short of perfection.  However, these are expected problems when implementing disruptive evolving technology in the complex changing health market. Challenge is a weak argument for giving up and bringing back the fountain pen.

I am not certain what the goal of Sommeri and Koppel was in writing this piece, they offer nothing but “hope.”  The WSJ has been a strong supporter of business technology leading the drive towards quality, and has long recognized the positive contribution of IT to industry.   Those of us in the trenches, putting EMRs in place, ironing out the kinks, know that electronic medical records are now and they are the future.  With IT at the core of the healthcare renaissance we can make medicine cost efficient, producing quality second to none.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

Image credit: Shutterstock.com

Tagged as: CANCER, HEALTH IT, PRIMARY CARE

Father of medical informatics, Utah’s Homer Warner dies

In my eHealth studies I had not heard of Homer Warner, but I did hear about Intermountain Healthcare in Utah, where Warner was working, because they did a lot of advanced EHR informatics using HL7.  This story about how he came to use computers in the study of cardiology was fascinating.  

http://www.sltrib.com/sltrib/news/55391911-78/warner-medical-utah-homer.html.csp?page=1

Father of medical informatics, Utah’s Homer Warner dies

Groundbreaking work of cardiologist is still redefining medicine.

By Kirsten Stewart

| The Salt Lake Tribune

First Published Dec 03 2012 04:49 pm • Last Updated Dec 04 2012 08:09 am

Homer Warner, a Utah cardiologist widely recognized as the father of medical informatics, died last week from complications of pancreatitis. He was 90.

Warner’s research is still redefining medicine, colleagues say. Modern intensive care units can be traced back to the electronic systems he built to monitor heart patients in the mid-1950s. And his creation of one of the first electronic medical records in the ‘70s set the stage for a new academic field and multi-billion dollar health IT industry.

     

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At a glance

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Funeral services

A public service will be held at noon on Thursday, Dec. 6, at the Foothill Stake Center, 1933 S. 2100 East in Salt Lake City.

In lieu of flowers, the family suggests donations to the Homer R. Warner Scholarship Fund in Medical Informatics at the University of Utah.

Online condolences may be left atwww.larkincares.com.

He had the mind of an intellectual and the soul of an adventurer, captivating University of Utah medical students in a speech just weeks before he died, said his son Homer Warner Jr. "He just had a quiet magnetism about him."

Warner checked into a hospital complaining of stomach pain before Thanksgiving, said his son. He died Nov. 30, about a week later, surrounded by friends and family.

A graduate of East High School, Warner earned his medical degree at the University of Utah in 1949 and then earned a doctorate in physiology from the University of Minnesota. While training in Minnesota, he worked at the Mayo Clinic with cardiologist Earl Wood, who spurred his interest in medical research.

He returned to Utah, where he opened a Cardiovascular Laboratory at LDS Hospital and studied waveforms as a potential path to diagnosing heart patients.

"His real genius was probably in that early work," said Homer Warner Jr. While taking an engineering math course to further his work in 1956, he once stayed up all night to analyze one heart beat using a 3-foot slide ruler.

"I got so excited because it was such an interesting way to look at things," Warner told Peta Owens-Liston, a freelance writer for the U.’s alumni magazine, in 2010. "This was a turning point for me, since it led me to the whole concept of using computers in medicine."

After the U. bought its first digital computer in 1960, Warner worked with graduate students to develop a tool to effectively diagnose congenital heart disease – but doctors were skeptical, he told Owens-Liston.

Two years later he became the chairman of what is now considered the first program to grant degrees in medical informatics. Then called the Department of Biophysics and Bioengineering, it was located in the U.’s engineering school.

In 1968, Warner wrote his first version of a software program to evaluate patient data to guide physicians. He had been inspired by seeing an Intensive Care Unit nurse overwhelmed by information from sensors.

"The venous pressure was rising, the arterial pressure was going down, and the cardiac output was dropping, and she didn’t know what to do," Warner told Owens-Liston.

As the HELP program, for "Health Evaluation through Logical Processing," was further developed, it expanded to include information about drugs, lab tests, pulmonary function testing, patients’ medical history and more. It is now considered one of the nation’s first electronic medical records – and is still operational 40 years later at Intermountain Healthcare hospitals.

"We clearly had a jewel. He gave us a huge advantage," said Intermountain’s Chief Information Officer Marc Probst.

Getting doctors to use computers is still challenging, but Warner chipped away at their resistance by providing them with not just data, but information with the power to improve care, he said.

In a 2011 announcement of the opening of the Homer Warner Center for Informatics Research at Intermountain Medical Center, the hospital chain’s chief quality officer, Brent James said, "Dr. Warner identified the field and then defined that field...It’s hard to describe that contribution, not just to Intermountain, not just to the medical profession, but to the patients that we serve."

Warner’s lab was moved to the U. in 1980 where he continued his research until retiring in 1996. He outlived two of his wives, Katherine Ann Romney and Jeanne Okland, marrying a third, June Okland Cockrell, who survives him.

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eSight - another Startrek spin off?

I read about this story in the local newspaper because a local person was one of the first to try the eSight goggles, and could see her husband's face and her two kids' for the first time very clearly. Turned out she liked what she saw, which is a good thing.  The technology behind eSight is company of people who I recognize because I used to work (on the margins at least) of Ottawa Silicon Valley.

eSight

eSight Corp is an early commercial stage privately held company that has developed intelligent video eyewear for people challenged by degenerative eye diseases.  We are primarily focused on eSight Eyewear – assistive technology that helps people with low vision lead more independent lives at home and at work.

Click here to find out more.