July 19, 2013
This post originally appeared on Health Works Collective.
One of the hottest trends in technology today is the Internet of Things or IoT. IoT was recently featured on the cover of Wired magazine for an article titled, “Awake: Welcome to the Programmable World.” The article begins, “When the objects around us can talk to each other, the elements of our physical universe converge and spring to life.” (Wired, June 2013 ).
The authors point out three stages for the IoT:
1) There need to be more devices on the network, everything from sensors to devices with embedded wireless.
2) The devices must coordinate with each other without human intervention.
3) Connected devices become ubiquitous, a programmable platform.
So is this just a techie dream born out of science fiction? And what is its relevance to healthcare?
There are several ways that hospitals are already part of the IoT. One big advance is smart IV pumps and their impact on patient safety. Not only can doses be preset, but the pumps can communicate with electronic medication administration records (eMAR) and bar code technology making them intelligent infusion devices. The use of robotics in hospitals continues to grow. Robotic-assisted surgery isbecoming widespread if not controversial . Other uses of robots include, “packaging drugs or delivering lab results, and telemedicine-based technologies that connect clinicians and patients in ways that previously didn’t exist”. Radio-Frequency Identification (RFID) is being used to track assets, such as, IV pumps, which can be difficult to find in a busy hospital or even hoarded. Others are using RFID to track medications administered to patients.
Another trend is the use of unique imaging technology, such as, Wireless Capsule Endoscopy, or camera in a pill, where the patient swallows this device and it moves through the GI track taking pictures as an alternative to the tube-based endoscope. (image at right from GIHealth)
It is only a matter of time, as these technologies mature and become ubiquitous, that these devices will begin to talk to each other and inform care throughout the hospital.
At the same time, the IoT is available to patients. The Quantified Self movement believes in monitoring many body functions from blood pressure to sleep and more. This is becoming fertile ground for innovation and startups are offering more consumer devices every week. One recent example is the Scanadu Scout that allows you to quickly check your vital signs by placing the device on your temple. (image below from Scanadu) David Pogue of the New York Times wrote a review of many devices which promote health from companies like FitBit, Nike, Jawbone and Flex. But he also critiques them for lack of Bluetooth connectivity in some cases or less than adequate user interfaces.
It is still early in the development of personal health devices for them to talk to each other or to larger systems through the Internet. In the area of telehealth, there are many devices and systems providing home monitoring of the chronically ill. These can provide an alternative to frequent clinic visits or visits by home health services when the data is reliably sent to the provider and algorithms are available to flag warning signs. The Veterans Administration is moving forward with an extensive program of telehealth to serve veterans everywhere.
Finally, there is the rare startup that is focusing just on the IoT. One company out of Cleveland has even taken on that name, iOTOS. They have developed hardware, a wireless device, which can be imbedded in all kinds of devices which is tightly integrated with their proprietary software platform. iOTOS is just beginning to look at healthcare applications of the device/software from diagnostics to home monitoring. Because it is cloud-based, the devices can display data through mobile devices. (image below from iOTOS)
In conclusion, the Internet of Things is creeping into healthcare, almost unnoticed. But the ubiquitous nature of IoT makes it self almost invisible to humans. Both in hospitals and at home, the possibilities are endless. Although we are early in the maturity of this technology as noted by the Wired article, we will soon connected devices become ubiquitous, a programmable platform, with medical devices talking to each other while improving care provision and our personal health.Share this:
July 10, 2013
Here are some major advantages:
- hands free browsing and video/photos
- lightweight and minimally intrusive
- can look at someone while browsing or during a hangout rather than looking down at a cell phone
- many possibilities for uses in healthcare and medicine – see this article from iMedicalApps. One additional thought – how about physicians receiving alerts on their patients’ lab results via Glass
- camera quality is excellent
Some downsides or challenges for developers to fix:
- dependent on open wireless networks or activating your phone as a personal hotspot ($$$$$)
- messages, searches and alerts limited to short text – considering the scale of the device, not sure how much more we can expect. If there is something that requires more detailed attention, we are at least alerted and can view it on a laptop
- especially in healthcare, privacy concerns since one can take an image of anyone without their permission. Maybe the device should have a small light indicating that a recording or photo is being taken
- If you are close to someone who also has Glass, their device might follow your verbal commands, “OK, Glass”. This actually occurred during my orientation
- Availability of prescription Glass
Most of these are easy to solve. The challenge is using this new technology in healthcare, developing apps, use cases and broader adoption.Share this:
July 9, 2013
On day 3, I brought Glass to work and introduced it to my staff and others at the hospital. Unfortunately, I could not connect to the internet thru Glass. The private wireless network did not allow a connection from the device and the public network requires browser authentication (like many airports and hotels) which is not possible in Glass. So the main demo was videos and photos I had already taken and demonstrating how to take photos and videos or having Glass read aloud alerts, such as, those from the New York Times.
So what applications are there for medicine and healthcare for this device? Already there are many ideas coming forward:
- “Google Glass makes some people uneasy, but a medical app that tells folks how to perform CPR not only could save lives, but also highlights what’s so awesome about our connected, sensor-rich future.”
- Google Glass Invades Social Media With #ThroughGlass
- Chloe Glass – a simulator wearing Glass to evaluate medical practice in training
- Use of Glass in surgery
- How Google Glass Is Changing Medical Education
- Glass on hospital rounds
July 9, 2013
Day 2 was spent at home trying it out on my home network and showing it to neighbors. I was becoming more comfortable with using and wearing it. The hands-free aspect of Glass does have a freeing sense.
Sunday I discovered that a flood of NY Times alerts came through. Fortunately, Glass with read them to you if you like (headlines only). Also tried a Google search which resulted in a Wikipedia entry for some (first line) which was more or less relevant to my request. Since I don’t routinely use Siri or Google Voice, my proficiency with voice to text was lacking but this is something that could improve with practice.
Also attempted a video call to Lucien Engelen in the Netherlands. Unfortunately, it was choppy and the screen froze for both of us at times. Not sure if that was Glass, as I moved around the house trying to maintain the wireless connection or the speed of my wireless network or the international connection. Another item which would require more trial and error, common with adopting new technology.
Someone pointed me to this video by Sergey Brin at TED which starts with the intro to Glass and then his statements of the purpose of Glass – to move us away from staring down at our phones and again facing our fellow human beings while staying connected to the world. Interesting concept. Would like to see some human factor researchers do a test of highly connected people using a mobile phone vs. Glass.
Two examples of videos taken Saturday in NYC
These 20 second videos are easy to do with a voice command.
More tomorrow on potential applications in healthcare.
July 7, 2013
Today I went
to Google New York to pick up Google Glass. I arrived at Chelsea Market in southern Manhattan. On the 8th floor is the headquarters for Glass on the east coast. We were issued guest tags The setting is loft-like with a small bar (we were offer drinks) and sat at one of several tall tables on stools with a mirror.
After an extensive orientation, I was ready to try them on my own.
Right next to the Chelsea Market is the Highline. Tired out photos and video which both worked well.
As I was warned that unless you are connected through the MyGlass website to an available wireless network or an open network that does not require authentication. The other alternatives is to connect through your phone’s bluetooth or better yet, enable your phone as a wireless hotspot, but that is an additional cost.
Later in the day, I was in Grand Central Station and took photos and videos from the balcony, aka, Apple Store.
Conclusion from Day 1 – There is a learning curve for Glass. managing the menu and voice commands. Learning to share photos is pretty straightforward. Adding apps like The New York Times can add a lot of content. Finding Twitter and Facebook deep in the menu can be a challenge. And remember, sharing photos or messaging are through Google+. Also, the Glass app is for Android devices only right now. So between the learning curve and the dependence on Google Apps means a change in orientation compared to managing apps through an iPhone. But the process is still interesting.
Does Glass have uses within healthcare? a growing number of users think so but it is up to the first 8000 Glass Explorers to determine its usefulness and prove that it is more than a toy.Share this:
June 4, 2013
There are actually many people to follow in this category but I was privileged to be first on this list by MedCityNews last week. Also, it put me in some good company, most of whom I already follow, such as, @jhalamka and the infamous @histalk.
This made me think of writing a brief post about how I use Twitter. I was an early adopter of Twitter starting just before attending Medicine 2.0 in Toronto in 2007. Meeting an energetic group from the US and Europe who were live tweeting at the conference got me hooked.
Now I have 5500 followers from Europe to Australia and follow about 1100. I post 3-6 times per day and more often at conferences. My focus in tweeting is health IT, health care social media, mHealth and apps, innovation in healthcare, conferences I attend, articles I read (newsletters and journals) and some notable Cleveland Clinic news. I try to share quality information and almost always include links. I use my favorite hash tags #hcsm, #mhealth, #HIMSS, #EMR. Have not gotten into the habit of using #HealthIT or #HITsm yet.
I also promote some of my favorite people, such as, @berci, @healthythinker, @lucienengelen, @nicolaziady, @ReginaHolliday,@ahier and many others.
Overall, I try to provide quality information that I think is important and not get bogged down in criticizing others or off-color remarks.
I hope I can continue to earn the respect of the wild world of Twitterland. See you there.
April 5, 2013
Several recent publications have focused on big data and data sharing in healthcare for secondary use of EMR data. First, the American Society of Clinical Oncology announced CancerLinQ. CancerLinQ is a proof of concept project which demonstrated the ability to integrate data from several cancer centers using existing tools (some open source) for research. While there are critics of this project in terms of it’s scalability and ability to integrate large amounts of data of different cancer types, its approach of attempting to simplify data integration. I commented on CancerLinQ for the iHealthbeat newsletter.
Second is a report from the Institute of Medicine on Sharing Clinical Research Data. This workshop report included pharmaceutical companies, academic researchers, and government agencies whom each have large amounts of research data and are beginning initiatives to make that data available for shared research initiatives. This is a hopeful trend and I hope to see followup on the presentations from this workshop.
Third is a report from McKinsey on The big-data revolution in US health care: Accelerating value and innovation. This report does a good job of focusing on the value of big data in health care, specifically: right living, right care, right provider, right value, and right innovation. Some see McKinsey as a late arrival in the big data realm but the report is a help addition to the discussion that cuts through some of the hype around big data.Share this:
March 1, 2013
Jack Dorsey, co-founder of Twitter and Square, spoke at Cleveland Clinic last night. Certainly a humble guy but also highly focused on using technology to solve problems. Here is the twitter stream from the presentation. Also, check out this cool 360 view.
As you can see, some very quotable lines, such as, related to the blocking of Twitter by Syria, Iran and China, “Information, like water, will always find a way.” And who does he like to read on Twitter – his mom and mom’s dog as well as his favorite authors.
“The biggest thing I learned from Steve Jobs is that you can’t follow in someone else’s footsteps.”
I love this principle of showing not telling. Doors open when I show, not tell.
@jack was asked whether he’s more artist or entrepreneur, he said artist but can never really call yourself one!
“When we drive over the Golden Gate Bridge, we don’t think about it. It’s a utility to reach destination.”
“The most precious thing we have is our health, and it’s the thing we understand least.”
“Design is immediately presenting the function through the form. Determine what is the most meaningful thing and focus on that.”
“Design is more than visual, it’s a practice – process”
“The power of the message to bring value to the receiver. ”
Great quote from
@jack talking about social media making people relatable. “The small details of life are what bind us together”
“I want to build things that will last, that are timeless…”
“Some view programming as a practical, mechanical interface, but I see it as very beautiful.”
“I believe we should build technologies that will disappear.”
But most significant was his business philosophy: Square and Twitter both founded on the premise of being a tool that “gets out of way” so people can focus on important stuff. That made me wonder about health information technology and particularly EMRs. Many (especially providers and patients) that the technology often gets in the way of the encounter instead of disappearing. How can that change? Mostly, I think in the user interface and device level. Can the EMR be mobile rather than having a desktop computer in the exam room? How about the provider being able to dictate and have that information inserted into the record. Are mobile apps for patients and quantified self transparent enough that they get out of the way or are they as clunky as large EMRs?
I think we need @Jack to teach us about the “art” in the UI and to think from the users perspective rather than starting with the technology.Share this:
February 26, 2013
IBM Watson is going to medical school at Cleveland Clinic. What Watson has to bring to medicine is the potential for advanced clinical decision support. Specifically algorithm-based, Bayesian decision analysis, rule based and expert systems. Several hurdles exist to accomplishing this: acquiring and validating of patient data, modeling of medical knowledge, keeping the data up-to-date, validate and integrate with the workflow. This process fits well with the Learning Healthcare System concept from the Institute of Medicine of taking research on evidence-based medicine into clinical decision support.
IBM Watson’s process in medical school will be to improve the inference graphs based on current data through human intervention. Providing clinical decision support is based on EMR data and the medical literature using DeepQA.
“The DeepQA project at IBM shapes a grand challenge in Computer Science that aims to illustrate how the wide and growing accessibility of natural language content and the integration and advancement of Natural Language Processing, Information Retrieval, Machine Learning, Knowledge Representation and Reasoning, and massively parallel computation can drive open-domain automatic Question Answering technology to a point where it clearly and consistently rivals the best human performance.”
Welcome Artificial intelligence to medicine and specifically clinical decision support.
February 21, 2013
My recent Perspective on iHealthbeat focused on the uses of data mining of EMR data which are yet to be fully exploited. My thoughts were provoked by a New York Times article titled, Mining Electronic Records for Revealing Health Data. Although data mining in healthcare has gotten a bad reputation, an approach which respects privacy and a focus on research discovery can yield important results. The potential uses of EMRs in research is another opportunity yet to be realized.
A new article in The Atlantic, The Robot Will See You Now, discusses IBM Watson and other initiatives moving medicine toward what I call Algorithm Medicine and Artificial Intelligence. The potential of mining EMRs to generate real-time clinical decision support has exciting possibilities. However, there are skeptics, especially when the predictions expand to entertain the idea of replacing physicians. Realizing the limitations of technology must be acknowledge. For instance, the concerning problem of copy-and-paste in EMRs would have a negative affect on data mining those records. Also, data mining has presents real challenges both in defining research questions and finding the correct data to answer those questions.
So data mining shows promise but a realistic approach without wild predictions can lead to real discovery and impact on practice.