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December 29, 2005

Robots in ICU

health-it-rp-robot.JPGI'm writing a couple of articles on the use of robots in healthcare and yesterday I spoke to a UK researcher in the field who is researching In Touch Health's RP7 robot. RP stands for remote presence.

The RP7 resembles a monitor and camera on a large vacuum cleaner base and is navigated remotely at a console by using a joystick. It's like telemedicine on castors.

The robot is already deployed in the Accident and Emergency Department and on one of the Surgical wards of the researcher's hospital. One of the areas he thinks is very suitable for robot use is Intensive Care wards.

At first this seemed odd to me because patients on these wards are normally under constant supervision anyway and often unconscious or too ill to talk.

However, many IC wards outside of large hospitals in the UK are managed by Anaethetists who sometimes need a second opinion from a specialist Intensivist. Such opinions could often be more easily given remotely using a remote presence-type robot.

Here is a US article that describes the use of RP robots in ICU. The best written section is at the end of the page: Robots In the ICU.

This PDF sent to me by In Touch Health is a more detailed description of the same application of RP robots written by Paul Vespa.

Picture of the RP6 in action by kind permission of In Touch Health.

December 27, 2005

Robots in healthcare: new version of ASIMO

robots-healthcare2.jpgThis month, Honda has unveiled its new, 1.3m tall version of ASIMO (advanced step in innovative mobility) one of the worlds most advanced bipedal robots.

ASIMO has been enhanced with a new selection of sensors--the key to future robot development. Using its visual, ultrasonic and floor sensors it recognises its environment, and steps out with the aid of its eye camera. Using wrist kinaesthetic sensors, it gives and takes objects.

New ASIMO displays a greater ability to work harmoniously with humans. It can walk while holding a hand and carry objects using a trolley or cart.

It has also doubled its running speed to 6km/hr with both feet off the ground during the gliding phase. For that it balances centrifugal force by tilting its centre of gravity.

"ASIMO has been created as a new form of mobility. In the long term, it should allow you to execute a task without having to move yourself," explains William de Braekeleer of Honda Motor Europe Ltd. "We see ASIMO as an aid to the nurse, taking care of the heavy aspects of their tasks, allowing them to spend more time with the patient."

Now ASIMO is capable of more grunt work, Honda says that future development will concentrate on its intelligence to enable it to make judgements in various situations.

Pictures of ASIMO by kind permission of Honda Motor Europe Ltd

December 26, 2005

Healthcare and the Internet: Dr. Google

In November 2005, Google and--within a year of its release--Google Scholar are the top referers to the British Medical Journal (BMJ). If this is a general trend I have an idea why it may be so.

My wife is studying Physiotherapy and attempts to use the user-hostile Athens to find relevant material in databases such as Medline and Cinahl to read and cite.

Her fellow students express disdain when she tells them she prefers Google to find her sources. Enduring the pain of academic search engines is, it seems, essential in the quest for the same knowledge. Or is this learned academic snobbery?

Dean Giustini, the author of the BMJ article, thinks that Google ought to create a medical portal. Fortunately, the National Electronic Library for Health (NeLH) already provides an excellent interface to a number of databases for clinicians and laypersons and my wife and I recommend it, together with Google as a general source.

The power of the internet in the hands of laypersons was amply demonstrated in 2004 when a 15-year old boy used the internet to track down his genetic father using a sample of his own DNA and on-line facilities.

Medical knowledge is no longer the domain of the few.

December 23, 2005

Internet has further to go in healthcare

The NHS Direct website is a popular resource in the UK. While in the US recent research indicates that patients trust their doctors but frequently use the Internet.

As access in the UK increases, more laymen will use the Internet to inform themselves about their condition, drugs, treatments. That shift in knowledge will fundamentally alter the relationship between clinician and patient.

But there is more to come. On-line consultations and routine monitoring will become normal, reducing the need for sick patients to wait and share infections in the GP's waiting room. It will also ease the GP's workload, making home visits less necessary.

Recent research indicates that about half of people in the UK have Internet access. Increased access may have a more profound effect on care than the whole of Connecting for Health's National Programme for IT (NPfIT).

I wish you a peaceful Christmas time and a successful New Year!

December 21, 2005

Health IT: making care better or worse? (cont)

I notice that the E-Health-Insider website also picked up on the increased mortality reported in Pediatrics after the implementation of a drug management system (see FHIT entry). This led to an interesting exchange of views the most important points coming out of it so far are:

  • IT systems do not automatically result in a net benefit. They may make care worse—at least for a while;

  • IT systems can distract carers from patient care; and

  • IT systems can improve patient safety—studies report that e-prescribing reduces errors, for example.

No-one knows how many people die as a result of medical accidents in the UK NHS—estimates vary from a few hundred to 40,000 a year (see "Patient safety: safer on a plane than in hospital").

I believe healthcare IT will improve patient safety, but its paradoxical nature needs careful management.

See "Increased Mortality Rate After Drug Entry System Installed" on the E-Health-Insider site.

December 19, 2005

Disaster planning: how simulation and aggregation help

At this time of worry about a possible flu pandemic and terrorist attacks its good to know that computers are helping medical staff to prepare.

This article Bits and Bytes: Video Games and Disaster Training describes how gaming software is being used to prepare staff to deal with major incidents.

In the December 2005 edition of "Wired" (p208) "Reinventing 911" describes how a community in Portland Oregon has improved its emergency services.

No matter how much we plan, disasters are addressed by intelligent improvisation. In order to be effective and overcome the human tendency to pause before acting, warnings must not be seen as single events but as a series of triggers for actions by informal networks.

The Emergency Digital Information Service (EDIS) aggregates weather forecasts, alerts and official warnings into a single database which can be transmitted to police, emergency centres and television newsrooms.

A common alerting protocol (CAP) tags events by location and urgency, allowing emergency services--police, firefighters and paramedics--to share information in a common format and to filter it according to its relevance.

December 17, 2005

RFID: what is it?

rfid-3.jpgMany articles on assume that readers know what Radio Frequency Identification (RFID) is. Items tagged with RFID can be uniquely identified at a distance using wireless emissions.

This published article gives an overview of healthcare applications of RFID.

There is also a good entry here on Wikipedia.

Image by kind permission of Precision Dynamics Corporation, California, USA.

Healthcare IT: making care better or worse?

Reposted. Original post on 10 December 2005.

Of course, computerised systems, by improving patient safety, improve outcomes. No doubt about that is there? Supporters of the National Programme for IT (NPfIT) assure us that is the case.

So we wouldn’t expect to find a drugs order entry system—one of the mainstays of the Care Records Service (CRS)—associated with increased mortality rates. But a study in the American publication “Pediatrics” found just that.

“Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System” describes a retrospective analysis of mortality in the Children's Hospital of Pittsburg for 13 months before implementation and for 5 months after it. Mortality rates increased significantly after implementation.

The study concludes this is an unexpected finding—it may have been due to delays in treatment. The study recommends that mortality rates are monitored post go-live.

Improvements do not arise by simply switching on IT systems. Inexperienced users and the rigour forced by computerised-systems may slow processes initially. Therefore, it is essential that IT-system benefits are rigourously identified, monitored and realised--many pay lip service to this, few practice it.

More discussion on this topic on the HISTalk Blog here.

December 16, 2005

Digital Paper: pulp fact

Good news for bibliophiles, technophobes and cynics: digital paper is a reality and the "paperless" hospital might never be.

This article in the Guardian describes the "Librié" a new product from Sony, Phillips and E-Ink.

Charged black and white microcapsules in oil line up in response to an electronic charge to form words on a screen. The Librié can hold the equivalent of 10,000 pages, about 40 novels, which can be reloaded. The boot of a Consultant's 4x4 may never have to be full of patients' notes again! (Only joking, guys!)

Digital paper is already used for in store displays that can be refreshed by wireless links.

However, Siemens has developed paper thin displays that could replace conventional labels. Walking down the isle of the supermarket could soon be like strolling around Piccadilly Circus as the labels of goods present us with changing, alluring images and displays.

And, don't we already have e-books on PDAs and displays that respond to digital signals? Oh, and where do those digital signals come from? Computers?

Though I love gadgets, it's difficult to see what more digital paper offers. It may be yet another solution looking for a problem. Suggestions for healthcare applications on white pulp or (better) in the "Comments" section below, please.

December 14, 2005

NHS and Government IT Transformations Compared

I compared the NHS Chief Executive's Report (PDF) with Transformational Government (PDF) released a month earlier in November 2005.

In its vision, Transformational Government states: "Technology alone does not transform government, but government cannot transform to meet modern citizen's expectations without it." Amen to that.

Transformational Government's strategy has three prongs:

  • Services designed around the citizen or business;

  • A move to a shared services culture;
  • and
  • A broadening and deepening of the government's professionalism in planning, delivery, management, skills and governance of IT-enabled change.

Services based on customers or patients is a common theme in both documents.

Transforming government recognises the importance of the Internet and mobile phones in communications. These do not have quite the prominence in the NHS document.

Now, it may be that the NHS already feels it has already achieved a lot with NHS Direct and associated website. That is a good start, I say, but there is much more that can be achieved in transforming care with these two technologies.

Transformational Government specifically addresses the possible creation of shared HR and Finance services. Will NHS overspending lead to similar initiatives in the NHS?

On page 19 the NHS report emphasises the need for innovation and new ideas and services, However, it relies on a description of progress on NPfIT for its IT-enabled change—though, as usual, the question: "Change to what?" remains unanswered.

Nonetheless, there are some interesting snippets in the NHS report. Page 4 refers to a neurology outpatients clinic that is held in a GP’s practice near patients' homes. On page 5 a description of changes to traditional roles: emergency care practitioners and a bigger part in prescribing for pharmacists and nurses. Decentralisation and a move away from highly skilled specialists: a taste of things to come?

December 13, 2005

RFID: closed or open loop?

RFID applications can be defined as closed or open loop.

Closed loop is where the item to which the RFID tag is attached is continuously recycled in a process, and the cost of the tag is amortised over many process cycles--making it a cost efficient way of deploying RFID technology.

Generally, if RFID can be deployed in an application where the performance gains are relatively clear cut it is often not too difficult to establish a cost benefit and business case. Often the standards issue and the type of technology is immaterial, particularly if the pay back is within 12 to 18 months--often the case for closed loop applications.

Many healthcare applications can be identified that fall into this category, including asset management (medical equipment, IT, beds, chairs, trolleys etc), patient tracking and identification (for procedures and medication), security and access control (for patients and staff).

In the open loop case, as with retail supply chains, the aim is to attach the RFID tag to the item at the beginning of its journey or process and wave goodbye to it. Bar codes have been deployed in this mode for over three decades and their cost effectiveness is well established. This cannot currently be said of RFID open loop applications in general and trials are still in progress.

The healthcare sector needs to understand that different RFID technologies and Auto ID (remember Automatic Identification encompasses linear, 2D barcodes and many other allied technologies for capturing information automatically) both have their role to play in diverse applications.

December 12, 2005

RFID: healthcare waiting for the holy grail?

RFID-1.jpgIt seems the healthcare sector continues to adopt a wait and see approach to RFID (Radio Frequency Identification) whilst the private sector deploys it in ever more diverse applications--not just tracking goods and assets, but also people and processes.

RFID comprises a wide range of technologies operating at different radio frequencies, using different operating principles (location finding, active/passive) and with a variety of available functions (writing as well as reading data, sensing, security, range).

In the supply chain arena there has been fast progress in the development of a global standard for RFID in retail supply chains (EPC Global), however standards are often used as an excuse for complacency. Continuing development of the technology, its diversity and ongoing development of standards will always mean that the healthcare sector will never find the holy grail of one technology with one standard set of characteristics that will fit all possible applications.

The healthcare sector needs to get a grip and begin to trial and deploy RFID where it has proven itself in industrial applications ranging from asset management through process control to logistics and supply chains. In these applications RFID has demonstrated for more than two decades a cost benefit or improved performance that increases customer satisfaction. There are many parallels and lessons for healthcare.

Photo by kind permission of Zebra Technologies Europe Ltd.

RFID: guest author introduction

Dr Carol David Daniel is a consultant with over 15 years experience in advising private and public sector organisations on Auto ID/RFID and its deployment for supply chain and asset management.

Carol will write for as a guest contributor.

December 07, 2005

Robot dog reduces stress

aibo.jpgNow, it has been known for some time that having a pet can improve your health. But what having about a robodog?

A study by the US Department of Health concluded that pets increased the survival rate of heart attack victims. The study revealed that 28% of heart patients with pets survived serious heart attacks, compared to only 6% of heart patients without pets.

Owning a pet it seems can lower blood pressure and cholesterol levels. In the US a study of elderly patients showed that those with pets sought the services of their doctor less frequently. This seems to be supported by another study in nursing homes that showed an animal companion reduced significantly the use of prescription drugs.

But pets are not welcome everywhere: enter robodog.

A recent study at the University of Missouri-Columbia,
found levels of the stress hormone cortisol dropped among adults who petted Sony's robodog AIBO. AIBO responds when stroked, chases a ball and perks up when it hears a familiar voice.

Unfortunately, unlike the real thing, AIBO did not prompt an increase in feel good chemicals like oxytocin and endorphins.

In the dog house or paws for thought?

Robots train doctors

At the International Robot Exhibition in Tokyo, the world's biggest robofest, Japansese researchers demonstrated a robot designed to train doctors to operate inside blood vessels.

Researchers showed the Micro Surgery Robot operating on the veins of a transparent human dummy. By guiding the robot, a medical student or a doctor can learn about endovascular treatment, or operations in which patients are treated through tubes inserted into their veins. Endovascular treatment is popular for victims of a stroke because it places less stress on them.

Robots in healthcare seem to be developing in three main ways: operational (like this one), anthropomorphic (like ASIMO: see "Robots in healthcare") and miniature (sometimes called nanobots)...

December 06, 2005

Patient safety: safer on a plane than in hospital

Liam Donaldson, Britain's Chief Medical Officer, says that we may be safer on a plane than in hospital. It seems the risk of being killed by a medical error in a developed country is about 1 in 300; the risk of dying in an air accident is 1 in 10 million.

Actually, it depends whose figures you take. The NAO recently said (PDF) that more than 2000 people a year die as a result of medical errors. The most common causes of error are: patient injury (due to falls), followed by medication errors, equipment related incidents, record documentation error and communication failure.

The NAO admits that the actual number of deaths by medical accidents is unknown, and there may be significant under reporting. Estimates range from 840 to 34,000 a year.

Based on Liam Donaldson's ratio and using an estimate of about 8m admissions to the NHS annually based on the NPSA report "Right Patient, RIght Care" (PDF), this would put the number of deaths caused by medical errors at about 26,000 a year.

December 05, 2005

Robots in healthcare

asimo-small.jpgI have loved robots since I was a child and saw Robbie in "Forbidden Planet" at the Saturday morning pictures. But my attempts to make one from old shoe boxes, torch bulbs and a couple of batteries ended in failure.

So, it was a great pleasure for me when I went eyeball to lens with the RP (remote presence) 6 robot being piloted at Imperial College Medical School at St. Mary's Hospital, Paddington, London. You can read more about my encounter with the RP6 in an article that I wrote Carebots in the Community.

The RP6 looks like a vacuum cleaner base carrying a flat screen monitor. A doctor consults a patient remotely, steering with a joystick and the help of an on board camera. It is also handy if a doctor in Birmingham needs a second opinion from a colleague in London, or in New York for that matter.

The advantage of remote presence robots like the RP6 over conventional telemedicine is that they can move to the patient, rather than the patient having to move to a telemedicine suite. In addition, they respect privacy, so there would be no need for a person at home to be subjected to 24 hour surveillance. Mind you, how would the RP6 make it upstairs unless it developed Dalek-like levitation skills?

Humanoid robots can climb stairs and will operate in our world. They will do the heavy work—like lifting patients, moving equipment and working gadgets like the washing machine and microwave—remember, many people give up living independently because of arthritis.

Here is a nice brochure about anthropomorphic robots from the University of Waseda in Japan. The University plans for its robots to use "multimedia such as speech, facial expression and body movement" (!) Robots like these could make carers' jobs less physically demanding and help the elderly and infirm to stay independent.

My wife says she wants one now (I say she already has one). Honda’s ASIMO (see pic) is an example of a bipedal humanoid robot, which unfortunately for my wife (and me) is still about ten years away from general deployment. Now where did I put those shoe boxes?

Picture of ASIMO by kind permission of Honda Motor (Europe) Ltd.

December 04, 2005

Patient safety and wristbands

I went to a meeting organised by "Intellect" (the UK's trade association for the IT industry) recently. The National Patient Safety Agency (NPSA) launched an intitiative to increase awareness of the importance of patient wristbands in patient safety. Incorrect patient ID is thought to be one of the main causes of "patient safety incidents".

Chris Ranger, the NPSA's head of safer practice, used the case of Graham Reeves, who had his remaining healthy kidney removed by mistake, to illustrate the potentially tragic consequences of human error in healthcare.

Even those NHS trusts that use patient wristbands do so inconsistently: some blue for men and red for women and some the opposite, for example!

Barcodes have been used for some time in healthcare and are still a reliable stalwart for wristbands, but please see this amusing anecdote posted on the E-Health Insider website (look at the first comment at the end of the article)about how clinical staff can "innovate" with them.

Both Chris Ranger and Alison Terry of the National Audit Office mentioned RFID as a technology with the potential to improve patient safety, either by allowing more confident patient-ID or by helping to prevent wrong patient, wrong site errors.

The NPSA has launched a briefing paper (PDF) on the use of patient wristbands.

The NPSA says, however, that wristbands do not remove clinicians’ responsibility for checking patients’ identity. They are an important way of validating identification particularly when a patient is unable to provide their own details.

Like all aids to identification, barcodes and RFID carry the risk that we "believe" them; cross checking against the patient notes, or--as in the case of a Wi-Fi tag pilot in Birmingham Heartlands Hospital--with a photo on the EPR, is still essential.

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December 03, 2005

Read, Enjoy, Join in

Picture of Colin Welcome to the blog that helps you to create the future of healthcare. I hope you enjoy the content, but most of all I hope you will click on the "Comments" link and contribute to the community with your ideas and opinions.

I am Colin Jervis and I help healthcare and other parts of the public sector in the UK to gain maximum value from their investments in IT. As well as having worked in Marketing and Management Consultancy in the private sector, I led from inception two major Electronic Patient Record (EPR) programmes in the UK National Health Service (NHS). Maybe that accounts for the loss of hair!

My first EPR programme began in 1991 at St. Mary's Hospital, Paddington (where Sir Alexander Fleming discovered the bacteriocidal qualities of the penicillium mould) in the days when the idea of a multidisciplinary patient-record in the NHS was about as attractive to most healthcare workers as a pile of mouldy Petri dishes. How things have changed! I revisited the hospital recently more than 10 years after I had left and found much of the infrastructure we had installed was still playing a valuable role.

I led a second programme at the Royal Berkshire and Battle Hospitals in Reading, UK as part of a major change and rebuilding programme. The ideas coming out of it were used by the developing National Programme for IT (NPfIT)--now part of NHS Connecting for Health reputedly the world's biggest IT project.

Since then I have also led as an interim director an EPR implementation at one of the UK largest Foundation Trusts and advised international suppliers on healthcare matters and healthcare IT. I regulary publish articles and am often invited to speak at, or chair, conferences and seminars. I have a BSc in Biochemistry, a MBA and a Masters Degree in Business Systems Analysis and Design.

On a personal note, I have been a fan of 70s progressive rock band "Yes" for, well a long time. A few years ago I met them in HMV on Oxford Street in London, and I confess there was a lump in my throat as the band members signed my book. You can find out more about these rock legends on the "Yesworld" site.

I will spare you my musings on Yes's music, however, I will indulge my fascination for gadgets, technology and innovation in healthcare in this blog. I am looking forward to giving my creative and fanciful streak a bit more latitude than I feel able to on the Kinetic Consulting website which will tell you about my work in healthcare and public sector consulting.

I hope you enjoy reading my blog and—most of all—I hope you join in with your comments!

Contact me: