« June 2006 | Main | August 2006 »

July 27, 2006

Heathcare IT: helping to collect the evidence

Picture of a judge with scales.I have mentioned my wife often spends evenings scouring medical publication databases for evidence to support her practice as a physiotherapist. This approach has been hammered into her by her tutors. But I have recently read two articles about medical practice that suggest there is further to go.

The first was picked up by the vigilant eHealth blog. An article on BusinessWeek online suggests that only 20-25 percent of medical practice is supported by evidence.

I am told the UK is a leader in implementing evidence-based healthcare. The National Institute for Clinical Excellence (NICE) provides "national guidance on promoting good health and preventing and treating ill health" that can be used by patient and practitioner. Also, the National Electronic Library for Health offers a range of resources, including a link to the Cochrane Library that offers "high quality evidence to inform people providing and receiving care".

However, a second article in New Scientist sees the challenge from another angle. In The Illness Industry Jorg Blech (the science correspondent for Der Spiegel) claims that "cures" for illnesses we did not know we had are converting society into a big hospital.

For instance, Herr Blech highlights the Western tendency to consider menopausal women as ill and to treat them with oestrogen and progesterone based on little clear-cut evidence. The "male menopause" shows a similar pattern, he says, with men now encouraged to use medications like testosterone gel.

In his book Inventing Disease and Pushing Pills Herr Blech quotes Aldous Huxley:

Medicine is so ahead of its time that nobody is healthy any more.

Both of these articles convince me that an integrated national Electronic Health Record, such as NHS Connecting for Health's NPfIT's Spine, has a crucial part in future healthcare. The analysis of anonymised data on patient care and outcomes could lay an even firmer foundation for medical practice.

July 24, 2006

High Street Healthcare

Picture of a doctor with a stethoscope.Several UK newspapers have reported plans for the UK's high street retailer Boots to house NHS GP surgeries and hospital consultants in its stores. The Government has apparenly been impressed by its management of free testing for Chlamydia, which about 14 000 people have taken advantage of. Boots is discussing its plans--which may entail offering in store podiatry, orthopaedic and physiotherapy treatment, as well as healthy heart checks--with UK Primary Care Trusts (PCT) .

The Boots group has three main businesses: Boots the Chemists, Health and Beauty and Boots Opticians. It operates from about 1 500 branches in the UK and Republic of Ireland and serves 8 million customers a week.

Boots has invested about £120m in one of Europe's largest SAP systems, which encompasses finance, treasury, HR and property and is also used to to plan the optimum layout and stockholding of its retail outlets. It has begun to use radio frequency hand-held terminals to manage stock in real time, and its MyStoreNet intranet site provides store managers with real time information on performance.

Decentralisation of healthcare and a move away from centralised, highly skilled specialists were hinted at in last year's NHS Chief Executive's report (see FHIT posting).

July 23, 2006

Health Robots: close, but not too close

As a physiotherapist, my wife can tell patients what exercises to do but can't be sure they do them after they leave the clinic. An article in New Scientist highlights a similar situation for recovering stroke victims, which has been addressed by using talking robots to motivate and monitor them.

But a style that motivates one demotivates another. So, researchers Mataric and Tapus from the University of Southern California in Los Angeles created a robot with a personality that can be adjusted to suit the patient by making it more or less extrovert.

However, robots must not resemble us too closely. In another study, UK schoolchildren shown pictures perceived human-like robots as more aggressive. This fits with the Japanese idea of uncanny (or spooky) valley I referred to in another posting.

Enter uncanny valley on Wikipedia.

July 16, 2006

Brain Training--and monitoring?

Like 1.4m Japanese, I have applied myself to Dr. Kawashima's Brain Training on the Nintendo DS. After 2 months I reduced my brain age to more than 20 years below my biological age--not bad I guess.

Using Magnetic Resonance Imaging (MRI) Dr. Ryuta Kawashima (a neroscientist at Tohoku University in Sendai, Japan) has selected numerical and verbal tests that most activate your brain's hemispheres. Surprisingly, the tests are not sophisticated. You solve a range of simple arithmetical and verbal puzzles quickly and your memory is also tested.

The handwriting and speech recognition are good--but it's still frustrating sometimes when the software misreads my handwriting scrawl giving me a red cross instead of the green tick I should have had!

I bought Nintendo's Big Brain Academy which was released recently in the UK. It also tests mental agility with another series of puzzles. I will let you know how I get on.

Devices like this could be used to remotely monitor cognition and perhaps give an early warning of its decline.

Nintendo's UK site for Brain Training.

July 13, 2006

Breathe Easy: testing breath for disease

A mobile phone carrying a breathalyser is about to be launched in the UK the Sunday Times on 9 July 2006 reported. The Samsung LP4100 tests drinkers's fitness to drive and may also lock out certain numbers to prevent embarrassing drunken calls to bosses, former partners or the local takeaway. The phone is multifunctional, even offering a remote control for karaoke machines.

I also spotted this article about a breath test for metabolites asssociate with breast cancer.

Lack of testing and diagnostic devices not needing specialist intervention have limited remote monitoring and the development of carebots, but that's changing fast with breath testing a promising area.

July 09, 2006

Consequences of Healthcare Convergence

I love films like Fritz Lang's Metropolis that are centred on the ultimate machine that resembles a bodge of a steam engine, a badly wired fuse box and the contents of a mad scientist's lab. So, it was a treat to visit an exhibition on Modernism in London.

A 1919 quote from Walter Gropius, a member of the era's hugely influential Bauhaus, caught my eye:

The old forms are in ruins. The benumbed world is shaken up, the old human spirit is invalidated and in flux towards a new form.

For a recently-published article on the flux in healthcare to a new form, convergence, I spoke to Microsoft's John Coulthard, Director of Healthcare, UK. He thinks predictive DNA testing, wireless communications and burgeoning diagnostic and monitoring devices herald a decisive shift from the management of late-onset disease to prophylaxis.

The Modernists were also inspired by a form of convergence. They found the separation of Art, Craft and Design artificial and admired the machine as the epitome. Le Corbusier, another of the movement's leaders, even described homes as "machines for living".

Today's acute hospitals may be "machines for health"...but that doesn't seem to follow, because they are centred on the management of illness, which, if Mr. Coulthard is right, makes them obsolescent.

Healthcare in the 21-Century is a new form. Though founded on technology, it will be less like a machine and more dispersed, amorphous and pluralistic. Not focussed on managing illness, but on maintaining health.

Read Come Together the article on healthcare convergence I refer to.

July 05, 2006

Future Health IT--Not

Picture of water.I have just written an article on convergence in healthcare. I interviewed a director of a major software company (I will post more when the article is published) who reminded me that most healthcare companies have concentrated on developing products for 1 billion of the world's population; 5 billion in the developing world have, by and large, been neglected.

I spotted an article in London's Metro newspaper about a device costing £1.50 (less than $3) that prevents deaths from water borne bacteria and viruses causing typhoid, cholera and diahorrea. Half of the world's poor suffer from water borne disease.

Lifestraw uses a slalom of filters to purify water and has been used in Asia, Africa and South America.

Off topic and low tech, I know--but effective.

July 03, 2006

Robotic Baby Seal is Good for You

Back to one of my favourite topics.

A short article in the UK's Financial Times: How humanoids won the hearts of Japanese industry covers familiar ground but introduces me to a robotic baby seal Paro that uses sensors to react to the way that it is treated by humans. It apparently reduces stress levels in the elderly and is popular, despite costing several thousand dollars.

Still, walking robots are even more expensive--about the same price as a Ferrari--though costs would fall with volume to about that of a cheap car.

The article makes an interesting inference about why Japanese are less suspicious of robots than Westerners. The Shinto religion allows for a living spirit to inhabit inanimate objects, whereas Christianity has found the notion of man creating an image of himself sacriligeous. Hmmm.