How Environment and Technology Can Improve Health Care
Putting comfort of patients first yields surprising results
More than 800 robots now rove the halls of U.S. hospitals, increasing doctors' efficiency by letting them be in two places at once. And these stand-ins for people are taking on other duties, too. At the UCSF Medical Center, a robot packages 13,000 doses of medication, including IV solutions, every day, "virtually eliminating the opportunity for human error," says Michael Blum, a cardiologist and chief medical information officer at the center. Each dose gets a bar code that a nurse must match to a patient's wrist band before the medication is administered.
The number of robot-assisted surgeries – for everything from gall bladder removal to hysterectomy – has soared, though critics say there's still little evidence that the method produces better results than comparable minimally invasive procedures. (The FDA has been looking into robotic surgery in response to growing reports of problems, such as the arms moving improperly.) Other robots emit beams of ultraviolet light to kill potentially deadly bugs. A recent MD Anderson Cancer Center study found that a unit from a company called Xenex killed 95 percent of C. difficile bacteria – six times more than bleach, the standard disinfectant.
Change is also coming to the ICU, which faces a daunting challenge. In any given hospital, as many as 15 medical devices, including monitors, ventilators and infusion pumps, are connected to an ICU patient, but because they are made by different companies, they don't "talk" with one another. Patient-controlled analgesic pumps that deliver powerful narcotics, where a known side effect is respiratory depression, aren't linked to devices that monitor breathing, for example. "Today's ICU is arguably more dangerous than ever," says Peter Pronovost, senior vice president for patient safety and quality at the Johns Hopkins Medical Center in Baltimore...
To address the need for "interoperability," health care and industry executives convened the first Patient Safety, Science and Technology Summit in January, and nine of the largest medical device companies pledged to share data and standardize device interfaces. According to a new report from West Health Institute, a research organization focused on reducing health care costs, true interoperability could save $30 billion by avoiding mistakes.
Meanwhile, design plays a role in intensive care, too. At Memorial Sloan-Kettering Cancer Center's 20-bed unit in New York, sliding glass doors are glazed with LCD privacy glass, which transitions from clear to opaque at the touch of a button and can be cleaned far more effectively than curtains. Monitors, medication pumps, oxygen, suction and power outlets reside in ceiling mounted mobile columns rather than in headboards, and no cables snake across the floor. "That allows us latitude and freedom that we would never have in standard rooms," says Neil Halpern, chief of the hospital's critical care medicine service. Seattle Children's similarly puts access to power and gases into movable booms so the medical team can quickly and easily get to the patient.Props to the THCB article "How a Washing Machine Inspired Me to See the Future of a Safer ICU" for turning me on to this.
Wachter is cautiously optimistic that all this innovation will lead to better, safer care. But the smartest of technologies still leave no room for complacency. "We've learned how amazingly complicated it is," he says, "to reliably deliver care to sick people."
The Robot Will See You NowGreat article. I'm a hardcopy Atlantic subscriber, so I read this when it first came out.
JONATHAN COHN, FEB 20 2013
IBM's Watson—the same machine that beat Ken Jennings at Jeopardy—is now churning through case histories at Memorial Sloan-Kettering, learning to make diagnoses and treatment recommendations. This is one in a series of developments suggesting that technology may be about to disrupt health care in the same way it has disrupted so many other industries. Are doctors necessary? Just how far might the automation of medicine go?
...Information technology that helps doctors and patients make decisions has been around for a long time. Crude online tools like WebMD get millions of visitors a day. But Watson is a different beast. According to IBM, it can digest information and make recommendations much more quickly, and more intelligently, than perhaps any machine before it—processing up to 60 million pages of text per second, even when that text is in the form of plain old prose, or what scientists call “natural language.”
That’s no small thing, because something like 80 percent of all information is “unstructured.” In medicine, it consists of physician notes dictated into medical records, long-winded sentences published in academic journals, and raw numbers stored online by public-health departments. At least in theory, Watson can make sense of it all. It can sit in on patient examinations, silently listening. And over time, it can learn. Just as Watson got better at Jeopardy the longer it played, so it gets better at figuring out medical problems and ways of treating them the more it interacts with real cases. Watson even has the ability to convey doubt. When it makes diagnoses and recommends treatments, it usually issues a series of possibilities, each with its own level of confidence attached...
I just put a new linked graphic in my right hand links column.
JUST IN (11:20 a.m., March 26th)
LinkedIn GroupsThat's pretty interesting.The Obama Administration is back on its heels these days over the continuing judicial challenges to the PPACA, and the just-now announced delay in the HIX individual mandate deadline. Having been seriously burned by the HealthCare.gov rollout, I could see where they would love to avoid a similar CusterFluck over the ICD-10 transition deadline, and push it out past the mid-term elections. So, while this is a congressional action, its one I could see Obama signing should it reach his desk.
Subject: Urgent Possible ICD-10 Delay: Announcement from AHIMA
CONGRESS TO VOTE ON ICD-10 DELAY TOMORROW, YOUR ACTION NEEDED TODAY TO STOP BILL
A new bill has been quietly introduced into the US House and Senate that features a section calling for the delay of ICD-10-CM/PCS implementation until 2015. This bill is expected to go to the House floor tomorrow, Thursday, March 27 for a vote.
The bill, which would adjust the Sustainable Growth Rate (SGR) and amend the Social Security Act to extend Medicare payments to physicians and change other provisions of the Medicare and Medicaid programs, also includes a seven line section that would delay ICD-10 to October 1, 2015.
This bill was negotiated at the leadership level in the House and Senate, and it is expected that there will be no debate before calling the bill to vote...
More to come...