EMR=CloneWars? – Hidden Dangers to Patient Care

Posted on January 30, 2008 by Steven F. Palter, MD

CRMbuyer is reporting on the benefits of using voice recognition for EMR’s in medicine and presents a series of case studies from the ER. There is a danger here in EMR’s I have not seen reported that voice recognition may help with – but first some of their stats on adoption rates in the ER

A 2006 Healthcare Information Management and Systems Society survey found that 65 percent of chief information officers planned to get it by 2008. It’s being touted as a natural add-on to the electronic medical record, since doctors are used to recording their notes, says Harry Rhodes, director of practice leadership for the American Health Information Management Association.

They list all the usual benefits, speed, digital readability, access, yada yadda yada. The obvious danger is misrecognitions since 2% error rates are not insiginifcant in large volume medical records.

But What is the hidden danger of EMRs docinthemachine you ask? It is the inadvertant cloning of patients.

Let me explain. If you are an ER doc an EMR is fine. Patient comes in with one line chief complaint. History of illness simple fact based. Short and to the point. But for detailed problems in the primary care and specialists’ office too much detail is getting lost in the EMR’s. That is because inmost cases docs are using template driven systems where they click off prepopopulated answers to questions or even touch screen menu choices. This is done to speed up data entry when there is no voice recognition. Most docs do not type well or when they do enter minimal info.

I am a fertility specialist. My practice Gold Coast IVF in New York has a set process we use to completely assess a patients’ past history and treatments and to really get to the nuances this requires quite a bit of narrative of question and answer info. When I am done I have an individualized picture of that patient that is totally unique from other patients due to the details. I know what her problem is and why and how she differs from others with the same diagnosis. Furthermore, during her treatment I can go back to the record and reassess all this wealth of information. What I see constantly when I receive EMR records from other practices (where the patient was first treated elsewhere and the treatments were not successful so they are now coming to me) is that the patients look identical. That is – I can see histories populated from checklists and quick electronic choices. Instead of all the details of a past treatment cycle it will list drug dose and failure with no detail of WHY it did not work. The diseases all look the same. There is never any detail on the nuances and subtle aspects of that individual’s condition. So when a group uses these records and they review a treatment every single person with the same disease (the “patient clones”) end up looking identical and treated identically. Cookie cutter assembly line medicine.

Perhaps voice recognition will allow the details to come back into medical EMR’s. That or a lot more typing by the doc…

Wireless HDTV- TV Today OR Tomorrow

Posted on January 30, 2008 by Steven F. Palter, MD

Here’s the next installment in my series on HDTV in the OR and the emerging use of HD for endoscopic surgery. Belkin introduced a new device for consumer HD video at CES that uses wireless technology to transmit the signal. In the past the enormous bandwidth of HD precluded the use of wireless transfers.

From what I have been told- the technology was developed by Amimon and is called WHDI. They report on the tech that:

WHDI™ – Wireless High Definition Interface sets a new standard for wireless high-definition video connectivity. It provides a high-quality, uncompressed wireless link which can support delivery of equivalent video data rates of up to 3Gbps (including uncompressed 1080p) in a 40MHz channel in the 5GHz unlicensed band, conforming to FCC regulations. Equivalent video data rates of up to 1.5Gbps (including uncompressed 1080i and 720p) can be delivered on a single 20MHz channel in the 5GHz unlicensed band, conforming to worldwide 5GHz spectrum regulations. Range is beyond 100 feet, through walls, and latency is less than one millisecond.

WHDI™ enables a wireless video link that offers the same functionality, cost and quality as a wired link. Practically all of the hundreds of millions of wired connections between video sources and displays today are based on delivery of uncompressed video. In order to replace these wired links, the wireless interface needs to be uncompressed as well.

The problem with traditional wireless modems for video is that they treat ever data bit equally. This new technology does not. WHDI takes the uncompressed HD video stream and breaks it into elements of importance. The various elements are then mapped onto the wireless channel in a way that give elements with more visual importance a greater share of the channel resources, i.e. they are transmitted in a more robust manner.

I presented research a few years ago on the development of a new endoscope that used distal CMOS imaging chios and distal end LED ilumination. The advantage of this is the ability to eliminate light and power cables once it goes battery powered. The developoment of wireless HD video transmission is vital to make the scopes totally wireless. Some details of this project and wireless power charging are here. The technology could also be used to develop real time image review from pill- cams.

You may want to check out past posts on the use of video compression as another tool enabling wireless OR’s.

Docinthemachine is Back!

Posted on January 29, 2008 by Steven F. Palter, MD

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Hello again all my friends, supporters, and loyal readers! After far too long of an absence I am back. So much time has passed and so much has happened that I wanted to fill you all in and welcome you back to my regular schedule of postings on all new in medical technology.

So you may ask- what the heck happened to you? We thought you were dead? Here is my free form list of all that has happened to tie me up and take me (temporarily) off-line. Here is a list of just some of things that took my attention in the last few months.

1) First and foremost my wife gave birth to our son the babyinthemachine. Despite being old pros at this a newborn really takes a hit to your free time! Happily she did awesome in pregnancy and labor and all went perfectly. It is always a bit of an event when an Ob Gyn’s wife gives birth we have really seen it all before, but that gets mixed up with the knowledge of every little thing that could go wrong at every step and trying to stay at the correct end of the bed (the head) ! The little guy came home and has been a delight. This led to the quick realization that these kids no way fit in our car we had to buy some new transportation. Thanks to Edmunds – remember never pay over invoice I won’t say what we got but I am sure you can guess…

Here’s the little guy in utero

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2) All of my research of the use of High Definition video for Surgery got picked up by the medical and lay press and I was doing a fair bit of lecturing and speaking. This was a real pleasure for me having worked on the development of these tools since 1999.

3) National Geographic featured footage from my high def surgery on their special Inside the living body. This led to a series of interviews and lectures including the peculiar thing that is morning drive FM radio shock jocks. No need to go any further. I’ll post some excerpts coming soon.

4) 20/20 did a piece on my research on visualization in surgery including high def and future vision autofluorescent laparoscopy. What a delight that was to do. Bob Brown and crew were great to work with and they then invited me back onto ABC News for a show about innovators. I’ll be posting video clips from this too.

5) DITM – this blog- hit its one year anniversary and I celebrated all that the experience has brought to me and allowed me to share.

6) My wifeinthemachine Michele Lang sold and published a major future tech-sci fi-romance Netherwood which included dozens of examples of current and future med tech from the pages of this blog in the Shomi Line from Dorchester Publishing. All this is woven into a story of a technological future world where computers become sentient and the local sheriff must destroy the man set out to destroy the network but learns he is her virtual reality lover who holds the secret to the survival of mankind. The book can be ordered at Amazon now and has gotten amazing reviews. She be posting some updates and interviews here to come!

7) I was honored to be chosen to be a High Definition Visionary Site by Sony Medical. As one of the few MD’d chosen for this distinction I have access to their wealth of electronic knowledge and product engineering. For full disclosure I do not receive any financial payments for this relationship. They are helping me with a demo research project for HD surgery education on the internet and on improving visualization and archiving of surgery. I’ll be posting more from this to come.

I was involved in the keynote general session at the 38th Annual International Congress of Gynecologic Endoscopy (The AAGL). A true honor, this was the third time I led a session on new technology in medicine and the second year in a row. This year I focused the session on NOTES – or natural orifice surgery. This amazing new technology still in development is where physicians pass special flexible never before seen endoscopes through natural body openings (mouth, anus, vagina, etc) to reach any part of the body without any incisions at all. Needless the say the audience was in awe of the video of an appendectomy removed without external incisions and pulled out the patient’s mouth! More from this session will be posted with updates and excerpts on this technology.

9) As part of this session I presented new research of mine on the transformation of medical technological research and mathematical modeling that shows we are on the cusp of unparalleled explosive growth in med tech innovation. Of course more to come on this!

10) I was elected vice-president of the ACGE (Council for Gynecologic Endoscopy) – established to elevate standards in operative endoscopic procedures performed by gynecologists. We will be continuing our efforts on surgeon and facility standards and review including the validation of simulator based evaluations. More to come!

11) I was chosen by the AAGL as well on a special ongoing press conference panel on the future of gynecologic endoscopy. I have to say it was a real honor and validation of years of work when The President of the society Dr Charles Miller introduced me as the visionary of the society. Videos and transcripts will be posted.

12) Related to this I began an advisory role for a company developing a gyn NOTES procedure which will likely begin clinical trials for infertility very soon.

13) We had the Annual meeting of the American Society for Reproductive Medicine (ASRM) – the largest infertility meeting where I serve on the program committee and chair the video program. I’ll be posting updates of new research including a dinner I had with the world’s expert on human pheromones.

14) The Society of Reproductive Surgeons (SRS) of the ASRM invited me to chair their postgraduate course on fertility surgery at next year’s meeting. Of course the topic I chose is “New Technology in Fertility and Reproductive Surgery”. I’ll run the course as a lecture and hands on lab and we will include robotic surgery, alternatives to hysterectomy, surgical simulators, Natural Orifice Surgery, Autofluorescence, Office Surgery, High Definition, High Intensity Ultrasound surgey and many others. I’ll post updates as we go along.

15) I continued my usual lecturing, research, publications, and the development of a new innovative DITM podcast series.

16) Had some minor surgery- I am really an expert on edoscopes and the entire GI track as well now.

17) My clinical practice Gold Coast IVF had our busiest and most fertile year ever! Countless pregnancies in my usual mix of complex cases left me grateful and delighted to be a part of this specialty. Using all the tools in my armamentarium (drugs, surgery, IVF, egg and sperm donation, etc) allowed me to help create more families than ever. I treated local patients and those who traveled from around the country and from Nations as distant as Russia, China, and Nigeria.

OK – it has been a busy few months here but I am ready for 2008 to do even more! Welcome back to docinthemachine!