TechCrunch, a technology blog focused on Internet-related products and companies, reports on the brewing partnership between Healthline (medical information portal) and Aetna (health insurance company) to create a personalized health portal. Similar to the Google and Cleveland Clinic deal, Healthline will benefit from a rapid infusion of new users, comprising the thousands of individuals insured by Aetna. It is unclear what Aetna gains from this marriage, as additional details surrounding the collaboration are yet sparse. It seems that dynamic duos are now the trend to remain competitive in the personal health record (PHR) industry.

Related Posts:

• Google Health collaborates with Cleveland Clinic
• Industry giants vie for your online health records

Google’s official blog revealed today some details and screenshots of its yet unreleased Google Health project, a web portal for your personal health records (PHR). It appears the site will provide more than just storage space for medical records. Complementary tools may include health information resources and a doctor directory. The two screenshots are only a first look into the new service, and it is likely that more features will be announced in future posts.

Related Post: Google Health Collaborates with Cleveland Clinic

Last month, I wrote an article on the brewing battle between Microsoft and Google to create the de facto portal for your online personal health records (PHR). It seemed that Microsoft’s HealthVault may have had the edge with its earlier deployment and collaboration with the Mayo Clinic.

In a move to equalize the playing field, CNN recently reported that Google Health will work with the Cleveland Clinic to store records of several thousand patient volunteers. Google has been relatively silent about its unreleased project, but I assume it will primarily serve as a portable repository of personal medical information, including demographic data, past medical and surgical histories, current medications, and allergies. It is reasonable to speculate that the web service would also store select test results and discharge summaries from participating hospitals. I doubt that the excruciating details of progress notes or consultations will appear in the near future.

Details about the Google Health project are largely unavailable to the public, but it is clear that both Google and the Clinic have potential to reap great benefits from this symbiotic relationship. Google will instantly acquire a user base in the thousands, while drawing consumers to its brand of products. More importantly, Google would create a working hospital-web service model to market to other health care centers. Hospitals are the natural gold mines of medical records. The web service (e.g., HealthVault or Google Health) that more quickly gains broad acceptance by hospitals will likely dominate the market. The exorbitant costs to develop and maintain an EMR (electronic medical record) infrastructure may prohibit interested hospitals from integrating with multiple web services; that is, it may have to choose one or the other, likely the more popular or widely accepted web service. There is a reason why Windows dominates the desktop OS market (hint: it is not for technological superiority).

As for the Cleveland Clinic, the project benefits the hospital by establishing itself as a leader in health care technology. The association with Google will also boost brand recognition for the Clinic. This is important in a highly competitive health care market where recognition and prestige have tangible effects on patients’ decisions and donors’ pocketbooks.

As I mentioned in my earlier article, there are reasonable privacy concerns with either Google or Microsoft having access to so much personal information. But, the general public has spoken with its money clicks: These are among the most popular web companies in the world. So who’s next in the line-up of PHR marriages … Revolution Health (created by AOL’s co-founder Steve Case) and Johns Hopkins?

The health care industry is one of the last bastions of industry to fully adopt electronic record keeping. Despite the forceful drive toward universal EMR (electronic medical records), the paper chart still maintains a key presence at most hospitals nationwide. The VA (Veterans Administration) Medical Centers is an exception to this stereotype.

In general, the slow evolution is somewhat understandable, considering the monumental investment (i.e., money, time, and training) required to transition to a completely paperless environment. Even worse, each hospital network possesses its own unique computer system, hindering electronic inter-hospital patient data transfers (only HIPAA-compliant transactions, of course).

From the consumer side, although the hurdles to electronic records are less prominent, people generally apply a more chaotic less systematic approach to record keeping: discharge paperwork in a Manila folder; medication list on a Post-It note; and “allergies” in two or three brain cells.

With the web industry giants competing to be the de facto warehouse of your personal data, it was only a matter of time until they would enter the arena of medical records. Last year, Microsoft and Google publicly announced their intentions to provide online services to store your personal health information. Microsoft released HealthVault in Q4 2007, while Google is expected to release its own version sometime this year.

In related news from this week, the Mayo Clinic announced a collaboration with the Microsoft Corporation to advance the HealthVault platform. The details of this strategic alliance is yet unclear, but I believe both Mayo and Microsoft will greatly benefit from the synergy these powerhouses have to offer in their respective fields. The Mayo Clinic is a world-renowned research hospital and Microsoft is indubitably one of the most powerful software companies in the world.

On the Google front, Google Blogoscoped captures a brief glimpse of the upcoming Google Health’s login page. The blog also provides preliminary
screenshots from last August 2007. Although Google does not have the first-to-market advantage, it has demonstrated its undeniable prowess in dominating the web industry. Its ubiquitous search engine (Google.com), e-mail service (GMail), and video site (YouTube) are few examples of its success.

It will be interesting to see where this heated competition leads us. The benefits of maintaining health information in one convenient location are numerous. With patients’ permission, doctors can easily retrieve pertinent medical histories to guide diagnosis, management, and preventive health maintenance. Easily forgotten will be the days of faxing consent forms and awaiting return faxes of hospital/clinic records. Inversely, patients can benefit from streamlined access to their own health information. This would obviate the need to contact a hospital to request paper copies–sometimes with a nominal fee–of their own medical records.

Despite some obvious benefits, there are also potential drawbacks, such as privacy concerns about an oligarchy storing all your personal data. In any case, the true impact of HealthVault and similar services may not be appreciated until after they become mainstream products utilized by both the patient and provider. Although a bit slow to the party, I am pleased by how health care is progressively embracing technology and how technology has embraced health care.

The Department of Health in the UK published today new guidelines for hospital dress codes and laundering. The guidelines represent a compilation of expert opinion, scientific theory, and empiric research.

Among other recommendations, it is expected that health care personnel wear short-sleeved shirts and blouses. The sleeve cuffs presumably present a viable source for transmission of microorganisms. Interestingly, the report also recommends that white coats not be worn. I have several colleagues who would willingly give up the extra layer of fabric in a heartbeat. Oh wait, they already do. I, on the other hand, would prefer to wear the coat for personal protection and as a reservoir for my million-and-one accessories (e.g., stethoscope, pens, penlight, paperwork, PDA). The report suggests that “(w)here staff have direct patient contact, then suitable protection - for example, plastic aprons - should be worn.”

If the sleeve cuff is the principal reason for abandoning the white coat, then why not go for a short-sleeve coat? They are already standard issue in several countries. I realize this may become a fashion nightmare, but the compromise permits the pro-coats and anti-coats to live in harmony. Moreover, I can easily imagine disposable gowns mounting health care costs, particularly given the large number of caregivers and high frequency of entries into each patient’s room on any given day.

Another interesting–and probably nit-picky–recommendation is that health care workers wear soft-soled shoes, because they “reduce noise which can disturb patients’ rest”. Although the recommendation sounds good and benevolent in principle, I question its relevance in practice. Take a moment on a relatively quiet call night and listen intently to the sound from hard-soled Dansko® clogs. Unless the wearer is running to a code, the sounds these clogs emit are largely trivial. Moreover, compared to the competing sources of sound in a noisy hospital, heel clicks are practically insignificant.

Not to appear completely critical of the report, one recommendation I can fully support is the ban on ties. According to the report, it is “poor practice to wear neck-ties (other than bow-ties) in any care activity which involves patient contact”. The ties supposedly “perform no beneficial function … and have been shown to be colonized by pathogens”. Despite the professional appearance, I feel that ties are more a nuisance than a benefit. I doubt any hospital will suffer in public relations due to an absence of ties.

The report admits that there is no definitive evidence that uniforms pose a significant infection risk. It also falls short of calling all physicians to wear pajamas, er, scrubs. It emphasizes that professional dress is still important for the professionalism it communicates and the confidence it cultivates. There are other related recommendations, such as the use of clear name tags to identify the provider’s role. Naturally, tattoos and excessive jewelry are discouraged.

I will not delve into the report’s discussion of laundering, but here are a few tidbits: 1) 10-minute washes at 60 ^oC supposedly kills most microorganisms (10% of C. difficile spores may remain); and 2) MRSA can be removed at 30 ^oC with detergent.

The recommendations are scheduled to take effect in January 2008. Despite my seemingly critical review of the report, I largely support the changes. I think it is a valiant effort at further addressing infection control and implementing policies to hopefully stave off a MRSA catastrophe.

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Similar to the controversy about whether cellular phones can cause brain cancer, there is brewing debate about whether these phones also affect medical devices. In two earlier articles discussing research findings from the Tan Tock Seng Hospital (Singapore) and Mayo Clinic (Rochester, Minnesota), I reported that mobile phone use was not detrimental to medical equipment. Similar studies have prompted the reversal of cell phone bans in many hospitals throughout the United States.

Just as we have become comfortable chatting on the phone while walking from patient room to the cafeteria, a new Dutch study presents a caveat to the earlier reports. While it is true that newer generation mobile phones may generate less electromagnetic interference (EMI) due to better shielding and signal downregulation, there is limited information characterizing the risks of using Internet-capable phones around medical devices.

To explore this question, researchers from the University of Amsterdam utilized wireless signal generators to mimic data transmission on modern mobile phones. The generators were placed in proximity of medical devices commonly found in the ICU, such as telemetry monitors, mechanical ventilators, and infusion pumps. The group detected 48 incidents in 26 devices (43%). Sixteen (33%) were classified as hazardous, 20 (42%) as significant, and 12 (25%) as light. The median distance of effect was 3 cm (range: 0.1 to 500 cm). Some hazardous effects included ventilator shutdown, restart, and setting adjustment. A syringe pump also stopped without an accompanying alarm. These were not trivial events.

One limitation of the study is that the group used signal generators at maximum power to assess the potential risk of cell phone use. Since mobile phones frequently regulate its power output based on the carrier network’s signal strength, we would expect lower EMI in real-world conditions. On the other hand, since the group’s aim was to characterize possible worst-case scenarios, this criticism is moot. Besides, deep inside the behemoth of a hospital, signal strength is usually weaker and EMI inversely stronger.

In brief, although newer generation Internet-capable smartphones present new challenges of electromagnetic interference, a one-meter buffer between phone and medical device still seems reasonable. Now to publish this article via my CrackBlackberry before I get too close to Mr. Johnson’s ventilator.

• Source
• van Lieshout EJ, van der Veer SN, Hensbroek R, Korevaar JC, et al. Interference by new-generation mobile phones on critical care medical equipment. Critical Care 2007;11:R98.

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Last year in February, I reported on a Singaporean hospital’s conclusion that mobile phones posed no significant risk to medical equipment. That same month, clinical and telecommunications researchers at the Mayo Clinic (Rochester, Minnesota) began a four-month study to evaluate for interference by cellular phones on medical equipment. After 300 tests on 192 medical devices, the researchers published their conclusions in the Mayo Clinic Proceedings (March 2007):

Although cellular telephone use in general has been prohibited in hospitals because of concerns that these telephones would interfere with medical devices, this study revealed that when cellular telephones are used in a normal way no noticeable interference or interactions occurred with the medical devices (emphasis added).

Interestingly, the same group published two similar studies in 2001 and 2005. Their earlier conclusions were less direct, noting possible interference from mobile phone use. In the 2001 study, they discovered that cell phones caused interference in 55% of the tests, affecting 41% (7/17) of the medical devices. The interference was considered clinically relevant 7.4% of the time, comprising “interference that may hinder interpretation of the data or cause the equipment to malfunction.” The 2005 study showed more promising results. While the number of devices affected remained constant at 44% (7/16), the incidence of clinically important interference dropped to 1.2%. This year, the incidence is reported at 0%.

Newer cell phone models presumably emit less electromagnetic interference (EMI), explaining the progressive decline in interference found among the three studies. The results are not novel, but they bolster the current belief that cell phone use is acceptable in hospitals. In fact, I have noticed a higher density of newfangled Motorola Razrs^® and Palm Treos^® in hospitals than in any community setting. I also know several physicians who have traded their antiquated pagers for the PDA-pager-phone-Batman buckle combos.

• Sources
• Tri JL, Severson RP, Firl AR, Hayes DL, Abenstein JP. Cellular telephone interference with medical equipment. Mayo Clin Proc 2005;80:1286-90.
• Tri JL, Severson RP, Hyberger LK, Hayes DL. Use of cellular telephones in the hospital environment. Mayo Clin Proc 2007;82:282-285.
• Tri JL, Hayes DL, Smith TT, Severson RP. Cellular phone interference with external cardiopulmonary monitoring devices. Mayo Clin Proc 2001;76:11-5.

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In just the past decade, cell phones have evolved from a luxury item reserved for an elite few to a standard personal accessory for the masses. The ubiquity of these devices has dramatically changed the landscape of interpersonal communication, benefitting virtually every industry. Unfortunately, the medical industry, particularly among hospital-based practices, still lags in the adaptation of mobile technology. All too frequent, we may be gently reminded by signs or hospital personnel to not use our cell phones in certain areas. The primary concern with these devices is possible electromagnetic interference (EMI) that would affect sensitive medical equipment. With the advancement of mobile technology and better shielding for medical equipment, this perception may change.

According to several Internet news sites, the Tan Tock Seng Hospital in Singapore recently concluded from an internal study that cell phones pose no significant risk to medical equipment. The hospital is purportedly converting its medical staff from the antiquated pagers to mobile phones. I could not find a reliable source (i.e., journal publication or hospital press release) to verify the reports, so I will not identify any sources.

There have nonetheless been other studies examining the impact of mobile phones on medical equipment. A study published last year in Anesthesia & Analgesia, for example, found that routine use of cell phones was acceptable even in critical care units. There are published specifications on how far the phone may be from a medical device, but a general guideline for a safe distance is 1 meter. I have observed wireless devices used at much closer distances to anesthesia machines without notable effect. But, I did not perform any formal or informal study, so I will not comment further on this.

• Source
• Wallin MK, Marve T, Hakansson PK. Modern wireless telecommunication technologies and their electromagnetic compatibility with life-supporting equipment. Anesth Analg 2005; 101:1393-400.

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