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?

It was not long ago when mobile phones were considered luxury items or tools reserved for corporate executives. A decade and a half later, every Joe, Jane, and their child now sport a cell phone or some multimedia-capable variant thereof. Fortunately for the general populace and myself, a recent case-control study done in Japan has shown no significant relationship between mobile phone use and brain cancer. There have been many other studies with similar findings, but this is the first to further analyze the spatial relationship between radiofrequency exposure and tumor location.

The case population included 322 patients newly diagnosed with a brain tumor (88 with glioma, 132 with meningioma, and 102 with a pituitary adenoma). They were pooled from neurosurgery departments throughout Tokyo and 25 neighboring cities. The control group comprised of 683 healthy volunteers who were randomly contacted by cell phone. From both groups, the study participants were interviewed on their patterns of cell phone use: type of phone, length of use, average duration per call, frequency of calls, etc. Use of cordless telephones was also considered. The study further analyzed the 3D spatial relationship between source of radiofrequency exposure and location of tumor. These data were used to estimate a specific absorption rate (SAR) within the tumor.

The study did not find a significant increase in the odds (presented as odds ratio with 95% confidence interval) of the three tumor types with typical use of mobile phones. There was no significant difference found in incidence of tumor with increased cumulative time of use. There was also no substantial increase in risk when analyzing subgroups according to mean levels of maximal SAR. The researchers therefore conclude that there was “no increase in overall risk of glioma or meningioma in relation to regular mobile phone use among [their] Japanese subjects“.

It is interesting to note how the general public had embraced mobile phones long before learning of its relative safety. Could this be attributed to our collective state of denial (”it won’t affect me“), the immense utility and convenience of the device overweighing any potential health risks, or the sheer skill of the Sprint-Verizon-Cingular- marketing machine? Fortunately, most research studies have so far dismissed links between mobile phone emissions and brain cancer. But what if they didn’t?

Related Post: Mobile phones are safe in hospitals

• Source
• Takebayashi T, Varsier N, Kikuchi Y, Wake K, Taki M, Watanabe S, Akiba S, Yamaguchi N. Mobile phone use, exposure to radiofrequency electromagnetic field, and brain tumour: a case-control study. Br J Cancer 2008;98:652-9.

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.

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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Imagine this far-fetched hypothetical scenario where an overworked, sleep-deprived, and hypoglycemic post-call resident is driving home (unbelievable, huh?). During a brief moment of weakness, he drifts to the right, but rapidly corrects his driving trajectory. However, a highway patrolman, Officer Poelis, is sitting along the shoulder of the road and notices the momentary lapse in the driver’s control. Sirens blare and the resident stops his car. Given the circumstances, the resident’s erratic driving behavior probably resulted from his prolonged lack of food and sleep. Officer Poelis, however, suspects that alcohol is involved and asks the resident to take a breath test. To the resident’s shock and surprise, he tests positive for alcohol despite not having had any alcoholic beverages since the last Residents Night Out party two weeks earlier.

Although a seemingly stretched hypothetical scenario, it is not beyond the realm of possibility. A Swedish group recently published a case report of a 59 year-old non-drinker who was unable to start a motor vehicle equipped with an alcohol ignition interlock device. A second breath-alcohol test revealed a blood alcohol level of 0.01-0.02 g/dL. These results were shocking, considering the gentleman has remained abstinent from alcohol his entire life.

There is nevertheless a biochemical explanation for the false alcohol reading. In an attempt to lose weight, the patient was on a very low calorie diet (VLCD). People on such diets or prolonged fasting states depend on fat metabolism for energy. Three forms of ketone bodies (acetone, acetoacetate, beta-hydroxybutyrate) subsequently accumulate in the body. The acetone can be metabolized by the liver to form isopropanol. A drawback of the breath-alcohol analyzer is that it cannot differentiate isopropanol from ethanol (the form of alcohol found in liquor). Consequently, despite the lack of substance use, he was recorded to have had an elevated concentration of alcohol in his breath.

Fortunately, blood alcohol tests utilize gas chromatography, which generate more specific results. This method could be used to verify false positives, but I doubt we will see bulky gas chromatograms in squad cars anytime in the near future.

Since this is the first case report of its kind, it is still unclear whether prolonged fasting states relate to a false positive reading. Besides the obvious warning to not drink and drive, I would strongly discourage the use of this excuse if caught. It would be much easier and safer to just find a designated driver. In the case of a resident on q4 call, finding a willing volunteer may be more difficult to accomplish.

• Source
• Jones AW, Rossner S. False-positive breath-alcohol test after a ketogenic diet. Int J Obes 2007;31:559-61.

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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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