The Daily Scan

Paging Dr. Luddite

Kard Robstad: Paging Dr. Luddite.

There have been a couple blog posts floating around the inter-tubes recently (like this one from C|Net News) concerning the digitalization of health care and the transition to EMR’s.  Some of them, however, have taken an interesting tack, pointing out that doctors, as a whole, are ‘luddites’.

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Are we that bad?  Unfortunately, we might be… 

First, granted- not everyone is technologically savvy, and granted that many doctors work well beyond the usual tenure of retirement, and those folks are less likely to be adept at mousing and typing, but in four years of medical school and two years of residency, I have definitely noticed that my peers, people in their mid-twenties and early thirties, are surprisingly lost when it comes to technology! 

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Hopefully we as a field will see the inevitable trajectory of our field and adapt accordingly, otherwise we could be in for quite a bumpy ride!

It is notable that the College of American Pathologists have come out strongly in favor of educating their members to the benefits and uses of new technology, and have made an active project out of promoting Information as a Disruptive Technology.

Cougar trial sees big response to prostate cancer drug

FierceBiotech reports Cougar trial sees big response to prostate cancer drug:

Cougar Biotechnology revealed some new clinical trial data this morning that helps explain why Johnson & Johnson is willing to pay nearly a billion dollars for the company.

Researchers say that Cougar's lead drug candidate--abiraterone acetate--produced positive data in a small clinical study on prostate tumors.  Abiraterone is designed to stop the body from producing a hormone tumor cells thrive on.  Imaging scans of the 54 patients in the study demonstrated that nine of 24 subjects demonstrated a decrease in tumor size.  Significantly, 28 of 42 patients who completed the study demonstrated a reduction in PSA of at least 50 percent.  Eight patients saw their PSA levels drop by 90 percent or more.

Excellent!

HIPAA remains the EMR deterrent?

Dana Blankenhorn of ZDNet recently opined that HIPAA remains the EMR deterrent:

Most of these problems come out of the HIPAA law, but more of them come out of the need for that law. The law is necessary because insurers routinely use health records to raise prices or deny coverage altogether. Employers seeking to limit their own costs share this incentive to pry.

HIPAA was a band-aid around this gaping wound. Almost as soon as the law was passed an arms race began, fueled by lawyers and lobbyists, aimed at getting around the law. Many doctors opted-out of the war, taking advantage of a provision that allowed small practices to stick with paper.

Without HIPAA, and the need for HIPAA, there is no doubt more doctors would be paperless. We might have already gone through several generations of electronic systems, and ironed out many bugs that still exist.

What do you think, is this true?  I've been thinking that lack of a clear ROI has been the main EMR deterrent, and an asymetry between the parties who benefit (patients and physicians) and the parties who have to pay for the systems (hospitals and labs).  HIPAA is definitely a consideration for the implementation of EMR - you might even say it is an issue - but whether it is truly a deterrent remains a matter for debate...

Virus Tamed To Destroy Cancer Cells But Leave Healthy Cells Unharmed

ScienceDaily reports Virus Tamed To Destroy Cancer Cells But Leave Healthy Cells Unharmed:

Scientists at Oxford University have tamed a virus so that it attacks and destroys cancer cells but does not harm healthy cells.  They determined how to produce replication-competent viruses with key toxicities removed, providing a new platform for development of improved cancer treatments and better vaccines for a broad range of viral diseases.

Excellent!

Modified naturally-occurring viruses have already had important uses in medicine including their use as vaccines, notably for measles, mumps, polio, influenza, and chicken pox. They have already been developed as potential cancer-killing therapies, in an approach called virotherapy.

More like this, please :)

chalk tip #16: ImageScope joystick mode

Did you know ImageScope has a “joystick mode”?  Actually we call it “autopan”, and it lets you use your mouse or trackpad as if it were a joystick for panning around within an image.  Using it is simple; any time you have an image open, click the mouse wheel (or the center button of your trackpad).  The mouse cursor will change into a little box, like this:

Now move your mouse (or brush your trackpad) in the direction you want to pan, as if it were a joystick, and the image will move in that direction:

The image will keep moving until you move your mouse (or brush your trackpad) back to the original position, you do not have to keep moving your mouse.  You can change direction just by moving your mouse in a new direction.  The further you move it, the faster the image will pan.

To exit joystick mode, just click the mouse wheel again (or the center button of your trackpad).  Joystick mode is easier to use than to explain, so please try it!

Oh, and if you don’t have a clickable mouse wheel or middle button, you can right-click and select “autopan”:

(As you can see, you can also select other tools by right-clicking; but that’s a chalk tip for another day :)

Taking your health record with you

CNet has an image gallery of online personal health tools:  taking your health record with you. 

There's a pretty sizable group of consumers who are going online and using Web 2.0 tools to not quite manage their own health but at least to communicate with others," according to Matthew Holt, co-founder of the Health 2.0 event and author of The Health Care Blog. "(Companies) are trying to make a connection between the data that exists in various places in the health care system and those consumers (who) want to be proactive in their health."

Ah, but do the EHR's include the pathology information?  They should :)

chalk tip #15: sorting lists in Spectrum

Today's tip is simple but really useful: When displaying lists in Spectrum, you can sort on any field by clicking its column header.  This works for search results too.

Please try it!

Dragging health records into the Digital Age

From CNet News: Dragging health records into the Digital Age.

Walk though a typical Kaiser Permanente doctor's office or hospital, and you won't find a paper chart lying around. Kaiser, with 450 hospitals and offices around the country, is almost entirely paperless.

But as the rest of the health care industry rushes to follow in Kaiser's digital footsteps, Kaiser's paperless success story--a 10-year, $4 billion effort--might actually serve as a cautionary tale.

By no means has the Kaiser e-health project failed. In fact, besides some hiccups, it has gone well: Kaiser said it has seen more satisfied patients and a slight dip in emergency room visits and hospital stays, which cuts costs. Even the doctors grumbling the loudest beforehand don't know what they would do if they were forced back to paper.

Unfortunately, the rest of the health care system looks nothing like Kaiser.

The article is a bit dramatic but it does touch on the various problems with implementing digital EHR broadly.  It is notable that most of the problems are not actually with the technology itself, they concern how to deploy it, new issues like access security that don't come up as much with paper records, and of course how to pay for the systems...

EHR driven by ARRA

Get on the bus! 

Yes, Live, from everywhere, it’s the EHR stimulus tour… I’m not sure this is what President Obama had in mind with the American Recovery and Reinvestment Act (ARRA), but the money is definitely driving activity.  Whether it will result in more and better adoption of EHR, and more importantly more and better medical care, remains to be seen…  it is definitely resulting in more and better attention paid to EHR...  including the formation of the EHR Stimulus Alliance.

And in other EHR news, Quest are Microsoft’s latest HealthVault customer.  I hope one of their goals will be to enhance HealthVault to link to digital pathology images…

ACLU wants patents on gene tests declared unconstitutional

ArsTechnica reports on the interesting lawsuit filed by the ACLU against Myriad Genetics: ACLU wants patents on gene tests declared unconstitutional:

Gene patents have always been a contentious topic, as many have questioned whether the products of millions of years of evolution really merits the same sort of protection that a new process technology does.  Nevertheless, the issue appeared to be diminishing in importance, as the rate of gene patenting dropped and most researchers weren't finding their work inhibited by patents.  Now, it appears that the issue will be coming back to the fore, as the ACLU is announcing a major lawsuit against Myriad Genetics, which holds patents related to testing for mutations in the BRCA1 and BRCA2 genes, which are often mutated in hereditary breast cancer cases.

This is going to be quite a fight, closely watched in many quarters.  It does seem like patenting something which exists anyway, a "discovered innovation", has less standing than creating something which never existed before.