HEALTH IT: The New iPhone... Dial " H " for Health

Elena Harman — Thu, 10 Jul 2008 14:48:00 -0400

Apple technology brings to mind sleek, hip devices, maybe a miniature music player or a laptop thinner than your hand. Medical technology conjures up thoughts of scary-looking big imaging machines, or maybe computerized health records.

What happens when you put the two together? No, not an MRI machine that plays Johnny Nash. When the iPhone G3 is released tomorrow, it will be paired up with some new medical applications (developed by independent companies) that will put new technologies literally at a doctor's fingertips. Here's a sneak peek at how three widely publicized programs could help improve the quality of care.

Reduce Adverse Drug Effects. Epocrates has been around for a while making clinical reference tools for PDAs and Smartphones, complete with alerts about dangerous drug interactions. The transition to the iPhone brings a slew of new features. The iPhone’s bright colored screen makes it easy to view not just drug information, but also pictures of the pills—and a great new tool: the “Drug Identifier.” Say a patient comes in and says, “ I’m taking a purple three-sided pill, but I don’t know what it’s called." This feature lets the doctor search for images of three-sided purple pills, see what they are prescribed for, show it to the patient, and figure out what he is taking, why he's taking it, and how it interacts with other prescriptions. In a fragmented health care system where patients may see several specialists who don't communicate all that well, this information could go a long way toward preventing unintentional and unknown adverse drug interactions, and even giving a more complete picture of the patient's overall condition. Epocrates was featured at the launch of iPhone 2.0, see a demo here.
Train New Doctors. Remember those multiplication flash cards from third grade? Well, now we have an iPhone anatomy equivalent. The Modality programs take Netter’s Anatomy flashcards, turns them electronic and adds a quiz mode where doctors in training are challenged to identify structures. It even links to outside web resources (handy if you still have your fibia and tibia confused). Modality was featured at the 2008 Apple Worldwide Developers Conference. See a demo here.
Mobile Medical Imaging. MIMVista takes the medical imaging away from those big scary machines and into the hands of physicians, and maybe even patients. The program uses medical images like a meteorologist uses a weather map. It overlays metabolic information (PET scan) over structural information (CT or MRI scans) and its mobility allows the doctor to share the images with the patient. The program also creates a 3-D reconstruction of the body, and the iPhone’s touch screen allows the doctor to investigate the image easily and quickly. Additionally, the program makes it easy to send images to other physicians for remote consultations. MIMVista was featured at the 2008 Apple Worldwide Developers Conference, watch the video (very, very cool):

As we’ve heard from many experts, health IT alone is not a panacea for the health care system, and the iPhone alone certainly won’t fix everything. But innovations like these indicate that the private sector is roaring to go on health IT,and there's got to be tons of really creative stuff being developed that we haven't heard about yet. With a little help from the government, (Congress is working on health IT legislation, HHS is still developing national policies) user-friendly health information technologies could vastly improve the quality of patient care…plus, who wouldn’t want a cool new toy?

COST: Getting the Prescription Right for Medical Imaging

Guy Clifton M.D. — Fri, 28 Mar 2008 16:44:00 -0400

Medical imaging, such as CT scans and MRIs, has become synonymous with medical cost growth, and both private insurance and Medicare looking for ways to rein in costs, according to a recent AP article by Linda Johnson.

Citing work done by the Center for Studying Health System Change, the article noted that from 2000 to 2005 the use CT scans in the U.S. rose from 12 scans per 100 people to 22-with each test generating between $500-$1000 in revenue. During that same period, Medicare's spending on imaging services nearly doubled from $6.4 billion to $12.0 billion, accounting for 23 percent of total outpatient hospital payments in 2005, according to MedPAC-Congress's advisory committee on Medicare.

Concerns are not just about the costs, but also the quality and value of the imaging services. Growth in CT scans—which expose the body to much more radiation than X-rays—has led some doctors to conclude that the amount of radiation exposure may actually increase the rates of cancer in future years (subscription required). Insurers have responded to the growth in imaging by requiring precertification before ordering new studies, much to the chagrin of some doctors and radiologists,

The problem is that no one can distinguish necessary from unnecessary imaging and all the financial incentives in medicine are for over-performance of imaging. One-third of medical malpractice suits are for failure to diagnose, so if a doctor has the slightest question about whether a symptom heralds something serious, an imaging study is ordered. The care of an individual patient is highly disorganized because patients are cared for by multiple doctors who rarely know what the other has done. Unless a single doctor is coordinating or managing the care of a patient—which is rare—duplicate studies are commonplace. Another factor is that no one measures the quality of a doctor's practice and without standards of performance who is to know necessary from gratuitous imaging? Even when there are standards for performance, such as in coronary angiography, the evidence is overwhelming that those standards are not followed with any regularity. Furthermore, in an effort to increase income, doctors have increasingly installed imaging units in their office rather than referring patients to radiology facilities for studies, further escalating the problem of unneeded studies.

The only way out of this box is to gather more information on what does and does not work, establish clear standards for the use of imaging, to hold doctors accountable to those standards—such as paying only for a standard workup unless the doctor certifies the need for additional studies in unusual cases—and to hold doctors harmless from medical malpractice suits for failure to diagnose if they follow those standards.