E-Collaboration in Healthcare: Telemedicine & E-Prescription

1. Fellowship Week # 13 E-collaboration for healthcare(Telemedicine / E-prescription) 29th of August, 2010 ITI Smart Village Sunday Week 6 Information Technology Institute

2. Agenda Revision Handouts Group Projects Telemedicine Types Services RSS feeds and Podcasts Lab guide Usage Types Conclusion – Further group work (presentations) 2 hours 2 hours 2 hours Information Technology Institute

3. Revision • Read along the handouts titles… Information Technology Institute

4. Traditional Telemedicine • Teleradiology • Telesurgery • Teleneurology • Telepharmacy • Teleconsultation (email) Information Technology Institute

5. Traditional Telemedicine Teleradiology: by the military, high rate of radiologists. By 2007 most Army x-rays became digital, • Helped the storage, transmission and interpretation of images. • Newer technology a computerized tomography (CT) scan • Small single image server for picture archiving and communication by the vendor MedWeb. Navy hospital ships Mercy and Comfort • Digital images can be transmitted to shore medical centers. • All are board certified; time for an image to be read is < 30mins Practice of radiologists reading films • High resolution monitors and high speed int. connections • Future Standard practice for radiologists, they can deliver interpretations while at home. Information Technology Institute

6. Traditional Telemedicine Telesurgery: Initially, it was used to “telementor” surgeons performing operations in remote sites. In 2001 surgeons in New York were able to successfully perform laparoscopic cholecystectomies (gallbladder removal) on six pigs located in Strasbourg, France. This was followed one year later by the uneventful remote removal of the gallbladder in a 68 year old woman; the first case of telesurgery in a human Information Technology Institute

7. Traditional Telemedicine Teleneurology, many regions lack neurologists and that leads to the increased malpractice risk, but now with telemedicine, the case can be discussed real time and the patient and their x-rays can be viewed remotely by a stroke specialist. REACH Call Inc. developed a web based solution that includes a complete audio-visual package so Neurologists can view the patient and their head CT (CAT scan). Accordingly, the physician can access the images from home or from the office. Information Technology Institute

8. Traditional Telemedicine Telepharmacy, like teleradiology, there was a shortage of pharmacists to review prescriptions. Vendors now sell systems with video cameras to allow pharmacists to approve prescriptions from a remote location. This is important at small medical facilities or after-hours when there is not a pharmacist on location. North Dakota Telepharmacy Project operates 36 remote sites where pharmacy technicians receive approval for a drug by distant pharmacists via teleconferencing. In this manner a full drug inventory is possible even in small rural communities and the pharmacists perform utilization reviews and other services remotely. Information Technology Institute

9. Traditional Telemedicine E-Mail Teleconsultation, Audio and Video teleconferencing is not the only way, to communicate between remote clinicians. The Army has established a Teleconsultation service based on e-mail communication. E-mail would be acceptable only for non-emergency cases. Almost every specialty is available to the military physician located in third world countries and the battlefield as part of the Office of the Surgeon General Teleconsultation Program Information Technology Institute

10. Telerounding • Telerounding,This is a new concept developed to help solve the shortage of physicians and nurses. Telerounding is being rolled out in facilities with reasonably good reviews in spite of the strained doctor-patient relationship. Robot Rounds | E-ICU Rounding Information Technology Institute

11. Telerounding Robot rounds,In 2005 a study showed that: Surgeons could make a second set of rounds using a video camera at the patient’s bedsite (InTouch Robots) A physician assistant makes the actual rounds, backed up by the attending physician remotely via the robot. They can move around and can project x-ray results to the patient. Physician satisfaction has been high but a study at Johns Hopkins showed that only 57% of patients were comfortable with continued robotic care Information Technology Institute

12. Telerounding E-ICU Rounding, There is also a huge shortage of intensivists (physicianas who specialize in ICU care) Why Remote monitoring? ICU beds > normal beds. nighttime hours? An e-ICU service is < expensive than hiring full time int. Avoiding law suits in the ICU also means a cost saving! Mortality rate was 9.4% compared to 12.9% for conventional care Add two-way video feeds so patient’s families can communicate with specialists. Benefits: Improved nursing retention Reduction in insurance costs Drawback: Many understaffed rural hospitals will not be able to afford these (expensive) services unless they are part of a larger network. Information Technology Institute

13. Telehomecare Firsthome monitoring unit was created just 11years ago but the concept is older… At least 55 companies offer technology to monitor patients at home. Vital signs, Weights, Blood sugars, etc. Can be sent wirelessly from homes to physician’s offices and databases. Information Technology Institute

14. Telemedicine Benefits • Decrease number of visits to the doctor • Audio / Video Contact at home – telemonitoring • Healthcare professionals shortage will be comp. • Next era, future is for telemonitoring • Cell phone monitoring (heart example) • Decrease admission to hospitals, allow time for serious cases. • Linking home monitoring devices to EHRs • Save costs, better quality… Information Technology Institute

15. Big Name: Health Buddy “home monitoring” • Data is sent via phone lines • National Committee Certified for QA • desktop decision support SW • Disease management program as it covers 45 disease protocols • Connects to a glucometer, BP machine, weight scales and peak flow meter for asthmatics • Interactive with patients; it asks questions daily 12,000 patients, it increases medication compliance reduce outpatient visits Information Technology Institute

16. Big Name: HoneyWell HomMed • Multilingual Voice messages to patients • Standard and optional features: digital weight scale, blood pressure, oximetry, glucometer, peak flow meter, blood tests (PT/INR), temperature and EKG • Data is transmitted via phone lines • Over 15,000 monitors currently in use and more than 300,000 patients have been monitored • Monitor weighs < 3 lbs • Cost is $3500 for monitoring system  Information Technology Institute

17. Telemanagement Home monitors and sensors Transmit Information Think about the future – refrigerator … Studies suggest: • Reduce hospitalization • Reduce emergency room visits • Pharmacy utilization Information Technology Institute

18. RSS Information Technology Institute

21. What does “RSS” stand for? • Rich Site Summary • Really Simple Syndication • RDF Site Summary

22. RSS = Really Simple Syndication

23. RSS feeds • How Information Technology Institute

24. What are RSS feeds? • Family of “web feeds” • XML, Atom • Feeds send new content to the user – automatic • Usually includes headline, link, and summary - can also include TOCs and search results

25. How do you read feeds? • Requires software • Desktop or Web-based news aggregator • E-mail client or Web browser • Easiest option: Web-based aggregator • Bloglines, MyYahoo, Rojo, Google Reader • http://allrss.com/rssreaders.html • http://www.newsonfeeds.com/faq/aggregators

26. Why we use RSS? • “RSS is … used to publish frequently updated content such as blog entries, news headlines or podcasts. • An RSS document, which is called a "feed," "web feed," or "channel," contains either a summary of content from an associated web site or the full text. • RSS makes it possible for people to keep up with their favorite web sites in an automated manner that's easier than checking them manually.”

27. Web 2.0 Blogs Blog Search Del.icio.us Flickr Groups Wikis Youtube more … Types of Information RSS Can Bring to You • Clinical Guidelines • Grant Opportunities • Journal Table of Contents • News Headlines • News Search Results • Organizational News & Updates • PubMed Search Results • Web Searches

28. RSS Logos • How to tell if there is an RSS feed available. Image from: http://www.cadenhead.org/workbench/news/3088/rss-graphic-under-creative-commons-license

29. "It's like having a personal assistant who goes through every publication and blog that could possibly interest you and picks out stories to bring to your attention" -- PC Magazine Instead of visiting many websites every day, let them send the information to you Get only the news you want RSSto Master the Information Overflow

30. Subscribe to specific searches on Pubmed / search engine and collect them in one place Subscribe to major medical journals RSS links from BBC incorporated in Firefox (Latest Headlines) RSS

31. Demo Two Types: • Web Based: Google Readed • Desktop Based: Feeddemon Information Technology Institute

32. Podcast

33. Podcast is a downloadable audio file you can subscribe via RSS Most major journals feature weekly audio summary of contents You can listen when you commute to work or exercise Make CME portable by using text-to-speech Podcast

34. Podcasting - Where Did It Come From? +

35. Podcasting - What is it? “A podcast is a multimedia file distributed over the Internet using syndicationfeeds, for playback on mobile devices and personal computers “ Wikipedia definition as of 10/27/06

36. Podcasting - Random Facts • Download content as a file - unlike streaming, TV, radio • Time shifting ability - just like TiVO™ • Usually audio (mp3), but now with video as well • Can subscribe to, or not • You don’t even need a pod!

37. How Do I Find Podcasts? • iTunes (www.apple.com/itunes) • Juice (http://juicereceiver.sourceforge.net/) • Podcast Alley (www.podcastalley.com) • Podcast.net (www.podcast.net) • Bloglines (http://www.bloglines.com/) • Search engines • Friends, colleagues

38. How Do I Use a Podcast? • With an aggregator or receiver (shared) • With software on your personal computer (like iTunes, Juice or RSSRadio) • On a mobile device (mp3 player, PDA, cell phone, etc) • On a website using links:

39. How Do I Make a Podcast? • Read the Wikipedia article + links • Hardware (microphone, computer and/or mp3 player/recorder) • Software (Audacity, Adobe Audition, Apple GarageBand, lots of others) • Remember the legal stuff - http://wiki.creativecommons.org/Welcome_To_The_Podcasting_Legal_Guide

40. Podcasts for the People • Johns Hopkins Health & Medicine http://www.hopkinsmedicine.org/mediaII/Podcasts.html • National Public Radiohttp://www.npr.org/rss/podcast/podcast_directory.php • National Geographichttp://www.nationalgeographic.com/podcasts/ • Civil War Traveller Podcastshttp://www.civilwartraveler.com/audio/index.html

41. RSS Feed Libraries • RSS4Lib: http://www.rss4lib.com • RSS Compendium: http://allrss.com/rssfeeds.html

42. RSS Feed Collections • Consumer RSS Feeds on USA.gov: http://www.usa.gov/Topics/Reference_Shelf/Libraries/RSS_Library/Consumer.shtml • Council on Federations: Getting Started with RSS: http://www.cof.org/Council/content.cfm?ItemNumber=1723&navItemNumber=1969

43. RSS Feed Collections: Health / Med / Dent • AAFP: RSS Feeds: http://www.aafp.org/online/en/home/aboutus/theaafp/about/helpcenter/rss.html • Health RSS Feeds on USA.gov: http://www.usa.gov/Topics/Reference_Shelf/Libraries/RSS_Library/Health.shtml • FDA’s RSS News Feeds: http://www.fda.gov/cdrh/rss.html • NIDCR RSS Feeds: http://www.nidcr.nih.gov/rss/ • NIH Library: RSS Feeds for Science and Medicine: http://nihlibrary.nih.gov/ResearchTools/RSSscimed.htm • RSS4Medics: http://www.rss4medics.com/

44. RSS Feeds & Collections: Journals • JAMA Current Issue: http://jama.ama-assn.org/rss/current.xml • JAMA & Archives: RSS Feeds: http://pubs.ama-assn.org/misc/rssfeed.dtl • Lancet: RSS: http://www.thelancet.com/online/rss • Nature Webfeeds: http://www.nature.com/webfeeds/index.html • NEJM Online Feeds: http://content.nejm.org/rss/

45. Examples of RSS Feeds: Publishers: Oxford • European Journal of Public Health

46. Examples of RSS Feeds: NIH Grants

47. Examples of RSS Feeds: MMWR

48. Examples of RSS Feeds: Google Video Search

49. Examples of RSS Feeds: Pubmed Search

50. Feed Readers & Aggregators: Google Reader • http://reader.google.com/