Sunday, April 19, 2009

Interactive Everyware Health Care, Web 2.0, Usability, & Electronic Medical Records: The Story. Part Two

My story:

In September and October of 2007, I spent quite a bit of time in and around hospitals and health care facilities, due to my father's declining health. At the time, I was taking a privacy & security/HCI class, and my head was full of information from the courses I'd completed earlier in the year, HCI and Ubiquitous Computing. I was curious to see how all of this worked in health care environments.

I was not impressed. My experiences at the time inspired me to write the following post, including pictures and a video clip: Usability/Interaction Hall of Shame (In a Hospital)

About the same time, Fred Fortin posted his thought on the World Health Care blog about an announcement of ATT's ubiquitous approach towards supporting health care operations.

“The company is offering the devices, infrastructure and systems needed for full-scale tracking applications — everything from tags and software to networks and data storage”. . .providing “a Wi-Fi-enabled location-based service to track equipment, devices and patients. . .”

A few days later, Fortin posted "EMR: The Movie", much to my delight. I hadn't really considered this approach to medical records, but it made perfect sense:

"In a previous post on the “everyware” revolution in health care, I argued, that we’ve come to think of the Electronic Medical Record (EMR) as an electronic snapshot of someone’s medical history and current health status, taken more or less regularly (more likely, irregularly), awaiting to be pulled for direct eyeball examination by the relevant medical expert (subject, of course, to the physics of the medical space/time continuum, otherwise known as the ‘office visit’.)"

"But what if the EMR was more of a movie instead. a continuous flow of real time information collected directly from the source — your body – by arrays of remote, ambient or wearable sensors, with the data ported to an intelligent, networked, expert system geared to flagging critical indicators, thresholds, locations and whatever else, for that matter, that needs monitoring. Out-of-the-norm readings would be protocoled to ‘push’ alerts out to the clinician (and to the empowered patient as well) who would use filtering and editing software tools to find the disease ‘narrative’ that lay hidden in the mountain of electronic data waiting at the ready. All this would happen behind the scenes, building up to the climatic moment when the clinical hands-on examination would take center stage (and only if a virtual one would not do)."

This was my response to his post:

"Having the greater portion of the past few weeks in medical offices, hospitals, and skilled nursing centers due to the illness of a close older relative, I’d agree that EMR “The Movie”, or at least something interactive and visual, would be a good concept."

"Medical professionals explain information verbally, and when a loved one is in a health crisis, much gets lost in translation. During times of stress, auditory working memory isn’t often working at a peak level. This isn’t a good thing when the patient and family members must meet a variety of specialist and health care professionals to discuss and share medical information. A chance to view something like a 3D CAT scan while listening to the medical jargon would definitely work towards reducing “cognitive load”.

My father was in the hospital once again, which gave me some time at his bedside to blog more about

Ubiquitous Computing- Grandpa and grandkids use a web-cam and Skype across the miles; "EMR: The Movie".

In the post, I discussed a new system at Metro Health, a hospital in Grand Rapids, Michigan, that introduced 37-inch TV screens in patient rooms, integrated with Internet access and a means of viewing the patients electronically stored medical records. Interesting.

On a parallel path, Fred Fortin wrote another post, Hospital RFID “Everyware” Hitting Prime Time

"Keeping track of how use of RFID (radio frequency identification) is fast affecting hospital work flows — and in turn of course, the quality of care,– is a bit challenging (see previous posts here, here, here and here). From an article in Health Data Management we see a description of one hospital’s deployment and the benefits it seeks to gain. Pretty impressive. One question is how is all this communicated to the patient and what role do they have in how it’s used on them."

I had another question:

How is this information tracked and stored, and what role does the patient have in giving permission for sharing it? Fortin brought up similar concerns in the following post: Health Care Privacy and the Surveillance State: The Struggle for Balance

How far have things come since then?

My father is still with us, and his journey deep into the health care system over the past month or so has really open my eyes. (Some of this was shared on a previous post: Everyware Health Care: A Personal Focus.)

Although this was not a life or death matter, I was disappointed to learn that the type of hospital TV's remote control my dad used in 2007 was not upgraded by the time of his March 2009 surgery:

2007, 2009 (looks like it was created in 1972)

The TV remote control only scrolls up the channels. If you skip the one you want, you have to scroll through everything again, and if you become distracted, yet again!

Or this?

Some hospitals are up on the latest interactive technology...

There is hope!

Virtual Tour of the eVideon Patient Interface

"Just what the doctor ordered": Metro Health puts video over IP network to educate and entertain its patients 12/19/08 (Via Visionary Solutions, via AVTechnology Magazine, November / December 2008. ©2008 NB Media, Inc.)

"Because the entertainment system is IP based, Optimal installers were able to connect it to the hospital’s HL7 network, a nationally accepted protocol that allows health systems to talk to each other. By connecting the IP network to the HL7, the system can access all patient records, entertainment, educational videos, even admissions information."

The article goes on to explain how the Optimal/eVideon system provides patients at the Michigan Assisted Breathing Center at Metro Health, many who are ventilator-dependent, with options to control the eVideon system with the same devices they use to control other things. For example, a patient who has a sip and puff switch device can control the channels up and down, without going around again. The patient's switches are programmed to control things in their environment along with a selection of TV channels.

eVideon is the company that provides IPTS, or Interactive Patient Television System

"We specialize in delivering personalized, high quality media over your IP network. eVideon is a hospital IPTV solution, bringing interactive educational content, entertainment and customized hospital information to patients and health care professionals."

FYI:eVideon's parent company is Optimal Solutions. The company is involved in health care and education, including something called Infinite Campus, a K-12 Education Process Management system.

Are there any other solutions?
Many companies are busy getting into helping our elder's with "senior moments", and addressing health care, assisted technology, memory, and communication needs more than in the past.During one of my recent "google" searches, I came across a great blog, which inspired my post, "ElderGadget Blog: Useful Tech and Tools"

In terms of electronic medical records, there are several companies that are moving forward:

Microsoft Health Vault attempts to address the needs of application providers, device manufacturers, employers, health plans, health care associations, hospitals, labs and imaging centers, pharmacies & BPM's, and physicians in one way or another.

Information from Microsoft's Health Vault website:
"Put consumers in control of their health information, store it in a central location, and make it easy to share and update. How? With Microsoft HealthVault, a security-enhanced, flexible health solutions platform.

Through HealthVault and the growing ecosystem of connected, patient-friendly applications, people can store copies of their health records obtained from several sources; upload information from health and fitness devices; provide their information to healthcare providers, coaches, and trainers; and access products and services.

HealthVault lets people consolidate their health information into one easily accessible account to help them become more informed and active in managing their health."

Google Health

Health Care is More than Records

As I sat by my father's side in the ICU, I was amazed at all of the people who attended to the bits and pieces of his body.

More links to this topic are at the end of this post.

VistA History Project
VistA -HealtheVet Monograph 2008-09 (doc)
World Health Care Congress April 14-16 2009


  1. I loved your post. I am familiar with this, as my father had multiple doctors and even hospitals (V/A records and private hospital records), and the doctors had no truly effective way to communicate across to each other, and sometimes the data was inaccurate, and at the time quite difficult to get corrected. I believe that having PHRs such as those created with HealthVault, will create better and better informed patient advocates. Looking forward to your next post!

  2. Nice post! I agree that, we need to "Put consumers in control of their health information, store it in a central location, and make it easy to share and update." well said. I think it can also be a big help for them. Anyway, thanks for sharing.