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iPad Pros for Primary Care Residents

Truman Medical Center’s Charitable Foundation has created a technology fund to provide incoming 1st year Family Medicine Resident physicians in the Department of Community and Family Med…

Source: iPad Pros for Primary Care Residents

iPad Pros for Primary Care Residents

Background

ipad-proTruman Medical Center’s Charitable Foundation has created a technology fund to provide incoming 1st year Family Medicine Resident physicians in the Department of Community and Family Medicine the resources necessary to practice medicine in the 21st Century.

  • This fund supports the cost of providing state-of-the art computers for each of the first year residents and to subsidize new technology tools that will help them learn and practice medicine.
  • This June, Truman Medical Center is implementing Cerner’s PowerChart Touch, a native Apple App version of the Electronic Medical Record used throughout Trum2016-05-31_19-44-49an’s system. The rollout will begin with the Department of Community and Family Medicine, with the new resident physicians leading the way.
  • These devices will be particularly helpful in giving resident’s the opportunity to install and use the flood of new mobile applications and app-linked medical
    diagnostic devices built for Apple iPhones and iPads. Effective use of these highly mobile devices will be able to improve the care they provide to Truman’s patients.  In the hands of primary care physicians this technology will help these physicians make speedy diagnoses and a lower cost wherever they are with patients.

Special Fundraising Event

Every year I have a tradition of walking and playing my age in holes of golf.  Later on this year I’ll be turning 66 so on June 23rd I’ll be walking and playing 66 holes of golf with Dr. Timothy Neufeld at the Nicklaus Club of LionsGate.  This year’s goal is $20,000 (roughly $300 per hole).

Stay tuned to my Facebook and Twitter feeds on 6/23 to follow me.  Once again Dr. Paul Terranova, Vice Chancellor for Research Emeritus at The University of Kansas, will be caddying for us.

Help us reach our goal by going on line and making your Tax-Free donation to Truman Medical Center Foundation’s Advanced Technology and Equipment Fund (see instructions below).

How To Make Your Contribution2016-05-31_19-46-38

From a computer or web site

  1. Point your browser to Truman Medical Center’s Charitable Foundation donation page https://app.mobilecause.com/f/v6x/n
  2. Select the amount of your donation (any amount will do but we’re shooting for $300 a hole)
  3. Complete the process conveniently and securely

From a mobile phone

  1. 1. Text “FPTECH” to 41444
  2. 2. Follow the donation link on the reply
  3. 3. Enter the amount and payment information
  4. 4. Encourage all of your friends to help

We will reach our goal if 300 people pledge $1 a hole but of course any amount will be appreciated.  Follow our progress at: https://app.mobilecause.com/public/campaigns_keywords/40425/graph?no_polling=false

Technology Fund for Family Medicine Residents

Background


One of my convictions is:

  • The total cost of healthcare is proportional to the amount of technology available at the primary point of care.

A corollary is:

  • The closer a task is to the patient the more efficient care will be.

Until recently healthcare stood out as an outlier from other industries in that technological advances have not resulted in increased productivity with decreasing costs.  There are a myriad of reasons for this and one big reason is most high end medical technology is found in the most specialized and expensive venues; imaging centers, surgery suites, intensive cares, procedure rooms and sub specialist offices.

This is totally reasonable as over the last 20 years the reimbursement models (especially in the US) were heavily weighted in favor of high-cost procedures.  The return on technology investment in a surgical suite dwarfed that of any investment in a physician’s office.  Subspecialty and hospital based services are relatively large revenue sources.  Comparatively speaking almost no investment was made in the humble exam rooms where the overwhelming majority of care is being delivered.

This is beginning to change.  Newer value-based reimbursement models are now turning the revenue stream on it’s head.  In a shared savings, value-based reimbursement model the extremely expensive surgical suite and subspecialty care become cost centers rather than revenue sources.  The most profitable interventions migrate from the surgery suite and special procedure’s labs outwards to the clinic and even to the patient’s home.  The hospital becomes a “point of failure.”

Unfortunately we’re not ready for this.  Very few, if any, of our training programs are embracing heavy point-of-care technology investments at the periphery of healthcare system.  Physicians in training are not being shown how to exploit the thousands of very low cost yet high-tech devices to augment patient interactions.  The main reason is most primary care programs in Academic Medical Centers do not have the funds needed to purchase hand-held devices and apps to give to their residents-in-training and medical students. That needs to change if we’re going to be able to finally join other industries in leveraging technology to lower the cost of care for our patients.  To this end we’ve created a fund to invest capital in technology as close to the primary point of care as  possible.

Family Medicine Technology Fund


We have created a special technology fund to give Family Medicine Resident physicians at Truman Medical Center’ Department of Community and Family Medicine the resources necessary to practice medicine in the 21st Century.

  • A significant portion of this fund underwrites the cost of providing state-of-the art computers for each
    Smartphone Otoscope for Doctors and Patients

    Smartphone Otoscope for Doctors and Patients

    of the 14 first year residents and subsidizes the cost of upgrading 2nd and 3rd year resident’s devices.

  • Each year we see advanced portable diagnostic devices hitting the market that enable primary care physicians to make more accurate diagnoses immediately in the exam room while engaging their patients. These tools, like Cellscope’s Oto, a smart phone physicians use to capture pictures or movies of a patient’s ears to share immediately with the patient are going to be a fundamental part of the primary care physician’s toolkit.
    Other similar products include the MobiUS SP1 hand-held ultrasound units from companies like Mobisante,  smart phone driven Mobile ECG devices from AliveCor

    Mobile electrocardiogram for physicians and patients

    Mobile electrocardiogram for physicians and patients

    and even more robust solutions like Triomi’s 12-lead EKG device that is being developed by a new startup company here in Kansas City as part of the Sprint Accelerator’s program.
    Other diagnostic programs such as MIR’s Minispir Spirometer are capable of very quickly producing sophisticated flow-volume studies previously only available in specialist’s departments.
    These new instruments put into the hands of primary care physicians tools that speed up and lower the cost of obtaining diagnoses thereby enhancing the value of primary care medicine.
    Unfortunately they are not cost-free and often beyond the budget of our training program and certainly for our individual residents.  A major portion of this technology fund is used to purchase these for our resident physicans to learn to use while they are in our program and better prepared as they begin their careers.

  • This fund has also been used to provide extra large screens for residents to use as second screens for their laptops or stationary workstations. Expanding the screen real estate helps resident physicians in their day-to-day activities and learning by reducing the time needed to display the right information at the right time.

Special Fund Raising Event


Every year I have a tradition of either running my age in miles or, as I’ve gotten much older, switched to walking and playing my age in holes of golf.  This year I’ll be turning 65 so on June 18 or 19 (dependent on weather) I’ll be walking 65 holes of golf.  This year’s goal is $200 per hole or $13,000. Stay tuned to my Facebook and Twitter feeds to follow me.   Once again Dr. Paul Terranova will be caddying for me.  Please help me reach our goal by going on line and making your donation to the Family Medicine Technology fund.

How to Make A Contribution


  1. Point your browser to Truman Medical Center’s Charitable Foundation donation page https://foundation.trumed.org/donate,TMC Charitable Foundation
  2. Select the amount of your donation
  3. Make sure to select the Family Medicine Technology Fund2015-05-07_09-34-17
  4. Complete the process conveniently and securely

Large Screen All-In-One Touchscreen Devices in Exam Room

We implemented large 24″ HP 9100 and 9300 All-In-One touchscreen devices in our clinic’s exam rooms nearly a year ago for several reasons.

New interactive exam room monitors

  • The monitor is as much for the patient and whomever is with them as it is for the nurse or physician using it to document the encounter or provided education
  • Documenting at the point-of-care is easier and more intuitive when it can be shared with the patient
  • The device can be used for interactive diagnostic procedures as well as education
  • Improved productivity with large screens as multiple parts of the chart can be viewed simultaneously or part of the chart (we often have the patient summary open beside the note being created.  This allows the patient and the physician to make sure chronic disease management can be seamlessly worked into a visit for an unrelated acute problem.
  • Touch screen allow us to capture patient input in on-line surveys (pain, anxiety, depression, mental status exams, etc.) as well as display and capture procedure consents that may contain multimedia content and then also capture the patient’s signature  without having to resort to static paper forms that require manual effort to customize and then need to be scanned in.  This has the potential to increase productivity.

    Paperless point of care services

    Everything at the Point-Of-Care

  • Many imaging devices can be connected to these computers and then images captured be displayed on the screen in real-time for the patients to see, learn and be reassured that the diagnosis being made is correct. We are currently using
    • An inexpensive dermatoscope from Bodelin (Proscope) with two lenses; 10x and 30x.
    • Earscope from Dino-Lite
    • Spirometer from Winspir
    • All of our cameras have Eye-Fi cards in them so any photos taken wind up on the network server in a shared drive that we can then open and display on the screen (transfer usually takes less than a minute and begins automatically as soon as the shutter is snapped) and then imported into the EHR.

      Things to Connect into the EMR

  •  Have also experimented with the Littmann 3200 electronic stethoscope with BT connectivity to record WAV filesand capture images of murmurs.  However, BT connectivity issues, cost of Zargis software and length of time to capture a workable waveform interferes with normal visit and until those a resolved we find just playing back a murmur works well.Everyday new devices are being made available daily and we’re constantly being constrained by the limitations of most of the device-centric software and the inability to connect multiple devices at the same time.
  • But the biggest impact for my patients has been the use of the touch screen devices using Google’s BodyBrowser from Google Labs.  This tool is essentially Google Earth for the body and enables the provider and the patient to touch the screen and have that anatomic item identified, rotated, zoomed in and out.  When Google Labs was shut down this application was unavailable for a month or so and not only we physicians but the patients really missed that application. Fortunately this application is now available for free through Zygote Media at Zygotebody.com.

    Showing What Most Patients Never See

  • Secondly, the device is very useful during the examination where we can use our hands as well as the keyboard to illustrate and educate at the same time.  Most patients have no idea what a normal ear drum works like and now we have a lot of anecdotal stories of parents bringing in their children and wanting to see for themselves the child who’s complaining of earache does or doesn’t have a florid otitis media.  They are becoming accustomed to seeing the proof rather than just taking the physician’s word.
    Children also are very tolerant of the the probes if they are seeing on the screen and also can reach out and touch the screen to capture the image.

In addition to these type of uses we’re noticing and beginning to use these for knowledge search and patient education.  It’s not unusual for us to have various web pages, Youtube videos and also getting the patient to show us what they’ve been seeing.

Other use cases that are very handy is for those deaf patients or foreign language patients where we exchange the keyboard to interview them and can have our own words translated automatically in their language (sometime with interesting and comical results).

Going forward we are already noticing that 24″ is too small and are looking forward to upcoming devices and operating systems that would allow us to use MS Surface computing devices from Samsung as the standard exam room device.  The key is that the visit should be something special and be leveraged to engage the patient, increase transparency and generate magic moments where teaching and learning can take place.

What’s all about 90 @ 90?

Where it all began

A number of us in leadership positions at the University of Kansas Medical Center back in the mid 1990’s had a retreat at Deer Creek in Overland Park, KS.  One of the assignments given to each of us was to craft a personal mission statement.  

It just so happened that the year before one of my Japanese patients said that I needed to join a club and play golf if I was going to be the physician for the Japanese Counsulate still located in Kanas City, MO at the time.  I joined Deer Creek which was near to my house and found my soul in the process.  So many life lessons were learned that first year of seriously playing golf. In addition I observed and admired the physical and mental fitness of those 70 and 80 year old members who were playing most days.  Many of them were shooting their ages (something all golfers aspire to) and were living engaged and vibrant lives in their retirements.

Reflecting back on the task at hand; “your mission statement.”  The moderator emphasized this statement should be short, clear and be able to guide. I played around with a few inane, wonkish phrases that all seemed good but didn’t really reflect me. Then suddenly it came to me as my gaze drifted down on the 9th and 18th holes that flowed up to the clubhouse.  What about shooting my age?  At the time it was a long shot as my good scores were barely breaking 90.  Hmmmm.  Ninety.  That’s a good age to live to and even though it’s not a good score in your 40’s it’s a great score in your 90’s.  The doodling stopped an I scratched out “90 at 90” and then changed it to “90 @ 90” with conviction.

That became my mission statement.  For the last 16 years virtually every little decision has been aided by answering, “Will this help or hurt my chances of shooting 90 at 90?”  Now I’m at my high-school sophomore weight, fitter and enjoying life more than I ever thought possible thanks to a crazy little mission statement.

That’s what 90@90 is all about.

A Quick Blog from Windows Live Writer and wheres NHIN when we need it?

So I get a page from my answering service about a patient of mine who I saw late this afternoon.  Turns out the treatment I gave her isn’t taking and she’s in excruciating pain. Logged into my EMR from home, pulled open her chart, reviewed the radiology image and the radiologist’s over-read.  Nothing.  No reason she should be feeling the way she is now.

After a brief discussion it’s obvious there’s nothing I can do over the phone so I ask her which emergency room she’s closest to.  It’s a hospital outside of our system but I tell her to go there as she can barely walk.

Call the ER and let them know she’s coming and ask them if they’d like my note from this afternoon.  Of course they would.  A couple of clicks later I’ve “printed” it to a secure PDF file and zipped it into an e-mail and off it goes.

Shows the importance of electronic access to information and also why we need a National Health Information Network (NHIN) so I wouldn’t have to take even these few steps.

Hello new world!

Just migrated my Spaces blog to WordPress in order take advantages of increased capabilities.

This all was part of the process up updating Windows Live Essentials in which the familiar Messenger becomes integrated with Facebook (but Twitter for some strange reason was left behind) and other social media.  This process has opened my eyes to a new world of computing and information management that has the potential to be as disruptive as the migration of music to the web that occurred over the last half decade.

First, the recent tools essentially integrate local instances of the application with web-based social media. This just streamlines the social communicating by eliminating the need to jump apps to participate in virtual communication. The distinction between e-mail, instant messaging and social media begin to blur and probably will evaporate.

Second, and probably more important, these tools have the potential to eliminate the need for local computing.  It now really doesn’t matter what you by for yourself and essentially the need to carry around a computer wherever you go.

MS Office now is really functional on the web with a stripped down but eminently functional version of Office 10 that enables me to keep relatively simple spreadsheets in sync using any device (hope pivot tables come soon).

 

Ubiquitous access in the making

 

What’s actually happening is that each of us who have a Windows Live account have a virtual Sharepoint services that we can use to manage our documents using any device that can connect to the web.

 

Same look and feel as Office 10

 

This is causing me to rethink cloud based computing.  I attempted to use Google Apps but they behaved too much like web-based applications and also required me to learn and manage different front ends to manipulate the data.  Microsoft’s cloud-based Office, on the other hand, looks and acts identically to Office 10 applications on my PCs and, I’m assuming will mirror the Office 11 apps soon to be available on my Macs.

With regard to spreadsheets, the only feature really missing that I use frequently is pivot tables and once that’s there then it begins to raise the question whether I need to perpetually upgrade to the latest version of Office on all of the 4 machines I use regularly (2 Win7 devices, an iMac and MacPro).

To be sure locally installed programs do have many more features, can be used when not connected to the web, run faster and are not constrained by space or size that would require space upgrades on web sites.  But from a rigorous fiscal perspective it probably makes sense to migrate all of my data to the web and be done with worrying about or putting a lot of expense into locally owned applications.

So what will the world in the near future look like?  My guess is that we will all eventually subscribe to storage and applications in the cloud and be free from having to purchase, haul and struggle with local computers.  Virtually everything will be connected to everything and all we need to do is walk up to any device anywhere in the world, identify ourselves and have immediate access to our own computing resources with unlimited power and storage.

Cool.