Trends in medicine don’t come screaming around the corner like a Grand Prix race car. They’re more like a meandering river, really. Initially finding their way into research centers or academic hospitals. Some catch hold and work their way into everyday practice while others fall by the wayside. This month we are looking at up and coming trends and future medical technologies. Some of the technologies mentioned here may already be familiar to you, some are right around the bend, some that appear to be beyond our wildest dreams may actually happen, while others may not prove to be as cost effective or beneficial as originally hoped.
Lipid Emulsion Therapy
Some of the most complex tox cases involve multiple ingestants. Lipid emulsion has been used with success in many Emergency Departmentss (including my own Barnes-Jewish Hospital) for concominate beta-blocker and calcium-channel blocker overdoses. This slows the cellular assault of the toxins and allows the body’s metabolism to keep up with the onslaught. Intralipid (originally manufactured by Upjohn but now widely available) is simply a combination of soybean oil, egg yolk, phospholipids, and water. With few side-effects the use of lipid emulsion will soon become a mainstay of the toxicology toolbox.
Telemedicine in a WiFi World
Through the use of cameras and the internet, telemedicine has allowed elite academic centers to assist in the care of patients thousands of miles away in small rural hospitals. This expanding technology, and the pervasiveness of internet connectivity, creates new opportunities within medicine. NASA is using such technology to perform fundoscopic exams on astronauts aboard the International Space Station. I’m sure many of you have been on a recent airliner that has inflight WiFi. In a few years you won’t need a doctor on the plane to diagnose and treat serious medical problems such as myocardial infarctions. The plane’s WiFi network will be used by an EMT-trained flight attendant to send a 12-lead EKG to the airline’s on-call doctor, who can see the patient and communicate through voice and video with the crew and the patient, directing medical care as well as determining the necessity of a potential emergency diversion. This “connectiveness” will also find its way into our every day medical devices. We are already seeing scales that post you weight to Facebook and Twitter (www.withings.com). Soon we’ll have “connected” physician equipment that will allow for the transmission and accumulation of patient data for evaluation. A great example of this already exists with the Littmann 3200 Electronic Stethoscope in conjunction with Zargis Cardioscan software. Prior Littmann electronic stethoscopes allowed users to record and upload sounds. The new generation sends them wirelessly to a computer that then analyzes the sounds to help confirm and identify suspected murmurs etc. Physicians’ equipment will be augmented by patients’ ability to transmit their own information (think blood glucose and AICD/Pacer information) to the web for evaluation by their physicians. Current systems such as those developed by NuMedics allow patients to upload their glucometer readings directly their electronic records at their PMD’s office. Things will only get easier as these devices lose the need for a tethered connection to sync information.
Modern simulation, as most of us think of it, started in the late 60s and early 70s. Comparing today’s Laerdal SimMan 3G to the Harvey of the 70s is like comparing an AMC Gremlin to a Tesla Roadster. They both get you from point A to point B, but the trip is completely different. The cutting edge of simulation has mannequins that can bleed, sweat, and vomit – everything short of full motor function. So where does the future lie? Refinement. Mannequins will become more and more life-like, but we have to be aware of the limits of simulated realism. The closer you get to reality the more the subtle differences stand out. One of the biggest short-comings of this generation of mannequins is that the equipment to make them life-like and portable consumes all of their internal space. Like all things tech, sim mannequins will benefit from the ever-decreasing size of electronics allowing them to become increasingly realistic while allowing physicians to be able to perform the full spectrum of emergency procedures.
**LEARN MORE Sim Man 3G www.laerdal.com (877) 523-7325
Social networking is quickly integrating its way into the fabric of everyday life. Not to be left behind, more and more hospitals are using social applications such as Twitter and Facebook to advertise the services they have to offer patients. Some hospitals even display wait times for their Emergency Departments, including Progress-West in the St. Louis suburbs and Detroit Medical Center’s Surgery Hospital among others. The future will see a continued expansion of these products with an emphasis on managed care systems. Insurers will use software like iTriage to help their customers direct their own care. Imagine an HMO utilizing such software to help a client determine whether or not a current complaint is an emergency. Once their complaint is determined to possibly necessitate an Emergency Department visit, the same program can then direct the patient to which of the HMO’s many facilities has the specialty support for their complaint. Finally, they can determine which of the appropriate facilities is closest and what their wait-times are. All of this will help the insurer and patient save time and money as well as improve satisfaction.
**THE MOST FOLLOWED HOSPITAL ON TWITTER
Mayo Clinic 34,450 followers
St. Jude 6,917 followers
Aurora Health 6,872 followers
Checklists and algorithms have long been a part of decision-making and safety in many fields and are just now working their way into medicine, often with reluctance on the part of physicians. While EPs like to consider themselves independent experts, there is mounting data that the use of systematic approaches to common patient issues through the use of checklists results in better patient outcomes. Current technology provides us rapid access to the information, but we are looking for more than that. The next generation of physicians will likely be using computers incorporated into their equipment to assist in treating patients. Already in the works are ventilators that wean patients through complex mathematical algorithms based on oxygen consumption and demand. A similar example are devices that monitor us as we perform patient care such as MEDUMAT’s Easy CPR that coaches the medical personnel through chest compressions and bagging much like an AED. Allowing technology to assist in the more mundane aspects of patient care frees up the physician and medical staff to spend more time on complex patient issues.
**MEDUMAT Easy CPR www.weinmann.de
According to Moore’s Law, the number of transistors that can be placed inexpensively on an integrated circuit will double approximately every two years, allowing new gadgets to be smaller, cheaper and higher functioning.
Thanks to Moore’s Law, all of our tech continues to get smaller. Most of us take for granted that the PDA in our pocket contains a virtual medical library. This technological pressure continues to shrink the medical devices we use every day. Currently you can wear a $20 LED head lamp that is as bright as a several hundred dollar ENT head lamp, doesn’t need to be plugged in, and can fit in your pocket. Fresh on the market are pocket-sized ultrasound machines that rival the resolution of the much larger older models. V-scan and GE currently have models available for purchase (look for a review soon). This miniaturization revolution is extending into endoscopy and laryngoscopy as well with devices such as those by Envisionier and Storz, where a handheld device is vying to replace carts nearly the size of a hospital bed. Combine this trend with non-invasive lab/monitoring technology, and we may not be too far away from the medical scanners seen in Star Trek, where a simple pass in front of the patient obtains vital signs, serious findings such as internal bleeding or broken bones, and even a diagnosis.
Electronic Medical Records
As we are all aware, there is currently a huge push towards EMR in the United States. Current investment and efforts focus on EMR within a given medical system (i.e. Kaiser-Permanente). To make the use of EMR there will need to be a refocusing of efforts on a centralized EMR system. Google and other companies are already spearheading this effort through self-constructed online records but these efforts are limited as they are managed by the individual. Google’s motto may be, “Don’t be evil,” but there are plenty of people who don’t want to trust their medical records to a company whose revenue model is based on advertising. Everyone knows what this data would be worth to the health care industry, insurance companies, and even employers. So how do we unite the ever-expanding and disparate EMR resources? While certainly divisive, unification of EMR may be a big plus to a government-run health care system.
Kiosk Self Check-In
Patient Registration Kiosks are sprouting up in more and more hospitals and Emergency Department’s. Like self-check-in for the airlines these stations allow users to input a variety of information without taking up time from the already over-worked triage staff. Kiosks that allow patients to input their personal info such as insurance (or lack there-of), address etc. The latest generation of kiosks allows patients to enter complaint-based information providing some initial triaging. This can be very useful in a busy Emergency Department where there may be a line before a patient makes first contact with a health provider. Parkland Hospital in Dallas and Kings County Hospital in Brooklyn are two of the many institutions currently using check-in Kiosks. I could see future versions integrating with automated blood pressure and pulse-oximeter machines to give vital signs as well as chief complaint/HPI alerting staff to concerning findings.
Patient Junction www.patientjunction.com (801) 208-2627
Touch Trak http://www.touchtrak.net/healthcare.aspx (949) 302-6828
MediSolve www.medisolve.ca (416) 259-4224