The accelerating introduction of new surgical technologies creates a need forsuitably equipped training facilities, of which there are currently very few. Doctors need to keep up with not just medical technologies, however, but information technologies (IT) also, or risk patients’ taking medical matters into their own hands. IT is too much of both threat and opportunity to ignore, as the drug companies know: Their consumer health websites tend not only to disintermediate the doctor, but to under-inform the patient as well, making it a win-lose-lose proposition as between drug company, doctor, and patient.AI-based software that matches candidates to jobscould help healthcare staff recruiters eliminate phsyician candidates who don’t measure up in IT skills. But it’s not just individuals who are failing to understand the threats and opportunities of technology: A Boston hospital is apparently (mis)using a sophisticated robot to do what an EMR system could dofaster, better, cheaper.Finally, regulatory hurdles to stem cell therapy trialsare leading some U.S. institutions to move their trials overseas.

Modern Surgical Training

The Florida Hospital Celebration Health Surgical Learning Institute (SLI) is one of only a few high-tech training facilities for doctors in the country. Such facilities keep their students abreast of fast-changing, high-tech, minimally invasive surgical techniques. SLI boasts a training suite with eight operating tables, each with its own camera, display, and Web connection.

Trainees can watch procedures under way in SLI’s OR suite or at other hospitals while manipulating the same high tech surgical tools on cadaver tissue. They have simultaneous close-up views of the patient and wide angle views of the OR.

Doctors anywhere can watch both training sessions and real operations over a broadband Internet connection.

We can expect to see more demand for such facilities as technology accelerates, and medical schools that do not provide them may lose students and CME clients to those that do.

Reference: Cobbs, Chris (2003). “Surgeons perfect their skills at institute.” Orlando Sentinel, June 16.

Professional Care, Self-care, and the Internet

Within two days of one another, articles in the Wall Street Journal and the New York Times dealt, respectively, with physicians’ continuing general aversion to using email for patient consultations, and frustrated patients’ flocking to online sources for medical help. The Journal documents the litany of physician fears, real and imagined, while the Times tells the story of patients “grappling with little-known diseases” through online support groups, getting advice on procedures, the length of recovery, and ways to change a tracheotomy tube at home. “The hospital only gave us so much information,” said one mother of a sick child. “Everything we’ve gotten has been from the Internet.” And she is a nurse.

The International Rare Disease Support Network, created by one frustrated father of a sick child, now links people to more than 1,000 online groups for specific disorders. A similarly afflicted parent scanned his son’s medical record and emailed it to hundreds of doctors and scientists. These people are alert to the dangers of misleading information and reaching faulty conclusions and self-diagnoses, but evidently they are willing to take the risk.

The message in all of this is that in failing to apply advances in information technology to the practice of medicine, physicians may be taking themselves out of the practice of medicine, at least as they have known it for a hundred years.

References: Landro, Laura (2003). “Doctors Fear E-Mail’s Effect On Care, Privacy, Liability.” Wall Street Journal, June 2; Tuller, David (2003). “Virtual World of Support for Real World Woes.” New York Times, June 3.

Disintermediation

“Disease information you can trust” is the tagline to Novartis Pharamaceuticals’ consumer health website SimplyStated.com. Most if not all drug companies provide or sponsor such websites. “Despite the new packaging, the primary usefulness of most pharmaceutical company Web sites still is to find out more about the drugs they make,” says Wall Street Journal correspondent Laura Landro, whose well-researched and -written article includes a comparison chart of different drug company Web sites and what they offer.

Noting the “thinness” of information on SimplyStated.com, she cautions consumers to “be wary of the objectivity and breadth of information about a disease provided by a company that makes a drug to treat it.” At the same time, FDA rules place restrictions on drug company websites that don’t apply to others. A drug company can’t make claims about drugs it doesn’t produce, or market drugs not yet approved, for example.

Reference: Landro, Laura (2003). “The Informed Patient: Drug Makers Retool Web Sites With Broad Health Offerings.” Wall Street Journal, June 5.

AI and Staff Recruitment

A press release for “Smart Genie” software claims it can analyze a job specification and resumes, and then rank job applicants for suitability. The artificial intelligence (AI)-based predictive modeling software is claimed to be able to spot the difference between a skill acquired academically, and one acquired through experience. It is intended to help recruiters eliminate time wasted on low-suitability resumes and give them more time to assess the really promising applicants for a job.

By storing and learning from information from resumes collected from users worldwide, the program gets continually better at recognizing relevant skills and quality candidates, and “will completely eliminate the need for recruiters to maintain an up-to-date skills library.”

We don’t know if these claims are accurate, but have no doubt that machine inroads into human decision making will continue to accelerate.

Reference: Unknown (2003). “People Genie spearheads the European launch of artificial intelligence technology.” Onrec.com website, June 13; see also.

 

Robots in Practice

We were surprised to learn that for several years apparently, Children’s Hospital Boston has used a 600lb, five-foot-tall wheeled robot to deliver medical records to nursing stations. The robot is guided by sensors and wireless communications and contains a fingerprint reader so only pre-authorized individuals can access the charts it carries. The hospital estimates that the robot saves at least an hour-and-a-half of staff time per day, compared to the old trolley delivery system. The robot is now being adapted to carry medications, as well.

We were especially surprised because, assuming the report is complete and accurate, it shows an example of healthcare’s curious (to put it kindly) approach to IT. Why build an ultra-sophisticated robot to deliver stone-age paper records–with all their well-known inherent quality-lowering problems–at a snail’s pace, instead of computerizing the records and delivering them over a network at lightspeed to wherever they need to be?

They could even be fairly easily retrofitted to work like InTouch’s roving robodocs, of which four are currently installed in nursing homes and a hospital to enable virtual visits by a remote physician. Sitting atop the five-foot-tall wheeled robot is a computer screen that shows the physician’s face and voice to the patient. A camera on the robot lets the doctor see the patients, and a joystick lets him or her maneuver the robot around a room. The robot costs $3,000 a month to rent.

This is somewhat limited functionality, but clearly some facilities anticipate a benefit, and in HFD‘s opinion it represents the start of a trend to much greater use of robots in nursing homes.

References: Hall, Barbara (2003). “Make way for the gofer, kids.” Boston Globe, June 1. Unknown (2003). “Robot delivers medical records at Boston hospital.” Wall Street Journal, June 4 citing the Boston Globe article just referenced; Associated Press (2003).

“Remote robot provides medical care to patients.” (Source/URL lost.) See also Domestic/Commercial Service Robots in Health Futures Digest, January 2003.

$nbsp;

Stem Cell Therapy

The Michigan youth who received a pioneering but unauthorized stem cell transplantafter his heart was punctured by a nail gun has made a good recovery, but it is not known whether the recovery is attributable to the therapy or to other factors, and the FDA has refused to allow the hospital to try the transplant in more patients. The refusal comes despite mounting enthusiasm among experts for stem cell treatment of heart attack and chronic heart disease patients, though even companies developing stem cell treatments share the FDA’s caution, because the research data are contradictory.

In response to regulatory reluctance at home, some US researchers are taking their human research overseas. The Texas Heart Institute, for example, has conducted stem call heart therapy on patients in Brazil.

One can certainly sympathize with every side of this argument, and the FDA is in the unenviable position of a sword-drawn Solomon facing a baby with two real mothers. Health Futures Digest would simply point out the real-world

inevitability, under ungoverned globalization, of promising research moving offshore if it is hampered at home.

Reference: Regalado, Antonio (2003). “FDA Holds Up Hospital’s Work With Transplanted Stem Cells.” Wall Street Journal, June 12.