• A surge in scanner purchases by
  family practitioners in the US is drawing dollars and ire from radiologists.
  It adds to costs by increasing the purchase of scanners, but it reduces costs by
  reducing the involvement of expensive radiologists and possibly by improving
  quality through earlier diagnosis of preventable or treatable disease. It also
  presumably improves the attraction of being a primary care physician. 
• A haptic virtual hand under
  development in the UK will likely be helping train nurses in venopuncture and
  possibly cervical smear-taking by 2006, potentially greatly reducing the time,
  cost, and risks of training on plastic simulators and real patients. We foresee
  this technology as becoming fundamental in all invasive procedures, from giving
  injections to performing laparoscopic surgery; although the injections part may
  disappear with the advent of needle-less drug delivery methods, one of which is
  described in the Therapeuticssection.

An angiogram goes for $1,052 (US dollars, we assume) plus five percent
service tax, comparable to about $1,000 in Thailand. The hospital offers
comprehensive packages for both patients and their families, including arranging
airport transfers, booking hotels, and arranging local tours.

Reference: Lloyd-Smith, Jake (2004). �Singapore
Aims to Lure �Medical Tourists.�� AP via Yahoo News, August 27.

Going National

Because of what its COO described as a �maxed out� local pediatrics market,
Boston�s Children�s Hospital�ranked by US News & World Report as the
country�s second best pediatric hospital�has been marketing itself nationwide
since May through magazine ads in Time and Newsweek, TV test spots in Rochester
and Buffalo, NY, a national contract with Yahoo.com, and a make-over of its
website. The campaign�s theme is �Where to Turn When a Childhood Is
Interrupted,� writes Liz Kowalczyk in the Boston Globe. The ads focused
on �devotion, innovation, and optimism.� An agency donated more than 1,000 hours
to create the branding and marketing campaign, while Children�s paid for the ad
placements.

Kowalczyk ascribes the moves partly to loosening geographic restrictions on
health plan members, and on the growing specialization of medicine, which leaves
some specialists thin on the ground and not available locally. Children�s, for
example, has a pediatric surgeon who specializes in a rare vascular birth
defect. Not only are there few physicians who can treat the disorder�there are
also very few patients�just one, in fact, in the Boston area, and an adult one
at that. However, marketing beyond a service area is more expensive than many
hospitals can afford, and it can cause friction among physicians who see it as
poaching on their territory.

Partners HealthCare, the parent organization of Brigham & Women�s
Hospital and Massachusetts General Hospital, began advertising cardiac services
on New England Cable News in June.

Reference: Kowalczyk, Liz (2004). �Hospital,
market thyself: Children�s promoting its specialized services to a national
audience.� Boston Globe, July 29.

Hospitals as Entertainment

The Cleveland Clinic is offering good times to seniors�sponsoring trips to
horse races, baseball games, and a New York casino, reports Susan Jaffe in the
Plain Dealer. Further: �University Hospitals is expanding its seniors
program to include discounts on cell phones, sporting events and 80 other
businesses, [and] MetroHealth Medical Center offers senior discounts at its hair
salon, its cafeteria and for eyeglasses.�

Seniors she interviewed told Jaffe they liked the good and inexpensive
(half-price for seniors) food in the cafeteria, the free exercise and cooking
classes, and the opportunity �to meet people, go places, and do things.� Other
hospitals in the region offer disease prevention lectures and cancer screenings,
and one even holds �annual Big Band dances held at banquet facilities that have
attracted 2,000 members. Another offers computer classes, training sessions on
care-giving, and post-retirement planning, free �lunch and learn� series, trips
at minimal charge to a ballpark, a dinner theater, a New York casino, and an
Amish wedding. The Clinic has collaborated with a national group that organizes
courses in the arts, culture, health and volunteer service for older adults in
conjunction with medical institutions and department stores across the country.

All this is more than just smart marketing and relationship-building; it is
also good healthcare: �Social and cultural activities appeal to active seniors
and keep them healthy,� the Cleveland Clinic�s director of community relations
told Jaffe. A business professor told her such a strategy was consistent with
increased hospital advertising, and successful, as attendance at the events
bears out.

Reference: Jaffe, Susan (2004). �Not
at all sick of being in a hospital: Programs, meals draw scores of seniors.�
Plain Dealer, July 28.

Telecommuting

A recent survey predicts that 44 million US workers will be telecommuting, or
working from home at least on a part-time basis, this year, and the number will
grow to 51 million by 2008, with 14 million working full-time at home. The
report notes that the rise in telecommuting has fuelled growth in broadband to
the home. Presumably, the effect is reciprocal.

Reference: Unknown (2004). �US has 44
million telecommuters: survey.� AFP via The Age (Melbourne, Aus.), July
21.

Telemedicine in Space

In October, NASA astronauts and a Canadian doctor will test the latest
concepts in what Science Daily calls �long-distance house calls�
involving telemonitoring and telerobotic surgery. The house calls would enable
physicians on Earth to provide healthcare, including emergency surgery, to
astronauts in space, though the concepts are first being tested on a simulated
patient in an underwater simulated space environment on Earth.

The ten-day �NEEMO 7� test will demonstrate and evaluate innovative
technologies and procedures for remote surgery. In one test, the doctor will
remotely guide the aquanauts through diagnosis and surgery on the mock patient.
In another, virtual-reality control technology will guide telerobotic surgery on
the mock patient.

Reference: Unknown (2004). �Undersea
Habitat Becomes Experimental Hospital For NEEMO 7.� Science Daily, adapted
from a NASA/Johnson Space Center press release, August 13.

Schism over Scanners

Diagnostic imaging is lucrative, fast-growing, and migrating from expensive
radiologists to family physicians and other non-radiologists, writes Lola
Butcher in the Business Journal of Kansas City. Given the mushrooming
overall costs of diagnostic imaging, it makes sense that government and private
payors would encourage the trend�and they are, by giving incentivizing
non-radiologists through reimbursements to buy scanning equipment, even though
the images still need to be interpreted by a radiologist.

But that too raises costs, since MRI, CT, and PET scanners are themselves
expensive. The president of Diagnostic Imaging Centers (who of course has a
vested interest) is also against the trend, and claims non-radiologists �order a
lot of excess exams that don�t need to be ordered.� His views would presumably
be supported by the radiologists who wrote a journal article estimating that
unnecessary imaging by non-radiologists costs the system $16 billion a year.

A family practitioner points out that patients want imaging done in the
convenience of their doctor�s office and that the timeliness of having scans
made there improves health care.

Reference: Butcher, Lola (2004). �Radiologists:
Docs don�t get the big picture.� Business Journal of Kansas City, August 27.

Virtual Hand

Perhaps by 2006, nurse trainees could be learning venopuncture skills on a
haptic virtual reality hand under development at British firm UK Haptics. An
executive told Jo Twist of BBC News Online: �You can feel the needle go through
the skin; you can put it in the skin and lift it out. You can feel the soft skin
and muscles and you can scratch the bone if you put it in the knuckle.� Student
nurses who have tried a prototype said they preferred it to conventional plastic
hands with replaceable pads containing the complex vein structures.

Those hands �give little idea of the pressure needed to puncture the skin,
and are not too realistic,� writes Twist, and at UK�300 for a hand and �65 for
pads it is cost-prohibitive to purchase multiple different hand types such as
elderly, infant, and injured hands for nurse training. The virtual reality
model, presumably, could be turned into any hand type at the click of a mouse,
since it is primarily software-based. Twist describes the use of the system as
follows: �Nurses sit in front of a PC wearing 3D goggles. A mirror in front of
them lets them see the projected hand image in 3D too. All the nurse has to do
is sit in front of the machine and stick the cannula, which they see as a
syringe, into the hand. The system feeds back information about pressure, and
blood appears to fill the syringe when the vein has been punctured. It will tell
users if too much pressure has been applied, and when the vein has been missed.�

The company told her the system could also be adapted for other uses, such as
cervical smear simulation. Currently nurses have to practice on at least 35
women until they are considered fully trained.

Reference: Twist, Jo (2004). �Virtual
veins give nurses a hand.� BBC News, August 20.