Amazon Fire Tablet Deal

We have previously written about tablets for medical students, and why you might want one. If you're not sold on a top of the iPad Pro, consider this deal for an Amazon Fire Tablet Essentials Bundle (16GB):

Simply enter the code FIREBUNDLE at check out and get the 16GB version, case, and a screen protector for less than you would spend for the tablet itself. If you do get any kind of tablet, a case or cover is a must. Think about it: between carrying it to and from the classroom, library, or wards, the various fluids and substances in a healthcare setting, and the possibility of others using it, the tablet is prone to falls. As we discussed recently, you should also consider the pros and cons of getting a warranty.

In addition to a case, you should consider a Bluetooth keyboard. I'm personally a huge fan of the Kensington keyboard/case combo I got for my iPad Air 2, the Kensington Key Folio Thin X3:


It works great, is backlit, and last for almost a solid *year* on a single charge via microUSB. It has proven invaluable for taking notes and making the device more functional. The combination practically serves as a laptop replacement for most light to moderate computing tasks. Not to mention weighing a ton less! For any medical student with limited carrying / storage space, such a compact solution is a definite plus. 

Should I Get A Warranty For My Device?

Many medical students will end up purchasing various devices such as tablets over the course of their training. When purchasing the device, a question that inevitably arises is: should I purchase additional coverage for any damage to my device? Admittedly, this topic is indirectly related to medical education. However, given that many of you are on limited budgets, it is a fair issue to consider. Buying a warranty vs. saving your money and being careful both have merit. Consider your own situation specifically before making a final decision

Why You Should Get A Warranty

As a medical student, your device is going to be more mobile and in more varied environments than someone who merely uses their device to binge on Netflix. Not only should definitely buy a case to protect your investment from minor scratches, wear, and tear, you should definitely consider a warranty in the event that your device is lost or stolen. Another major factor to consider is your own track record with devices. If you often drop items or otherwise damage them, you should be more inclined to purchase an extended warranty.


Why You Should Avoid A Warranty

Given the ever-shortening upgrade cycle in tech, you will most likely upgrade your device by the time you may incur any damage worthy of replacement. As prices are generally falling over time, the money saved up front may be enough to cover a brand-new replacement device. A rule of thumb for determining whether a warranty is worthwhile is to calculate the implied risk. The formula is simple:

100 x (Insurance Premium / Item Cost)

For example, if a device costs $200 and the extended warranty costs $40, then the implied risk is 100 x $40 / $20, or 20%. Now, ask yourself: is there a 20% or greater chance that I will break this device or otherwise invoke this policy? If so, you should buy the warranty. If not, then save your money and avoid the policy. Need a tie-breaker? Well, do you have children that will ever use the device? That alone probably makes the warranty worthwhile!

Where To Purchase A Warranty

After weighing the pros and cons above, let's say you decide to opt for a warranty. For simplicity sake, purchasing the warranty offered at the time of your purchase is probably easiest. For example, let's say you were purchasing an Amazon Fire Tablet:

You can purchase additional protection for 2 to 3 years from Amazon, provided by SquareTrade:

Looking at reviews online, SquareTrade is well reviewed with reasonable prices. Similarly, for Apple products, an AppleCare service plan / warranty is also a reasonable option.

Have you purchased an extended warranty before? What has your experience been like? Please leave comments below!

3 Great Reasons to Get Amazon Prime for Students

As you can tell, we are big fans of Amazon on this site. Admittedly, we get a commission from products purchased on Amazon through this site, but even if we didn't, the site is a great deal for students. Between textbooks, games, and other resources, pretty much anything a medical student would need is at their fingertips.

I still remember the days before Amazon, trying to buy books for a required reading list for school. I forget the title, but I found out the night before an assigned reading was due that I needed to have a certain novel. I called up a few bookstores, who said they carried the book generally but did not know if they had it in stock. Figuring the only way to know for sure was to check, I dragged my parents to THREE bookstores before finally getting lucky. Even then, I think we paid the cover price for a paperback, which in retrospect was outrageously expensive. While authors and publishers may not be fans, anyone who enjoys books should be very thankful that Amazon exists.

As a student, the benefits are even better. Amazon Student offers Prime services for free for SIX months. After that, enjoy a reduced rate for four years. If you refer a friend, you also get a $10 credit:

One of the big benefits of Amazon for students in general is their Kindle program. Once you download the app, you can read any Kindle title that you own on any supported device, including web browsers. Download the app today.

But wait, it gets better. If you own an actual Kindle device, you get access to two free books a month through the Kindle Lending Library, and the Kindle First program. That's up to a $480 value! I personally own a Kindle Paperwhite and am a huge fan.

For the medically inclined, many texts are available. Trust me, it's much easier to carry around one Kindle than several large textbooks. For example, I own the Handbook of Interventional Radiologic Procedures. While the paperback version is highly portable, here are some benefits of the Kindle version:

• Searchable
• Bookmarkable
• Portable - what happens if you forget the paperback at home one day? No worries - just log into read.amazon.com from any desktop computer and boom! Your entire Kindle library at your fingertips. 
• You can even highlight and annotate

I cannot tell you how often these features have unexpectedly come in handy today. If you are not already part of the Amazon ecosystem, why not give it a shot? Amazon also has a large textbook exchange service, which can come in handy if you are thinking about making the switch to an all digital personal library. What have your experiences with Amazon and e-books, in particular e-textbooks been like? Comment below, or use the Contact form above to share your thoughts!

The Medical Student's Daily Bag

Much like students of any stripe, medical students often have many items they need to have on their person during their daily sojurns to lecture halls and wards. While this may be a bit dated, my go to bag in medical school was an earlier version of the Targus Checkpoint-Friendly Mobile Elite Laptop Bag. The other items I typically would have in my bag were:

• Littmann Cardiology III Stethoscope - a nice gift from a good friend, and quite useful on wards
• Penlight
• Mobile device - at the time, a Palm Pilot, but these days I would highly recommend an iPad Air 2 due to the wide range of medical apps, light weight, and long battery life. 
• First Aid for the USMLE Step 1 - until I passed at least, haha
• Nalgene water bottle
• Clif Energy Bar - my current fav, but any snack works
• Pens - always get clickable, black ink pens. And always have an extra one because they will get stolen. Trust me. 
• Highlighters
• Pocket Medicine - probably should have carried this more during medical school, but was definitely a must-have during internship, so why not start early?
• Pager - [grumbles]

Aww, I'm getting a little nostalgic thinking about my old bag. Anything you think should be in there that I missed? Please let me know in the comments below!

Can A Machine Replace An Anesthesiologist?

It could happen. A recent article discusses the Sedasys anesthesiology machine:

TOLEDO — The new machine that could one day replace anesthesiologists sat quietly next to a hospital gurney occupied by Nancy Youssef-Ringle. She was nervous. In a few minutes, a machine — not a doctor — would sedate the 59-year-old for a colon cancer screening called a colonoscopy.

The Johnson & Johnson device won approval from the US Food and Drug Administration in 2013, but so far only four hospitals are actively using the machine. Of course, anesthesiologists are opposed to the machine, as it threatens their livelihood. So far, they have succeeded in having the machine limited to very restricted indications, mostly simple screening procedures. The benefit of using the machine over referring physicians self-administering sedatives is that the machine can administer more powerful drugs like propofol, and more closely monitors vital signs.

Your next anesthesiologist?
Source: fda.gov

What this means for anesthesiologists of the future is unclear. Will the machine stay limited to such narrow indications? Or will it gradually increase its scope, eventually displacing anesthesiologists in all but the most complex of cases? In some ways, the situation is even more dire for nurse anesthetists, as one can more easily imagine replacing them with such a machine. The question of liability is left open in the article, but I imagine most referring physicians and hospital administrators would take on the increased risk if the machine proves to improve patient volume sufficiently without sacrificing safety.

What about medical students deciding on a specialty? It is always hard to forecast the future and one certainly shouldn't make career decisions simply off of potential risks. Each specialty faces the threat of technological disruption (just ask cardiothoracic surgeons who trained before the advent of coronary cath). The world described by physicians past in books such as The House of God no longer exists, much like the world we now inhabit described in Intern will be considered antiquated in decades hence. What is a medical student considering anesthesia to do?

Each person has to answer this question for themselves. However, if you are passionate about a specialty such as anesthesia, the answer is simple: pursue it. Do not let fears of future change dissuade you from the field where you believe you can be your best. Instead of avoiding the risk, embrace it by keeping abreast of the changes in the field, staying ahead of them, and perhaps even being the game-changer within the specialty. Over time, all medical fields evolve. Make sure you choose a field where you will be excited to change to meet the future.

The Ultrasound—More Than Just a Diagnostic Device

Today's guest post discusses some of the cutting edge work being done using ultrasound. 

Imagine a world where a woman can give herself an ultrasound without leaving the comfort of her own home. To anyone who has ever gotten an ultrasound, this sounds like science fiction. After all, it currently takes anywhere between 2-4 years of sonography school become a fully qualified ultrasound technician. The level of training and technical expertise required to use an ultrasound machine make it difficult to imagine a world where getting a sonogram is as easy as taking your own temperature.

According to Paul Carson, a professor of radiological sciences at the University of Michigan, sonography machines will someday be among the many medical appliances that have made their way from our hospitals into our homes. If the current rate of technological development continues, we could have hospital quality, at-home sonogram technology within the next twenty years.

At-home sonogram technology won’t render ultrasound technicians obsolete any more than at-home thermometers rendered nurses obsolete. That said, the rapid rate at which sonogram technology is advancing could redefine the role that ultrasound technicians are expected to play.  

There are many medical professionals, for example, who believe that ultrasound technology could one day become the foundation for entirely new types of surgery. A team of scientists at the University of Michigan, for example, has recently pioneered a technique they’ve labeled “histotripsy”. 

For those who haven’t heard of it, histortripsy involves using high-intensity ultrasounds to create and break apart microbubbles, which fragments cell-tissues with a high degree of accuracy. Doctors could theoretically use histortripsy to target and destroy damaged cells while leaving healthy cells intact.

Other doctors are experimenting with ultrasound technology to develop more effective methods of drug delivery. One of the experiments that Professor Carson’s team is conducting involves injecting inert liquid droplets into the body, then vaporizing those droplets with targeted ultrasound blasts. 

There are two benefits to this new process. First, an active drug contained within an inert liquid droplet is exposed, but only in the part of the body targeted by the ultrasound. Second, doctors can deliver much higher doses of drugs without having to worry about side-effects that would otherwise be present.

If these experiments are successful, it could expand the medicinal role that ultrasound technicians are expected to play. People would begin to rely on ultrasound technicians for both diagnosis and treatment. The implications of these technological trends are all too obvious—if you’re considering become a ultrasound technician, there’s no better time than now.

Arthur Posey is a retired guidance counselor who now spends his days as a freelance blogger. Given his wealth of experience in the field, Arthur frequently writes about the importance of pairing students with the right trade school. When he's not doing that, Arthur is likely to be found rafting on his favorite rivers or working on his motorcycle.

Should Medical Students Buy The Kindle Fire?

Back in 2009, when tablets and e-readers were first becoming popular on the market, we discussed whether medical students should be required to have tablets like the iPad, or whether one should wait for an e-reader like the Kindle geared towards medical education. Now, two years later, as tablets and e-readers continue to converge and prices fall, Amazon had introduced the Kindle Fire:

What is the Kindle Fire? It is Amazon's $199 color 7-inch tablet that runs Amazon's custom version of Android for tablets. Why does this matter for medical students? Here are a few reasons why the Fire does matter:

• Price - At under $200, the tablet is much more affordable than the iPad for most medical students on a budget. 
• Portability - At 7", the tablet is light and small enough to carry to any lecture hall, or even on wards potentially.
• Color - Unlike prior Kindles, the full color screen lets students get the most out of any medical resources they find online.
• Amazon - Yes, the company selling the tablet matters. Given the huge amount of content Amazon offers and the proven track record of the Kindle family, students who buy the Kindle will not get left behind, unlike, say, buyers of HP's TouchPad, who shelled out 3x as much money just to find out less than 2 months later that HP was killing the product.
• Price, again - Hello, you can buy three of these for the cost of an iPad. 

All that being said, the Kindle Fire is not an automatic slam dunk. Some users find the 7" screen cramped for web browsing and that the browser is slow compared to the iPad's. Also, if you are interested in using apps that only run on iOS, they cannot be used on a Kindle Fire. Even some common Android apps may not function perfectly given Amazon's tweaks to the OS.

So, where does this leave a medical student? Basically right now, first ask yourself whether you really need a tablet and what role it would play in your education. Are the text books you like to read available in e-book versions? Do you heavily use online resources? Is your campus fully Wifi-enabled? If so, a tablet makes sense. But which one? If you have the budget, certainly test drive an iPad 2. However, if your budget is a little tighter, the Kindle Fire seems to be a fitting alternative. Although, for what it's worth, the best bet may just be to wait a little while for the Kindle Fire 2! 

Updated 2015-12-20

Dale Dubin's "Rapid Interpretation of EKGs" PDF Preview

This is an updated post of an earlier post detailing how to preview Dale Dubin's Rapid Interpretation of EKGs on Google Books. After doing some more research, I came across a pdf version as well - see below. Disclaimer: visit the site and download the pdf at your own risk.

_________________________________________________________________________________

I'm sure some of you came across this site while looking for something related to Rapid Interpretation of EKGs or Dale Dubin. Well, the book is a good primer on understanding EKGs, but some of may have your doubts before investing in a copy. 

If you want to preview the book before you purchase it, check out Rapid Interpretation of EKGs at Google Books. The preview will show you roughly 70% of the pages in the actual 6th edition, published in 2000. Google Books also has many other medically-related books that you can try-before-you-buy. If you like what you see, check out the full latest edition: 

Still not convinced? Check out the pdf version at Free E-Book Downloads. While good to peruse, I would still recommend purchasing the full book version of Rapid EKGs so that you can take notes on it as you learn. EKG interpretation is a visual skill; therefore, you should be actively sketching notes to yourself in order to clarify the points made in the book. Additionally, once you have annotated the book yourself, you can add to it as you learn from subtle EKG techniques from experienced cardiologists. Note: you can search for other medical books in pdf form on this site as well! Happy EKG interpretating!

Updated 2015-12-20

Top Medical Titles On The Amazon Kindle

The last few posts have covered the various advantages of the Kindle (Should iPads Be Mandatory?, The $99 Kindle), but as we all know: content is king. So, you may be rightly asking yourself, what titles can I find on the Kindle?

Here are some key medical textbooks / titles already available on the Kindle specifically for the USMLE exams:

• First Aid for the USMLE Step 1, 2010
  The standard textbook for studying for Step 1 on your ereader. And before you fret, remember the Kindle version still lets you highlight, annotate, and even search the text.
  
• First Aid Q&A for the USMLE Step 1, Second Edition
  
• First Aid- Cases for the USMLE Step 1 : Second Edition
  
• First Aid for the USMLE Step 2 CK, Seventh Edition
  
• First Aid Q&A for the USMLE Step 2 CK, Second Edition
  
• First Aid Cases for the USMLE Step 2 CK, Second Edition
  
• First Aid for the USMLE Step 2 CS, Third Edition
  
• First Aid for the USMLE Step 3
  

Additionally, there are many general medical books / medical titles available as well, including journals:

• The New England Journal of Medicine
  The flagship American medical journal
  
• Harrison's Manual of Medicine
  The premier comprehensive textbook of internal medicine in the palms of your hands
  
• First Aid for the Medicine Clerkship, Third Edition
  
• Case Files Internal Medicine, Third Edition
  
• First Aid for the Surgery Clerkship
  
• The Gawande Collection:
• Complications: A Surgeon's Notes on an Imperfect Science
• Better: A Surgeon's Notes on Performance
• The Checklist Manifesto: How to Get Things Right

Poke around the Kindle Store and you'll be amazed at what you can find. The medical section is surprisingly more complete than one might expect. Have fun Kindling!

Updated 2015-12-20

The $99 Kindle or the Medical Kindle?

The market for e-readers is evolving rapidly. Our last post discussed the iPad vs. the Kindle for medical trainees. However, a recent article in Slate argues that the price for the Kindle will soon fall to less than $100:

All of these trends likely guarantee that Amazon will release a $99 e-reader someday. But why do I think it will do so before the end of the year? If the company is already selling out of its inventory at its current prices, what's the point of making the Kindle even cheaper? The quick answer is that tech companies usually ramp up production and lower their prices for the holidays. Last October, Amazon cut the price of the Kindle from $299 to $259. The day after Christmas, it reported that the Kindle was the "most-gifted" item in the company's history. Even so, the Kindle never ran out of stock in December (as it had in 2008). If it lowers the price this October, you can be sure Amazon will make enough to satisfy the demand.

And at $99, demand will be unbelievable. Last year a Forrester Research survey found that fewer than 20 percent of "U.S. adults online" would consider buying a reader priced at more than $100. When asked about a reader priced under $100, however, nearly 65 percent said they would consider one, and almost 40 percent said they'd buy it within six months. In other words, $99 is a magic price—the threshold where a huge number of customers who are on the fence about e-readers decide to jump in.

Clearly, there are going to be big changes in the Kindle / iPad worlds very soon. And, if the price suits you, go for it.

However, this evolution opens up the possibly of a two-tiered system: a general ebook reader priced under $100, and then special edition customized ebook readers aimed at niche segments, such as the medical market. Imagine a special Medical Kindle, utilizing Amazon's Digital Ink technology, but in *color*, allowing medical students to have the benefit of crisp text of the current Kindles with the full blown color of the iPad. Color is the next big 'killer app' on the kindle, and with a two tier system, Amazon could justify such a move. Here's hoping the race to the bottom for the $99 Kindle opens up room at the top.

Update: It happened:

Updated 2015-12-20

Should iPads Be Mandatory For Medical Students?

The e-reader battles are clearly heating up, with the recent introduction of the Apple iPad (color!), the aggressive marketing of the Kindle with newer models, and the Nook trying to sneak its way into the conversation. What does this mean for medical students? Should iPads be mandatory in medical school?

Joseph Kim of Mobile Health Computing argues that it certainly should be, but I think the argument is not well formed. Of course we want medical students to have the latest whizbang technological gadgetry, but the real question is: what role will this technology play? For example, we could provide all medical students with electron microscopes during their study of histology, but clearly this would be ridiculous: the knowledge yield would not justify the cost at all.

So, let's consider what we want our ereaders to do. Clearly, Kim wants a Swiss Army Knife type tool - a tool that lets students become fully engrossed with their study materials, interacting in a way that was never possible before. One can easily imagine an iPad with a digital cadaver, first years carefully "finger dissecting" away layers to reveal deeper structures, or sweeping their fingers to rotate and pan the images to see other angles. Because its digital, such anatomy could much more easily linked to its practical application in medicine via linked diagnostic images, intraoperative findings, and even path results.

But, is this what we really want? Or rather, is it the only thing we want? Clearly, even with all this neato technology, there is an ocean of information to absorb and comprehend in a limited amount of time. Sorry, first years, but you will still have to spend hours in the library pouring over textbooks. This is where the argument gets a bit murkier, primarily because of technological issues. The iPad is backlight; the Kindle is not. For medical students spending hours staring at text, the Kindle actually provides a much better user experience. And, imagine being able to carry the entire library in this one lightweight device! Yes, the iPad can do it too, but do you really want to read an iPad for that many hours?

The question of whether devices should be 'required' of medical students is not a new one. Ever since portable devices became popular, medical schools have struggled with whether to mandate that their students have a laptop, or PDA, or now, e-reader. Until technology advances far enough that we can have all the functions we desire in one device with a user interface we like, medical schools may be better off simply supporting the purchasing choices of their students without mandating any particular device. Let students choose how they like to learn, and what tools they want to use to accomplish that, and they will be the better for it.

Updated 2015-12-20

Dale Dubin's "Rapid Interpretation of EKGs" Preview

I'm sure some of you came across this site while looking for something related to Rapid Interpretation of EKGs or Dale Dubin. Well, the book is a good primer on understanding EKGs, but some of may have your doubts before investing in a copy. 

If you want to preview the book before you purchase it, check out Rapid Interpretation of EKGs at Google Books. The preview will show you roughly 70% of the pages in the actual 6th edition, published in 2000. Google Books also has many other medically-related books that you can try-before-you-buy. If you like what you see, check out the full latest edition: 

Updated 2015-12-18

Scientists Extract Images From Brains Directly

A recent post claims that Japanese scientists have discovered how to extract images directly from one's brain.

The scientists were able to reconstruct various images viewed by a person by analyzing changes in their cerebral blood flow. Using a functional magnetic resonance imaging (fMRI) machine, the researchers first mapped the blood flow changes that occurred in the cerebral visual cortex as subjects viewed various images held in front of their eyes. Subjects were shown 400 random 10 x 10 pixel black-and-white images for a period of 12 seconds each. While the fMRI machine monitored the changes in brain activity, a computer crunched the data and learned to associate the various changes in brain activity with the different image designs.

Sometimes I feel like everything important that needs to be developed has been already, but stories like this renew my hope in what lies ahead. Even if we understand how MRI works, we are still far away from understanding how the human brain functions. I can't imagine how such technology will develop over the next 10 - 20 years.

(Image Source: PinkTentacle)

The Robot Who Smiled

Jules the Robot is the first humanoid robot (see video at bottom of the page after the jump). This isn't particularly related to medicine, but I just found the video so eerie I thought I should post it:

Scientists have created the first 'humanoid' robot that can mimic the facial expressions and lip movements of a human being.

'Jules' - a disembodied androgynous robotic head - can automatically copy the movements, which are picked up by a video camera and mapped on to the tiny electronic motors in his skin.

It can grin and grimace, furrow its brow and 'speak' as his software translates real expressions observed through video camera 'eyes'.

As I said, this isn't directly medically related, but one can envision this technology being used to make more realistic robots for students and residents to train on, with the "patient" robot grimacing if students examine it too roughly, or laughing if they're being tickled. Advances like this also make me wonder whether medical ethics can keep up with the pace of innovation.

Image Credit: The Daily Mail

Google: Finding Flus Fast?

Google Flu Trends is a new system set up by Google through its Google.org philanthropy site that tracks American's search queries related to the flu. Apparently, Americans turn to Google before turning to their PCP when trying to decide what their symptoms mean. Now, Google has started to look at this data in the aggregate with Google Flu Trends:

There is a new common symptom of the flu, in addition to the usual aches, coughs, fevers and sore throats. Turns out a lot of ailing Americans enter phrases like “flu symptoms” into Google and other search engines before they call their doctors.

That simple act, multiplied across millions of keyboards in homes around the country, has given rise to a new early warning system for fast-spreading flu outbreaks, called Google Flu Trends.

Tests of the new Web tool from Google.org, the company’s philanthropic unit, suggest that it may be able to detect regional outbreaks of the flu a week to 10 days before they are reported by the Centers for Disease Control and Prevention.

In early February, for example, the C.D.C. reported that the flu cases had recently spiked in the mid-Atlantic states. But Google says its search data show a spike in queries about flu symptoms two weeks before that report was released. Its new service at google.org/flutrends analyzes those searches as they come in, creating graphs and maps of the country that, ideally, will show where the flu is spreading.

The C.D.C. reports are slower because they rely on data collected and compiled from thousands of health care providers, labs and other sources. Some public health experts say the Google data could help accelerate the response of doctors, hospitals and public health officials to a nasty flu season, reducing the spread of the disease and, potentially, saving lives.

Seems like a smart idea. I wonder if Google will apply this to other diseases as well. Going beyond infectious diseases, what if Google were to track search queries related to other potential 'trends' like teen pregnancy? Should raise some interesting questions about how to utilize this technology for public health issues while respecting the privacy of Google users.

Social Networking and Proprioception?

Social Networking (Source: Simon Whatley)

A friend recently sent me an interesting article on social networking, specifically twittering, that compared the phenomenon to proprioception. As you all know, proprioception is our sense of relative position within space. It's what lets us know that our foot is pointing upwards or that our thumb is pointing down. How does proprioception apply to social networking though?

When I see that my friend Misha is "waiting at Genius Bar to send my MacBook to the shop," that's not much information. But when I get such granular updates every day for a month, I know a lot more about her. And when my four closest friends and worldmates send me dozens of updates a week for five months, I begin to develop an almost telepathic awareness of the people most important to me.

It's like proprioception, your body's ability to know where your limbs are. That subliminal sense of orientation is crucial for coordination: It keeps you from accidentally bumping into objects, and it makes possible amazing feats of balance and dexterity.

Twitter and other constant-contact media create social proprioception. They give a group of people a sense of itself, making possible weird, fascinating feats of coordination.

For example, when I meet Misha for lunch after not having seen her for a month, I already know the wireframe outline of her life: She was nervous about last week's big presentation, got stuck in a rare spring snowstorm, and became addicted to salt bagels. With Dodgeball, I never actually race out to meet a friend when they report their nearby location; I just note it as something to talk about the next time we meet.

The author Clive Thompson does pose an interesting idea, and I can see why he used the term proprioception. However, I think the term is misleading. When used in terms of physiology, the term implies one's own relative sense of position. But, in the social world, the term is being applied to your friends' mental and physical states relative to your own (or, one could argue, relative to your prior knowledge about them). Although I'm not particularly a fan of the awkward physiological analogy, if one must be made, I think the social networking phenomenon is more akin to the way in which our brains integrate various sensory inputs to form a coherent image of the outside world. Online social networks help us with social integration as we process what our numerous contacts are doing in the real world in real time.

Somehow though, I don't think social integration will catch on quite like proprioception...

The Web 2.0 EMR?

Kevin M.D. has an interesting post about the poor implementation of current EMR efforts. As his post notes, none of the innovation people see in online apps like Facebook or Google Docs are being used in EMR services. The post primarily refers to a piece by hospitalist Bob Wachter. So yea.. Why hasn't social networking affected EMRs yet?

One problem is that much of health information technology is staffed and programmed by has-beens. There is very little innovation, with most of forward-thinking ideas confined to sites like Google, Facebook, and MySpace.

It would be nice if an electronic record was designed with the singular focus being the end-user experience. They should make physician's lives immeasurably easier, and significantly decrease the time spent charting and tracking patients.

There are very few record systems that meet even this minimal standard.

An EMR like Facebook? We can only wish.

Indeed, a EMR with a Facebook-style interface would be a godsend. I think the real problem currently though is not necessarily a lack of technological know-how, but rather the high cost of implementing such systems and the relatively poor demand. Furthermore, the medico-legal environment also contributes to physicians being unwilling to abandon the old forms that worked on paper. Hopefully one day physicians will take that step en masse into the brave new world of social networking-based EMRs.

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Medgadget

Not much to say today, other than check out Medgadget, a blog devoted to emerging medical technologies. I particularly like the post about C-arm / DynaCT, a relatively new technology to let interventional radiologists take CTs of their patients during procedures. Perhaps a bit dated, but it was interesting to read about the cutting edge technology and then see how far behind the stuff we learn in med school is.

The Heparin Mishaps: Would More Technology Help?

Dennis Quaid? Heparin? Confusing, perhaps, but there have been several recent cases of overdoses of the drug heparin. One case unfortunately involved the children of actor Dennis Quaid. Some have proposed that automated systems may have prevented these errors, but the Wall Street Journal's health blog argues otherwise:

There’s just one problem in this case: automation wouldn’t have done much for the tots in Texas. A pharmacist made an error mixing heparin solution, often used to flush IV lines — and IV flushes often aren’t part of physician orders anyway. You can read the statement from Christus Spohn, which also says there’s no indication as yet that heparin contributed to the deaths in the NICU.

Doctors typically prescribe a dose of a particular drug over a particular time, and whether it should be administered intravenously or by mouth, for example. But a pharmacist often decides just how the drug will be prepared, whether by syringe into an IV or pre-mixed with saline. The pharmacist may note that a heparin flush is indicated before and after administration, or the nurse may know that it’s just part of the standard procedure.

The article does go on to note that some advanced systems do exist, but even they have their drawbacks:

Another up-and-coming technology might have helped the Quaids, but not the Texas tykes: Bar Code Medication Administration, or BCMA. Those systems require medications to be labeled with bar codes in the pharmacy identifying drug, dose and patient, and then checked — via scanner and computer — against codes in the medical record and a patient armband. But if the wrong dose is mixed and mislabeled in the pharmacy, overdoses can still occur.

“There still is that interface of human to computer that is always going to be plagued with problems,” Zachary Stacy, an associate professor at the St. Louis College of Pharmacy, tells Health Blog.

Clearly, the human element means these systems will always have some level of error, but I think this should not be used as a strong argument against their use. Any reduction in the rate of errors is an improvement, even if not all errors can be eliminated. What these hospitals really need to do is examine the processes and safeguards they had in place and why they failed to prevent this error. If they have too few techs who are perhaps overworked, the solution may actually lie in hiring more staff rather than switching systems.

The Economics of Electronic Medical Records

As a big believer in the efficiencies gained by technology appropriately implemented, I always find it shocking that medicine seems so far behind the curve in terms of electronic medical records (EMR). Most doctors agree that EMRs are beneficial, yet a recent report found that only 1 in 5 doctors have them in their practices:

The report, published online on Wednesday in The New England Journal of Medicine, found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care. Yet fewer than one in five of the nation’s doctors has started using such records.

Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care system. The slow adoption of the technology is mainly economic. Most doctors in private practice, especially those in small practices, lack the financial incentive to invest in computerized records.

At first, I was disappointed and wanted to blame the doctors for not biting the bullet and paying for EMRs looking at it as an investment. But, the more I considered it, I can't blame them. If it were my practice, and the implementation costs of EMR were in the tens of thousands of dollars, I might hold off as well. I know I am over-simplifying this, but an EMR is really just a fancy, specialized database. Databases are ubiquitous in business. Clearly, the costs of implementing one cannot really be that high across the system.

The problem, as in many other situations in U.S. healthcare, is the lack of centralized, standardized solutions. Honestly, this can be either through the U.S. government or through free markets. Either the government should provide incentives, perhaps tax credits, for physicians to implement EMRs (heck, even low or zero interest loans, whatever). Or, the free market should step in and provide a low-cost solution that becomes the de facto standard for EMRs. To some degree, Google and Microsoft are already doing this, but their approach is more patient-centric isntead of practice-centric. What medicine needs is a "patient OS", much like how Microsoft Windows became the standard platform for PCs. With a patient OS, there would some default format for EMRs making it easy for offices even with different implementations to communicate with each other. If the basic patient data is defined in this open standard .emr format, then it would be easy for groups to implement modules for particular specialties (like, the results of p-thal tests in cardiology or something). Patients benefit, doctors benefit:

Dr. Masucci was already using Athenahealth’s outsourced financial service, and less than two years ago adopted the online medical record.

Today, Dr. Masucci is an enthusiast, talking about the wealth of patient information, drug interaction warnings and guidelines for care, all in the Web-based records.

“Do I see more patients because of this technology? Probably no,” Dr. Masucci said. “But I am doing a better job with the patients I am seeing. It almost forces you to be a better doctor.”

At the end of the day, this just shows the lack of leadership within medicine as a whole, which is why doctors end up getting squeezed by service providers as well as by insurance companies. Sad, really. Today's reality is doctors lose and patients lose.

I'm not really this pessimistic. Read the next, hopefully happier post! Subscribe to Scrub Notes by email or in a reader!