Category: Technology

A diagnostic odyssey

published date
February 28th, 2007 by

There’s a good Cases column in today’s New York Times (A Mystery Ailment, but not for the Right Doctor) about a patient with a mysteriously sore foot. He’d done his research on the web and sought out a tropical medicine expert (the author of the Times article) to test his theory that the problem was caused by a mosquito bite he got in India. To make a long story short, what he really needed was a bone and joint expert. Partly by luck he ended up seeing one and having his condition diagnosed properly.

If you already know your diagnosis –even if it’s for something obscure– it’s not hard to find good information about it on the web. But if you have only a collection of symptoms to go by, you’re in much tougher shape (even if you try your hand at Google diagnosing). It’s hard to even know what symptoms or other findings are relevant and what kind of physician to go to. You could go to one that causes more harm than good or ends up prescribing a medication that masks symptoms another doctor would need to make an accurate diagnosis, as happened in this case.

There is an answer to this problem: consumer-focused decision support tools that help patients figure out what kind of physician to see and what information to present. I predict you’ll be hearing more about this approach within the next year.

Note: the Times site was down so I’ve linked to the same article in another newspaper. 

My kind of doc

published date
February 23rd, 2007 by

Last day of vacation and no real time to blog, but two people sent me a link to today’s WSJ article: Faltering Family M.D.s Get Technology Lifeline; Doctors Think Small To Revive Solo Role For Primary Care.

They rightly concluded that I would applaud the efforts by some primary care physicians to offer a high-service model to a regular sized panel of patients by relying on technology and intelligent operations. It’s a much better solution than the concierge model.

[I]n early 2001, Dr. Moore took a risky step. He borrowed about $15,000 to start a solo medical practice in a tiny space with no nurse, receptionist or waiting room. He bought computer software to help him track patients’ appointments, illnesses and medications, and to process insurance claims.

Patients at his “micropractice” can call or email to get appointments the same day. Visits last 30 minutes. Dr. Moore can be reached day or night on his cellphone. To refill a prescription, he walks “zero feet,” he says, and taps a few keys on his laptop. “I was able to build a Norman Rockwell practice with a 21st-century information-technology backbone,” he says.

More later…

Just imagine what HDTV could bring

published date
February 2nd, 2007 by

It’s a good thing doctors in Ireland have time to watch television:

An Irish doctor, however, has [performed a diagnosis] while watching television by spotting that a government minister had a tumor in his cheek.

The… surgeon…was at home with his doctor wife before Christmas. They were following a current affairs program…in which… the overseas aid minister… was being interviewed.

“If you look very carefully,” the surgeon reportedly told his wife, “his face moves when he talks but the lump doesn’t.”

The next day he called the minister’s office and left a message. [The minister]… phoned back and the surgeon told him about his fears, advising him to see a head and neck specialist at a Dublin hospital immediately.

Doctors… carried out tests and quickly found a tumor on his salivary glands. It was removed during an operation last month…

[The minister] told the Irish Independent newspaper: “I’m a very lucky man. The consultant wouldn’t have seen the left side of my face but for the fact that I was sitting at the left of the group in the television studio.

Thanks to Mickey for spotting this one.

Pfizer and iCardiac announce cardiac safety alliance

published date
January 30th, 2007 by

I recently joined the board of iCardiac Technologies, which is commercializing ECG analysis technology from the University of Rochester’s renowned Heart Research Follow-Up Program (HRFUP). I’m excited to pass along the news that Pfizer and iCardiac have agreed to an alliance. According to the press release:

The aim of the research alliance is the further development of iCardiac’s COMPAS platform and advanced ECG markers for use in the safety testing of in-development and on-market drugs, and includes a cross-licensing arrangement by which iCardiac will receive rights to ECG analysis technologies developed within Pfizer.

Under the terms of the agreement, iCardiac and Pfizer will collaborate on a research program comprised of a series of studies, including retrospective and prospective ECG data analyses. iCardiac will receive an equity investment and technology license payment, plus research and development funding over the term of the alliance. iCardiac will retain commercial rights to the validated technology platform and new biomarkers for future application in cardiac safety clinical trials and technologies.

…As part of the Critical Path Initiative, the FDA has stated that there is a significant opportunity to further improve the cardiac safety testing process and identify better markers of cardiac risk. The long-term goal of the alliance is to improve the precision, increase the speed and reduce the costs of cardiac safety clinical trials. Â

Pfizer spokeswoman Kate Robbins said:

“Cardiac safety is one of the most challenging hurdles in developing new medicines. We support the development of new tools that may enhance our ability to predict the safety of potential new medicines in early stages of research and development.”

iCardiac’s tools are exciting in two ways: 1) They may knock out drugs with cardiac safety problems earlier in development –saving lives, money, and time. 2) For certain drugs that are wrongly flagged as potentially dangerous using cruder methods, they may allow development to proceed. That would help more good drugs make it to market.

Congratulations to CEO Mikael Totterman and the entire iCardiac Technologies team.

Commoditizing medicine

published date
January 11th, 2007 by

About five years ago I heard a fascinating talk by Harvard Business School Professor Clay Christensen that applied his well-know “innovator’s dilemma” reasoning to health care. In a nutshell the idea was that tertiary care centers should keep pushing the envelope on complex diagnoses and treatments and that over time diagnoses (though maybe not treatments) that had initially been considered complex and challenging should be systematized and therefore able to be carried out in less expensive settings by less expensive staff. The progression would go from academic medical center to community hospital to doctor’s office to retail clinic.

Clay was interviewed recently by the New York Times where he covered this ground again –lamenting the lack of progress- and also gave a clue as to why there is a shortage of convenient, low-cost diagnostic settings in Massachusetts.

We haven’t moved the health care profession into a world where nurses can provide diagnosis and care. Regulation is keeping the treatment in expensive hospitals when in fact much lower cost-delivery models are available…

In Massachusetts, nurses cannot write prescriptions. But in Minnesota, nurse practitioners can. So there has emerged in Minnesota a clinic called the MinuteClinic. These clinics operate in Target stores and CVS drugstores. They are staffed only by nurse practitioners. There’s a big sign on the door that says, “We treat these 16 rules-based disorders.” They include strep throat, pink eye, urinary tract infection, earaches and sinus infections.

These are things for which very unambiguous, “go, no-go” tests exist. You’re in and out in 15 minutes or it’s free, and it’s a $39 flat fee. These things are just booming because high-quality health care at that level is defined by convenience and accessibility. That’s a commoditization of the expertise. To have those same disorders treated in Massachusetts, you’ve got to go to a regular doctor, go through a long wait in their office, you go in and see the doctor for two minutes. He says, “You have an earache,” which you knew already, and then they charge you $150.

The whole interview is worth a read if you have the time.