Details of highly successful U Chicago hospital iPad program revealed

[cross-posted from iMedicalApps.com]

Recently, physicians at the University of Chicago published a research letter in the Archives of Internal Medicine detailing their experience with the routine use of iPads by internal medicine residents during their regular duties.

What they documented was that use of the mobile device was objectively associated with faster order entry after patient admission and the subjective assessment that it saves up to one hour per day for each resident.

We had previously reported on the Univ Chicago iPad experiment here and here.

In our recent article reporting on the research paper we agreed that rate of order entry is a reasonable proxy for increased workflow efficiency but also noticed the study raised many interesting questions. Bhakti Patel, MD is the first author of the study was kind enough to talk to iMedicalApps about the research and to share some of the interesting findings that did not make it into published article.

Some of the questions that I asked of Dr. Patel, currently a critical care-pulmonology fellow at the University of Chicago, were:

• when & why did you decide to study the use of iPads?
• how did you choose the study setting?
• what were some of the hurdles in initiating the trial?
• how did you decide what security & infection control measures to use ?
• how were the devices managed?
• what do you plan on doing next?

Read below to learn more about this groundbreaking study on the use of mobile devices by hospital based physicians.

Background

Dr. Patel started by asking what is the fundamental issue, that “a lot of people in medicine are realizing that our decisions are becoming very data driven and that data is now housed in computers”. Furthermore, doctors are fundamentally mobile, clinical medicine is not practiced behind a desk. Therefore, this critical data also needs to be mobile. Thus, we need to “allow providers to be at the bedside to make these decisions and yet still be able to access the data.”

In 2010, Dr. Patel was one of the the chief residents for internal medicine at the University of Chicago when the concept of using personnel mobile computing was beginning to be discussed. In part, the study was motivated by the observation that residents were already trying to connect to the hospital EHR via their iPhones using the mobile Citrix app. As Dr. Patel put it, “necessity is the mother of invention” and residents “desperate to get something done” would take advantage of the mobility of an iPhone despite the “clunkiness of trying to connect remotely through Citrix” on a small device.

At that time, some of the residents and faculty including program director, Jim Woodruff, MD and Vineet Arora, MD, set up an informal task force to look at the idea. An initial pilot launched in September of 2010, remarkably only five months after the iPad came on the market.

At that point, only five iPads were purchased. These were given to “the busiest residents on service” to make sure they would be used and to see how they impact efficiency. Dr. Patel said the reason that the iPad was chosen was that “at the time that was the main tablet on the market.”

The task force also included leadership from infection control and also information technology and met weekly during the pilot process and then again to plan for the deployment once the decision was made to proceed with a larger trial.

Dr. Patel noted that UC is very “data driven and so when you are trying to say that something is worth doing you have to you know show them that it is”. Some people were “skeptical” because the devices are a significant investment and not without risk.

Not only that, the department had tried smart phones and PDAs before and that “we have this PDA graveyard now because they were not helpful for people or they only had one function.” So, “we had to prove it to make it possible”, initially with the pilot and later with the fuller study.

Future Uses for the iPad in the Operating Room: a Game Changer ?

[cross-posted from iMedicalApps.com]

As we discussed in the first of this two part series, mobile devices are already entering the world of the surgeon. Currently, it is mostly downloadable apps that promise to help surgeons with the informational portions of their tasks, such as tracking the cases they have done, e.g. Surgichart or helping in the consent process, e.g. Surgery Risk

While apps that are dedicated to the technical aspects of surgery, such as the excellent AO Surgery Reference, are becoming available, in the future we will see the iPad (or its brethren) actually in the operating room. Why ? Because the iPad has many characteristics that make it a great an advanced surgical instrument.

First is its small size. Every modern operating room has stacks of electronic equipment hanging from the ceiling or in large cabinets for patient monitoring and controlling in-field devices. Since the iPad already supports a bevy of standard wireless communication protocols, many of these large boxes’ functions could likely be off-loaded to an iPad with clever engineering. One immediate advantage would be that the iPad could be brought directly into the operative field in a small sterile bag where the touch interface makes it possible to change settings even using gloved hands. This means that the surgeon or assistant could manipulate the controls rather than asking the room staff to make every little change. The long battery life means that an iPad can make it through even a long surgical day without needing a recharge (at least not before the surgeons do !)

Even more intriguing are the possibilities for user interfaces that incorporate the built-in sensors in the iPad, specifically the accelerometer and gyroscope. These sensors have made the iPod Touch a massive success in the mobile gaming world by allowing players to interact with games by turning and twisting their devices. Could they also lead to new types of assistive surgical instruments ? Read below as we explore these ideas.

[This article, and the first part of this series, is co-published in the Journal of Surgical Radiology]

Communication

The most basic and fundamental function of mobile devices is communication. In the surgical realm, this often means sharing visual information since intraoperative observations are critical to understanding surgical options and prognosis. But this can even be extended to the preoperative setting, where the ability to quickly consult with a colleague about physical findings could help guide surgical planning. The built-in FaceTime videoconferencing feature in the iPad 2 and iPhone 4 is as simple as it gets. In fact, this is exactly what Armstrong et al showed could be one use of FaceTime, in a brief report describing its use in sharing the appearance of pre- and post-operative wounds, where two surgeons discussed the appearance of an extremity and whether surgery is indicated, as seen in the image below. If the Wi-Fi network is encrypted, the communication is likely in fact HIPAA compliant.

Sharing intraoperative images with patients and other professionals is also a feature of SurgiCharts, as our recent review showed while eGoWorks is an iOS app for sharing endoscopic images stored using Envisionier’s web-based endoscopic image server by the same name. For more robust video sharing, JEMS offers a system where multiple mobile clients can view the same video stream (image below). The stream is encrypted and mobile clients are available for both iOS Android devices. A video server is required, which can take in up to four different video inputs. This means that the same surgical procedure can be viewed in multiple locations, even in different cities, making it potentially a great tool for teaching.

Intraoperative visualization

While the iPad could be used to view a remote surgery, it may be put to even better use in the immediate operative field. One use could be to follow the patient’s vital signs. The AirStrip platform already allows for live remote monitoring of fetal heart tracings and is already deployed in multiple hospitals. Now also available is remote monitoring of vital signs, such as EKG tracing, blood pressure and oxygen saturation. While this is mostly the responsibility of the anesthesiologist, in cardiac procedures especially, the surgeon is also acutely interested in heart electrical activity and blood pressures. Thus, large and expensive plasma screens are often hung from the ceiling in cardiac operating rooms. An iPad in the operative field running AirStrip may be a far more economical alternative.

Another interesting possibility is to use an iPad as a microscope. Surgeons are used to using “loupes”, eyeglasses with built in magnification, when working on small objects such as nerves and vessels. Other times, large and expensive floor microscopes are brought sterile-wrapped into the operative field. However, there may be times when an inexpensive video microscope may be all that is needed. One university project, “CellScope” demonstrated the feasibility of attaching a magnifier to a cell phone camera to make an inexpensive 45x microscope that can be used in rural settings or less developed countries. Instead of using the built-in camera, if the image sensor was a the tip of a thin extension tube, such as seen below, it could be brought into the field and the video transmitted wirelessly to a nearby iPad. This would then function as the surgeon’s eyes, allowing her to peer into poorly lit body cavities and magnifying small objects.

Intraoperative measurement

The accelerometer inside many smartphones is sensitive to changes in position, such as rotating the device between portrait and landscape. It can also allow for software to be written to allow the device function as a sort of “level” to determine when objects are parallel to each other or to the ground, as demonstrated by the popular iPhone app “iHandy”. This capability is exploited by the “Scoliogauge” app to help orthopedic surgeons measure extent of spine curvature in scoliosis. By having the patient bend forward and placing the iPhone on their back, the angle of trunk rotation can be measured. This rotation corresponds to the degree of curvature in scoliosis. You can read more about this in our recent interview with the orthopedic surgeon and app developer Matt Ockendon.

The same concept has been used to help guide surgeons planning reconstructive eyelid surgery as reported by Mezzana et al, who used an iPhone intraoperatively to ensure that eye lids are parallel during oculoplastic surgery, as seen below.

The app is called Laser Level and it is was originally designed for home decorators to determine when wall hangings are perfectly level. The app overlays two “laser” lines in real-time onto the camera image which turn green when they are parallel, as seen in the image above. The authors reported they were able to get both 100% interobserver reliability as well as “perfect alignment of the lateral canthal position after surgery verified by manual level assessment” in all nine of their patients.

Intraoperative “navigation” refers to a group of technologies that are used to assist surgeons in locating deep anatomic structures or accurately placing implants inside patients. In orthopedics, navigation has been shown to increase the accuracy of placement of knee replacement prostheses. However, one consistent complaint among surgeons has been the inconvenience of assembling the  required transmitters and registering them onto the display sensors while in the operating room. Now Brainlabs, in partnership with implant maker Smith & Nephew, has developed a system that uses an iPod Touch to replace almost the entire device.

As can be seen in the image above, the reflectors and the user interface are incorporated into the iPod Touch which is inside a case and brought sterile into the field. The alignment of the implant is read directly off the screen. The device is awaiting FDA approval in the USA  and a demo is available in the iTunes App Store.

Augmented Reality in the Operating Room

Object recognition software is becoming increasingly sophisticated, even on mobile devices. A great example is the remarkable iPhone application MagicPlan that can almost “magically” draw the floor plan of a room by using the iPhone camera to determine the distance to each corner in a room. The user points the iPhone camera at each corner in a room and the app draws green lines, which are approved the user. Once all the corners are registered, the floor plan, with actual distances, is shown.

This type of technology is termed “augmented reality” and generally defined as the practice of combining or superimposing computer generated data onto live-obtained images. Familiar examples include televised football where a virtual first down line is superimposed onto the field or televised soccer where advertisements seem to be displayed on the walls enclosing the playing field.

The medical uses for augmented reality are just being explored. One app currently available measures the angle between bones on an xray. The app is called Hallux and it is specifically designed to guide surgeons planning reconstructive foot surgery.

In this case, the software combines readings from the iPhone accelerometer and the user determined positions of the bones, using the on-screen alignment guide, to read the angle between the first two metatarsal foot bones. You can read more about it  at our more detailed app review.

Much of surgery has to do with imagining deeper structures, such as organs and bones. Sophisticated image processing techniques make it possible to render three dimensional images, even color coded by organ. These types of images can be invaluable for identifying pathology and planning complex surgery.

The above rendering was produced by Dr. Maki Sugimoto a hepatobiliary surgeon who is pioneering methods of incorporating advanced imaging techniques and surgery. In this example, he uses an overhead projector to overlay the 3d image onto the actual patient during surgery, as seen below. In order to align the images, he uses anatomic landmarks, such as the navel and the iliac crests. to properly align and scale the image.

His group reported their findings in seven surgeries including three cholecystectomies, two gastrectomies and two colectomies. They found that live image registration helped the surgeon locate small objects and tumors introperatively that would otherwise have been difficult to find, and potentially helped avoid intraoperative injury.

An even more useful and convenient method of combining real and computer generated images during surgery, I propose, would be if this “overlay” image could be displayed on an iPad. In this concept, the three dimensional image would be manipulated in real time by pointing the iPad at different portions of the body, giving the sense of being able to peer inside the body. A method of simulating a live three-dimensional view on the iPad was demonstrated by the Engineering Human-Computer Interaction Research Group in France (below).

By using the iPad’s accelerometer, different aspects of a computer-generated 3D object are displayed as the iPad is tilted (video). This can simulate the familiar stereoscopic 3D image display which relies on polarizing glasses, without the glasses. The group even demonstrated how using the front-facing camera and face detection algorithms, the same 3D experience can even simulated when the user looks at the iPad from different angles. A demo version of the software is available for download in the iTunes App Store.

Going further, perhaps the remarkable technology developed by Microsoft for its Kinect could be incorporated into surgery. The Kinect was developed as a gaming tool to allow players to interact with objects on the screen by moving their own bodies. It works by projecting a dense yet invisible mesh of infrared dots into a room and, by rapidly reading the reflection of the infrared light, it can track the movement of people.The image below is from source Matt Cutt’s blog.

The Kinect has already been “hacked” to work inside an operating room by allowing a surgeon to manipulate the display of CT & MRI images from across the room, hands-free.

From there, it is not hard to imagine the same technology being used to track the movement of a surgeon’s hands or instruments. What could be a great leap forward would be to combine the position of the surgeon’s instruments with live-registered three dimensional anatomy images and thus simulate the instruments inside the body. A Kinect-like device could “watch” the surgeon’s hands and instruments outside the body while the iPad is pointed at different parts of the patient to virtually peer inside and show the instruments.

Conclusion

The iPad has the potential be a game changer in surgery because of its small size, built in sensors and wireless networking capabilities. The only restriction is the imagination of future surgical innovators. Even if the above predictions fail to materialize, it is safe to say what the future holds is only barely imagined today.

References

Armstrong, D. G., Giovinco, N., Mills, J. L., & Rogers, L. C. (2011). FaceTime for Physicians: Using Real Time Mobile Phone-Based Videoconferencing to Augment Diagnosis and Care in Telemedicine Eplasty, 11, e23.

Mezzana, P., Scarinci, F., & Marabottini, N. (2011). Augmented Reality in Oculoplastic Surgery: First iPhone Application. Plastic and Reconstructive Surgery, 127(3), 57e–58e.

Image overlay navigation by markerless surface registration in gastrointestinal, hepatobiliary and pancreatic surgery. Sugimoto, et al. J Hepatobiliary Pancreas Sci. 2010 Sep;17(5):629-36. Epub 2009 Oct 2.

Veterans Administration hospitals CIO says VA must become “iPad friendly”

[cross-posted from iMedicalApps.com]

In a nod to the reality of rapid physician adoption of tablets and smartphones, the CIO of the VA system recently stated that the VA must find a way to accommodate iPads at a  conference on federal information technology.

According to Baker, the fact is that 100,000 residents rotate through the VA each year and “they’re all carrying mobile devices”. In order for them to do their jobs, they want to be able to access resources on the internet.

In an article published at nextgov.com, CIO Roger Baker said

I’ve told my folks I don’t want to say ‘no’ to those devices anymore…I want to know how I say yes

The key, according to Baker, is security. While the iPad can be secured, proper protocols need to be developed. Otherwise, the device can be likened to a “huge unencrypted USB stick with no pin”. In order to facilitate development of security protocols, a pilot program has been launched giving out iPads to select employees in situations where security is looser.

In an easy to understand analogy, he proposed

If it won’t go on a device where you’re willing to put all your banking information, your pins, your passwords, [then] don’t put veterans’ information on it.

As we have published on this site before, there are ways to secure your iOS device adequately for medical use (“How to secure your iPhone or iPad for medical use“). The issues are not always technological, often it is a question of policies and habits of the users. A positive contribution by a large scale institution like the VA can only help to instill good habits and a better understanding of security in future doctors.

Mobile MIM liberates doctors to view CT & MRI scans on iPads and is FDA approved

[cross-posted from iMedicalApps.com]

One of the most attractive uses for an iPad in the clinical setting is the potential to view radiologic imaging at the point of care. But, while the graphics capabilities of even the first iPhone were enough to be able to adequately display multi-slice imaging, there were two critical pieces missing to make the iPad a viable mobile radiology workstation: FDA approval and a simple way to store and transfer images to the iPad.

MIM Software, a radiology software company, seems to have neatly solved both these problems by pairing their viewer, Mobile MIM, with MIMCloud, their cloud based radiology (DICOM) viewing and sharing web application and by obtaining the first ever FDA clearance for mobile imaging software in February 2011. The story of their FDA approval process will be highlighted in an interview with Mark Cain, CTO of MIM Software tomorrow.

MIM Mobile is a free download from the App store and runs on both iPhone and iPad. As the video portion of this review will demonstrate, the app is very well engineered with amazingly fluid navigation. even with images containing hundreds of slices. It also performs mutli-planar reconstructions out of the box, meaning that the same body part can be visualized in three planes simultaneously. These are invaluable tools for evaluating imaging abnormalities and for planning surgery. When you realize that they were executed on a device with limited physical memory and no virtual memory , they are even more remarkable. This might be why MIM was on stage with Steve Jobs at the unveiling of the iPhone software development kit in 2008 and why MIM Viewer was one of the few non-Apple apps highlighted in the recent iPad 2 commercial, as we recently noted .

Mobile MIM

Use of the Mobile MIM app is straightforward. The iPad version of the app opens to a two column display (in landscape), with options on the left and a list of studies on the right. Your MIM Cloud studies are listed but downloaded only when tapped. One nice feature is that downloading continues in the background, even if the app is closed, using the iOS 4.0 multi-tasking features. This is helpful for time-consuming downloads of large studies over 3g. Once an item is downloaded to the device, it is stored locally, with no need to reconnect to the internet to view it again. This, of course, can use up local storage but the total local storage is always displayed at the top. Images can be deleted by swiping. On my iPad, the application was quite stable, although I did often receive low memory warnings that suggested rebooting device may free up more memory. I typically dismissed these and the app continued to work, although perhaps some features were disabled as a result, although which ones were never specifically explained.

When an item is tapped, it opens in the viewer. Controls at the bottom allow for changing between window presents (bone, brain, liver, etc.). Images will by default open in multi-planar view (as shown below) unless the feature is disabled. My testing seems to imply that the app automatically determines whether this is possible depending on the number of slices and thus the amount of memory required. The iPad2 with its additional on-board memory will probably allow larger image sets but in my testing multiplanar view seems to be limited to a minority of studies, usually those with less than 30 slices, eliminating most CT sets. Mark Cain reports that the iPad2, with its increased memory, allows for much larger studies, even up to 200 slices, to be seen with multi-planar reconstruction.

Additional viewing features include distance measurement, an ROI measurement which allows for the radiodensity of a portion of the image to be measured in “Hounsefiled” units, or in the case of PET studies the Standardized Uptake Value (SUV – which quantifies glycolytic activity). Colors can be assigned by pixel values to substitute for the default grey scale (CLUT or color look up table), to make subtle differences more apparent (see above example). Tapping on the patient’s name in the top left hand corner will expand an overlay with image details, such as acquisition time and technique.

Navigating among series is performed with a quick flick across the screen. Alternatively, the list of series can be viewed by tapping on one of the tool bar icons. There sometimes seemed to be slight lag with activation of these controls, perhaps reflecting memory usage. On other issue with the viewer is that the image list is not grouped by patient which would have simplified locating a particular study when there are more than a handful of studies.

To see Mobile MIM in action, check out this video:

MIMCloud

While other iPad radiology viewers are now available, such as OsiriX HD, Aycan xr.ay, Merge & ResolutionMD, one feature that sets MIM apart is that it offers MIMCloud, an integrated, cloud-based DICOM service that makes storage and sharing of imaging studies very simple. The other solutions either require direct (WiFi) transfer of images to the iPad from a desktop workstation or directly from a radiology department server (Picture ArChiving System or PACS). Once in MIMCloud, any image study can be downloaded to the iPad. Obviously, the download will be faster on WiFi, where it takes usually less than a minute, Using a cellular 3G connection took 7-8 minutes to download a mid-sized (35Mb) MRI study in my tests.

In addition to downloading to the iPad, images can also be viewed from any web browser using the platform-independent Java MIM Viewer (below).One very useful feature of MIMCloud is the ability to share images with other account holders. Setting up an account is free and since there is an included a web-based viewer, it means that you can refer a study to another physician simply by entering their email address.

Since the DICOM data can be downloaded from the MIMCloud, this means that exchanging imaging CD ROMs between doctors can now effectively be a thing of the past.

The MIMCloud web application is fairly workmanlike, with just the necessary options available to manage studies, and share them with other physicians. Like the mobile app, each study gets its own row, and since the studies are not grouped by patient and names are only displayed as initials, the list is difficult to browse. A search feature makes it easier to locate a particular study.

A more challenging problem at the current time is that uploading a DICOM study to the cloud via the downloadable Java app is still clunky. The uploader only recognizes studies if they are stored in a physical folder, so if you are using OsiriX as I am, the study first needs to be exported to a folder on a disk. After that, each sequence seems to generate a warning dialog that it is a “non-standard orientation” meaning that it cannot run unattended for the several minutes it takes to upload a complete study. Also the Java app seems to be something of a memory hog.

Mark Cain has told us that the the upcoming revision to MIMCloud will address both these concerns. In particular, a new Java background service will be built that will represent itself as a “DICOM node” to any PACS server, including OsiriX. (a DICOM node is a kind of a standard “address” in DICOM-speak). Thus in the future, any study can be directed to MIMCloud with just a few clicks and uploading will occur in the background. Collaborating physicians’ MIMCloud accounts can even be designated as “nodes” so that a study can be sent directly to their accounts without intervening steps. This will greatly simplify the process and will be a welcome upgrade.

Pricing

The pricing schema is, unfortunately a bit complex. As above, the app itself is free. Charges are incurred when a study is uploaded to MIMCloud or downloaded to a mobile app for viewing or when viewed using the web-based MIMViewer.

According to Mark Cain, after the April 2011 MIMCloud 2.0 update, the pricing will be as follows:

• Transfer charges will be gone, charge by GB stored only
• Viewing charge is per study (not device)
• $1 for iPhone view
• $2 for iPad view
• $2 for MIMviewer (workstation software launched from mimcloud)
• $4 for MIMviewer Pro (adds diagnostic tools for radiologists)
• Cost per study is one time (many people view with iPhone, still just $1 once)
• Cost per study will be charged at the highest viewing cost. e.g. 5 users user iPhone, one user uses MIMviewer; final cost is $2

For radiology departments, bulk pricing and invoicing are available. Personally, I would prefer a monthly subscription fee instead of a per study fee. Perhaps in the future that will be offered as an option.

Conclusion

MobileMIM and MIMCloud are a great way to view, store and share radiology imaging. The Mobile MIM is a great piece of iOS software engineering, with remarkably fluid navigation throughout even large study sets. The ability to perform mutli-planar imaging and locate a structure in three planes simultaneously if very useful. Using MIMCloud to share imaging studies greatly simplifies communication and removes an important pain point, while while the updates to uploading studies coming with MIMCloud 2.0 will also be very welcome.

We understand MIM has received much attention from physicians following the announcement of their FDA clearance. From this experience, it seems the attention is well deserved.

iPrescribe turns your iPhone into a prescription pad [App Review]

[Cross-posted from iMedicalApps.com]

Billed as the “the first and only standalone electronic prescription application for smart phones”, iPrescribe allows for easy electronic prescription using an iPhone app.

To use it, the doctor only has to enter the patient’s name, date of birth, drug and dosage. Favorite prescriptions can be stored. If the patient’s zip code is entered, the app will even suggest nearby pharmacies. The magic is that once you touch “send”, all that is left is for patient to pick it up the pills at the drug store. No more holding on the phone or fumbling for a script pad. It is an enticing proposition for many doctors.

iPrescribe was just recently released to the App store and uses the SureScripts national e-prescribing network to process the electronic prescriptions. By utilizing this network, iPrescribe thus has access to pharmacies in just about every community the US. Only qualified medical professionals with valid NPI and DEA numbers are allowed to use it. In addition to the $19.99 download fee, there is a $9.99 monthly subscription fee, following a free 30 day trial. Doctors who already have e-prescribing included as part of their electronic health records (EHRs) may not have need for a separate app.

I found the app easy to use with a clean, well-thought out interface. The web interface, where you could also add and edit patients, is less polished. The main drawback of using app is the most obvious one, namely that the any prescriptions entered will have to be recorded separately into patients’ charts, although the web interface does allow for export of prescription histories.

Patient and prescription information is encrypted before transmission . For additional security, the app requires you to enter a 6 digit code, emailed to you at installation, every time the app is launched to prevent unauthorized use. Opiates, i.e. schedule II drugs, cannot be prescribed electronically so you don’t have to worry about your iPhone now being the target of crazed drug-seeking thieves.

For the more computer-savvy, patient information can be imported into the app in large batches by uploading files in CSV format. Unfortunately, the site provided scant documentation on how to do this, such as the expected name and number of the columns, nor were the error messages very edifying. I am sure with assistance this would have been feasible but a reasonable expectation should be that it can be done without calling tech support. However, once patient information is entered on the site, it can almost instantly be uploaded to the device. Similarly, any interactions performed on the phone can be reviewed on the website.

The app comes pre loaded with over 3,500 FDA approved medications including all available dosages. Once a prescription is entered, the app offers you to save it as a favorite, saving steps the next time the drug is prescribed. Note that If you use another e-prescribing solution, you can only receive refill notifications with one provider.

Surescripts

Surescripts, which calls itself “the nation’s e-prescription network”, was founded by the drugstore industry’s two largest trade groups in 2001. Every major pharmacy chain participates, and Surescripts is now expanding its network’s capabilities to participate in the National Health Information Network to allow interchange of even more health data.

According to SureScripts 2009 annual report,  e-prescribing has reached a “tipping point”, citing these findings:

• the number of prescribers routing prescriptions electronically grew from 74,000 to 156,000.
• 85 percent of community pharmacies in the U.S. are connected
• Surescripts can provide access to prescription benefit and history information for more than 65 percent of U.S. patients
• the number of e-prescriptions grew from 68 million to 191 million

Almost certainly, these numbers jumped again in 2010, especially with federal meaningful use incentives and CMS directives to Medicare Part D to participate in e-prescribing, Although reporting of patients’ pharmacy benefits and complete prescription history are the other two components of e-prescribing, the app does not currently appear to provide access to these information.

Conclusion

iPrescribe is leading the path for iPhones and other portable devices to more completely become tools of the doctor’s trade. While 78% of e-prescriptions (in 2009) were entered within an EHR, that leaves a large number entered through standalone software. Although I doubt that the prescription pad is quite ready for the trash heap of history, clearly the combination of decreased errors and increased convenience will make handwritten prescriptions more and more a quaint relic of the past. For physicians with iPhones, who do not have ready access to e-prescribing through their EHR, iPrescribe is a highly attractive option.

The past, present, and future of medical apps

[The article below is simultaneously published by iMedicalApps.com and the Journal of Surgical Radiology (http://www.SurgRad.com), a widely read, peer reviewed journal]

In just a few short years, smartphones with advanced operating systems have sparked a bright new era of mobile medical applications. Although the Blackberry smartphone had been the device of choice for physicians for most of the previous decade, the arrival of Apple’s iPhone in 2007 revolutionized mobile phones. The highly anticipated release of the iPhone software development kit (SDK) a year later immediately launched a wave of mobile software development and, almost immediately, interest in medical software.

As if to underscore this interest, a physician was on stage with Apple CEO Steve Jobs in 2009 demonstrating an early version of Air-Strip, an iPhone application that provided real-time monitoring of fetal heart rate tracings. This was nothing less than a thrilling peak at a possible future where physicians remained connected to their patients’ data, freed from the physical constraints of having to be at the hospital or office.

In the last two and half years, a new world of mobile medical applications has flourished. Currently, there are over 6,000 apps classified as health related across the various app stores, although only 30% are directed to clinicians. Still, with the numbers of physicians using smartphones climbing from an already high 72% to a projected 82% by 2012, the market for clinician oriented apps will only continue to increase.

Here at iMedicalApps we review and comment on mobile medical technology and apps from the perspective of physicians. In this column, we are going to explore the world of mobile apps and ask where medical professionals will be going to look for the medical apps of the future.

App Stores

After the iPhone in 2007, the next major revolution in mobile computing was the iTunes App Store, introduced a year later along with the iPhone SDK.

Suddenly, users could directly browse a huge array of applications directly on their phones and, with a single click, purchase and install software (“apps”) directly to the device. Along the way, the problems of software distribution – all publishers instantly had global reach – and security from viruses and rogue applications were mostly eliminated. By hiding the complexity of application installation from the user, Apple unleashed a commercial juggernaut and within 9 months, one billion apps were downloaded from the iTunes App Store.

The power of simplicity was not lost on other platforms and within a few months, Google launched the Android Market for its then nascent platform. Since then, of course, sales of Android powered phones have skyrocketed and, in December 2010, a dedicated medical section of the Android marketplace was inaugurated. Each of the other major platforms now has its own market, including Nokia (Ovi store), RIM (Blackberry App World), Palm (WebOS App store) & Microsoft (Windows Phone 7 Marketplace).

Web 2.0

In the same period as the smartphone revolution, rapid advancement in web browsers and software technologies has occurred that could conceivably displace the central role of “apps” in the future.

In the first decade after the birth of the world wide web, usually marked by the launch of the first Mosaic “browser” in 1994, the web was essentially a publishing medium. A single entity could broadcast widely using the world wide web but the audience was limited simply to absorbing the content or, at most, purchasing online.

The first “Web 2.0″ conference in 2004, organized by O’Reilly Media, popularized this moniker. Although there is no canonical definition, Web 2.0 pertains to the web becoming a two way medium. The definition often given is “the internet as platform” or “the participatory Web”. By collecting data from users, brand new types of services and companies could be created. One example is Wikipedia, a user-generated encyclopedia. Another is Reddit, a highly successful news site founded in 2005 that relies on its thousands of readers to vote items of interest up or down. By “crowdsourcing” the editorial process, massive amounts of data could be sifted and the publishing process could profitably be automated. In effect, the rise of a social, collaborative web meant that news, shopping, even software development became group efforts.

The evolution of Web 2.0 was in part facilitated by browser based technologies that allowed for more sophisticated interactions with the user. These were lumped into the memorable but loosely defined acronym “Ajax” (Asynchronous JavaScript and XML). Ajax allows for small portions of a web page to be modified in response to user input, instead of having to reload the entire page. This allows for more fluid interactivity. The original poster-child for Ajax is Google Maps, which can zoom, pan and display map overlays in a way that is still inspiring years after Google acquired and relaunched it in 2005.

Web Apps

While most people do not think of it as such, a website such as Google Maps is an application, only that it resides on a remote server and interacts with the user (executes) within the confines of a web browser. In contrast, an app such as Epocrates or Microsoft Excel resides within the device and directly manipulates the computer, via the intermediary of the operating system.

In fact, until recently all software applications were written exclusively to work within the environment presented by a computer operating system. For much of the last three decades, this usually meant the Microsoft Windows operating system. Until fairly recently, the kind of applications that worked within web browsers were just too simplistic to satisfy the wide variety of users’ needs.

However, the powerful browser based technologies mentioned above are starting to blur this distinction. Certainly, applications can be delivered through the browser much more cheaply and are far easier to distribute and maintain. Google, by giving away its barebones Chrome OS operating system is betting that web applications can deliver enough rich functionality to displace the role of device-specific operating systems such as Microsoft Windows and Macintosh OS X.

The end of Apps ?

While the demise of “native” app development and operating systems in favor of web applications has been regularly predicted for more than a decade, will the benefits of economical app distribution and maintenance finally be enough to overcome the shortcomings of browser based apps ?

The short and safe answer is no. The first reason was inimitably articulated by David Pogue in “The Lessons of 10 Years of Talking Tech” in the New York Times. As he put it:

TV was supposed to kill radio. The DVD was supposed to kill the Cineplex. Instant coffee was supposed to replace fresh-brewed.But here’s the thing: it never happens. You want to know what the future holds? O.K., here you go: there will be both iPhones and Android phones. There will be both satellite radio and AM/FM. There will be both printed books and e-books. Things don’t replace things; they just add on.

More arguments for the continued need for “native” medical apps were proposed by Albert Santalo, CEO of CareCloud – an EHR company, in his guest post on iMedicalApps. His arguments, paraphrased, were:

1. Offline Usability

Native apps can run in offline mode and then synchronize with the server when a signal becomes available. Dropped connections are a nuisance for the average consumer, but for health workers they can be “devastating”.

2. Full Functionality

Web apps cannot access device features and hardware such multi-tasking, Bluetooth, address books, the camera and microphone.

3. User Experience

Web apps lack a dedicated, device-optimized user interface and thus cannot be precisely catered to fit a particular device’s form factor, input methods and screen size. Thus, web apps typically deliver an “abridged” user interface.

Medical Apps Distribution

If “native” medical apps are going to be with us for the foreseeable future, how will physicians continue to find and deploy them ?

A recently published broad survey of the mobile industry by Research2Guidance predicts that the dominant mode of application distribution in the future will be from doctors, hospitals and other care providers, rather than via the current familiar App stores.

While App stores have been a revolution for consumers, this distribution mode is not adequate for health information technology, where isolated data stores are dead-ends. In particular, the ability to reference clinical evidence, prescribe medications, or communicate with other providers is of greatly diminished value unless all parties have simultaneous access to the same patient record.

The current generation of medical apps still emphasizes information retrieval – think Epocrates & Medscape. Although AirStrip Ob and Critical Care stand as a shining example of mobile devices acting as extensions of the doctors’ hands and eyes, the main mode of usage for smartphones remains information retrieval.

Therefore, it makes sense that hospitals and other provider networks will be the ones to develop and distribute intrinsically networked apps for their providers in the future. These future apps will be powerful extensions of physicians’ clinical tools, seamlessly extending their reach from hospitals and offices onto their mobile devices.

The Future of Medical Apps

Finally, a couple of other potential developments to look out for in the future. First is Practice Fusion, a free web-based EHR, which is seeing rapid adoption. If the enthusiastic developer response to the first, limited deployment of its API at the Health 2.0 meeting in July is any indication, there may yet be a flourishing App store within this EHR in the future. Also, look out for the Accelerator Apps Network , a sort of “meta-platform” for health care applications which aims to provide an environment where multiple health care apps can communicate with each other. From their description:

The Health 2.0 Accelerator Apps Network is a growing ecosystem of web applications and services that work together – collaborating 2, 3, 4 and more at a time, serving as platforms for other apps and as interoperable bridges between apps – all to connect and support patients, caregivers and providers

The future for medical apps is bright. There will coexist both native and web based apps. App stores will continue to thrive and the market for consumer directed health apps will thrive. However, apps directed at physicians will become increasingly better connected to patients’ clinical records and will more likely be distributed by hospitals and other provider institutions.

Apps for management of diabetes could be vehicles for reducing health care expenses in future [mHealth]

[Cross posted from iMedicalApps.com]

The cost of managing chronic diseases is the largest portion of health care expenditures in developed countries. For example, the prevalence of adult acquired diabetes has been rising in the United States, in concert with increasing rates obesity. The CDC has termed it an “epidemic”, especially in light of the massive costs incurred by the health care system due to diabetes.

The deleterious health effects of many chronic conditions can be diminished by behavior modifications. While few would underestimate the difficulty of having patients lose weight or exercise more, good management of blood sugar in diabetes is both objectively measurable and strongly correlated with reduced end-organ damage.

This is among the reasons why Research2Guidance has recently nominated diabetes as the condition most likely to be most targeted by mobile medical software and devices (mHealth). This finding is part of their recently published Global Mobile Health Market Report 2010-2015. This is the same report that also predicted that, in the future, medical apps are likely to be distributed by physicians and health care institutions.

This time Research2Guidance is highlighting the portion of the survey where they looked into where mobile devices have the most potential to affect health outcomes. While other chronic conditions such as hypertension and obesity have larger populations, the market researchers felt diabetes had the largest market potential due to the huge cost saving potential, the demographic & geographic overlap between smartphone users and diabetics and the real potential to improve sugar management using mobile devices. As per Research2Guidance,

To manage patients diabetes in “real time” and “on-the-go” situations, shared information within the healthcare industry and especially between medical professionals whilst “on-the-go” is essential.

Medgadget recently reported that Sanofi-Aventis and AgaMatrix have deployed in Europe the iBG Star, an integrated iPhone app and glucometer for measuring and recording blood sugars. This app stores recorded sugars and allows for data to be easily “communicated to healthcare professionals.” Unfortunately, this likely means that the app sends an email. And thus, it demonstrates one of bottlenecks for behavior modification by mHealth, i.e. the lack of integration into health care professionals’ workflow. In this vein, the efforts of EHR vendors such as Practice Fusion to develop APIs for direct, real time importation of patient data could be a key ingredient.

Nevertheless, the excitement around mobile medical software and devices is evident in this quote in the blog Diabetes Mine from noted endocrinologist Bruce Bode, MD:

The user experience is so rich and just amazingly simple. When you look at the iBGStar, you just know what to do with it – plug it into the iPhone, stick a strip in, and test! Amazing! The potential for this connectivity to the healthcare providers, family members, and smart software systems will change how we manage diabetes in the future. …I have never seen such an incredible device in my 25 years as an diabetologist.

Even then, the major driving force for adoption will remain the potential cost savings. Again, as per Research2Guidance, the direct costs alone of diabetes for a patient with diabetes in Western European countries are between 4,000 and 5,000 EUR annually. In the United States, adoption of these technologies will also hinge on FDA approval and adoption of more rational payment structures for physicians (e.g. medical homes and ACOs) that reward improved disease management, not just office visits.

Practice Fusion to launch EMR App Store, launching next evolution of EHRs: Interview with Matthew Douglass, VP Product Development

[Cross-posted from iMedicalApps.com]

Practice Fusion is a free, web-based electronic health record that has seen a rapid rate of adoption over the last two years and, as we reported recently, is currently the largest commercial EHR installation after Kaiser and the Veterans Affairs.

But like all “overnight successes”, the rise of Practice Fusion is not accidental and not without laborious engineering. In fact, important design decisions at its inception have been instrumental in its growth, allowing for rapid iteration of features without incurring heavy development and deployment costs. Matthew Douglass, currently the VP of Product Development, has been through almost the entire history of the company. He was the second person to join the company and continues to lead the engineering process.

In this interview we learn some of the fascinating story of Practice Fusion’s rise, its plans to expand its API (application programming interface) and launch an app store.

We envision that doctors could prescribe an app much like they prescribe a medicine now. – Matthew Douglass

How did you get involved in Practice Fusion?

At the time I was approached by [now CEO] Ryan Howard in 2007, I was working in energy and finance. But, even then, I wanted to do something besides, as I said, “turning millionaires into billionaires”. Ryan had started in 2005 and had just bought a one site EHR that was developed by a family practitioner. I was charged with making it multi-tenant and web-based. Multi-tenant means having all the data stored in a single database, instead of separate for each user. Back then, we worked in coffee shops, communicating electronically. I worked hard for six weeks, including one non-stop 72 hour stretch just before we launched, which has become urban legend around here. Three months later, we went on to the web. That was the beginning of 2008.

How did Practice Fusion initially grow?

We initially charged $50 per month per doctor. Then we decreased it to just $50 for support and training. By the time we went to the web, we were free. This led to rapid growth. We started rapidly signing up physicians. Our very first web user, by chance, was also in San Francisco. With the passage of HITECH act in Feb 2009 [which provided financial incentives for physicians adopting EHRs], we started to get interest from investors. The first were a large Bay Area angel group called the Band of Angels. Later Mark Benioff [CEO of Salesforce] invested. We recently completed a series A round from a venture capital firm [7.2m, 11/24/09, Morgenthaler Ventures]. We don’t do direct sales, meaning door-to-door. Most of our customers find us online. The majority of our users are in California, New York, Florida and Texas.

How did you settle on free as the price?

We found that primary care practices were quite price sensitive, as their real income had stagnated for more than 20 years. We decreased our price until we got to free. We are committed to keeping it free. We feel there are enough other participants in the health care IT ecosystem who can subsidize the EHR, such as device makers, labs, billers, pharmacies, etc. Doctors should not have to pay.

How about advertising revenue?

Ads are a large part of our revenue.

Talk about your implementation

The original EHR was written by a physician, Robert Rowley, who is now the Chief Medical Officer. Our multi-tenant database, where all patients around the country are stored in a single database, has allowed us to scale smoothly by allowing us to release new versions of the software while keeping everybody on the same version. Our architecture also allowed us to easily add a patient portal [Patient Fusion]. Initially we were adding 5-6/day users a week, now we are adding as much as 350 users or about 40-50 practices per day. We have surpassed 60,000 registered users. Just two months ago we were adding 250/users a day, so the rate of growth is accelerating quickly, and we feel that with HITECH incentives in 2011, this may push it higher. We are planning for even greater acceleration.

How many engineers do you have at Practice Fusion ?

We have a total of 53 employees, 17 are engineers and we are hiring 6 more, thanks to the stimulus.

What are your continuing challenges?

A lot of what we do is integration, tying together other systems and suppliers. This does not always show up as an explicit feature. For example, seeing a Labcorp result requires getting a file, parsing it, displaying and storing it. And every single lab is different. e-Prescription integration, such as with Surescripts, and determining formulary eligibility can be very complicated behind the scenes. But because our system is multi-tenant and web-based, we just have to do it one time and all our customers get the update simultaneously.

Tell us about the Practice Fusion Developer Challenge

Last spring, Matthew Holt and Indu [Subaiya, of the Health 2.0 Conference] approached us about posting a Developer Challenge at the Health 2.0 meeting in July. We decided within a week, and launched within 3 weeks. [The Health 2.0 Developer Challenge is supported by HHS but run by Health 2.0]

For our Developer Challenge, we discussed it and decided to go with a limited API emphasizing ways to get real time data into Practice Fusion. We felt that getting the physician real-time measurements [e.g. blood pressure, etc] could be really valuable – instead of requiring the physician or practice to enter all the clinical information. We were very surprised when 35 developers submitted projects, more than any other challenge.

Of the 35 submissions, 25 had to do with medical devices and data transfer. This tells us that there is a market for this connectivity. The winner [Team Critical Systems] was a great example of hacking – a simple bathroom scale was hacked to read the LCD display and the result is transferred directly into Practice Fusion.

Any surprises among the submissions ?

I was surprised that 10 of the submissions did not even submit their own data, but rather co-opted the API to present unstructured data, for example turning a patient intake form into a rudimentary data entry API, e.g. patient submitted “mood” data. This [type of observation] will drive our API strategy. Other types of structured data we had not anticipated such as reporting diagnoses or clinical workflow.

How did you decide on your Challenge ?

There are a lot of medical device manufacturers which already transfer measurements to their own servers. However, this data is isolated. It does not take too much work for them to use an API to transfer this data to patients’ records and allow clinical decisions to be made from this information. This is what could be revolutionary. We already have a dozen companies lined up to work on our API

What future directions are you anticipating for your API ?

We are planning on extending the API enough to allow a limited interface. The first will be scheduling, problem list and medication manager. As with everything else, we will listen to the market. Extending the API has to be carefully done not to disturb published APIs. Developing an API does take away resources from other efforts, but we feel it is important.

What are your mobile plans ?

We will shortly have a Practice Fusion interface which will work on smartphones. It will have limited functionality, giving you the ability to view patients and the schedule. The extension of the API will probably have the same capabilities. We will be bringing our mobile interface, including iOS, Android, and RIM, hopefully in first half of 2011. This will work across all mobile devices with web enabled browsers. We are planning on native apps, depending on marketplace.

The Practice Fusion app store

The biggest enhancement will be a Practice Fusion app store. This is not yet announced although I have a rough date. The idea is that the doctor will have access to all the application within the Practice Fuson network . The app store concept is a way to unify the apps, downloading may occur elsewhere. We put the application as something the doctor can prescribe. The instructions to download the application may be sent to the patient via email.

This is a way for making applications work for you. The buyer could be the doctor, patient, payor, etc. It will be a place where developers can showcase their apps. The apps will be attached to a user’s account but could also be used on other devices, such as a communicating smartphone app.

We envision that doctors could prescribe an app much like they prescribe a medicine now. Right now all a doctor can do is write an order [CPOE] or hand out a pamphlet. But, there are a lot of things in between appointments where a patient can report back to the doctor – maybe compliance with a medication or nutrition plan. A weight monitoring app for a patient trying to lose weight can directly enter weights into their record. Simple alerts can signal patient compliance, or can even provide feedback to the patient herself.

Interview with Founding Member of Health 2.0 Accelerator, Erick Von Schweber, CEO of SURVEYOR Health

[cross-posted from iMedicalApps.com]

For those who are not familiar with the the Health 2.0 Accelerator, it is one of a few organizations dedicated to shaping the future world of interconnected healthcare “apps”. The promulgation of the carefully crafted Meaningful Use criteria has standardized a minimum set of requirements for EHRs in order for physicians and hospitals to qualify for federal incentive payments. With these incentives being substantial, the rate of physician EHR adoption has been climbing, recently passing the 50% mark.

However there is little organized push to integrate health IT for consumers looking to learn more about their health, their medications and to help them communicate with their physicians & other providers. The Health 2.0 movement was founded with this glaring inadequacy in mind. It was defined by Ted Eytan in this way

Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or create, we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself.

We recently wrote about the Health 2.0 Accelerator (H2A), describing it as “laying the foundation for interconnected medical apps of the future”. In this interview, we talk to Erick Von Scheber, one of the founding members of the Accelerator. He is also co-founder of SURVEYOR Health, a service that analyzes patients’ medications and makes sophisticated predictions of the likelihood of drug interactions and their potential presenting symptoms.The Health 2.0 Accelerator was founded with the following principles:

• Developing common understanding of consumer value and promoting trusted use of Health 2.0 technology solutions
• Removing integration barriers that limit mutually beneficial collaborative business opportunities
• Facilitating integration of Health 2.0 technology solutions in traditional health care environments and with provider-centric technologies

The non-profit and vendor neutral nature of H2A has attracted a broad spectrum of industry participation.

The strategy of the Accelerator is to provide a “light-weight open framework”, not comprehensive standards. As with the best of multi-lateral organizations, the members are all individually motivated to participate in solutions that could potentially benefit their businesses. What has emerged over time is that H2A may end up serving providers and EHRs as much as consumers.

How was the the Health 2.0 Accelerator started ?

It was at the very first Health 2.0 conference, in September 2007 in San Francisco. At that time, it was a one day conference. Right after Esther Dyson, Marty Tennenbaum spoke. If you don’t know him, he is literally the godfather of ecommerce. He launched a company named Commerce One which did the first transaction on the ARPANET.He made out well before bubble burst in 2000 and in 2003/4 became interested in health care. He learned from his own experience that healthcare had a far way to go, and that it would do well to adopt ecommerce technologies.

At that conference, he said “if the people in this room do absolutely nothing, in 10-20 years health care will adopt technologies from the web”. Then he paused and added “but there are a lot of people that don’t have that long to wait.” He encouraged the founding of a non-profit to accelerate this of web technologies in health, which became the Health 2.0 Accelerator.

How did you get involved in the Accelerator ?

After the Fall meeting, there was a Spring meeting six months later, in San Diego. The first morning, Marty put together a group to informally discuss this idea. He had about 100 people from different companies (this is now formalized into the lunch time “unconference”). Marty did not take no for an answer, he went around and picked people to join the project. He chose us and Destination Rx, who are Medicare D administrators for CMS.

How did the Accelerator evolve after that ?

In 2008, at the Health 2.0 Conference, we showed an example of how two web apps can integrate. By the Spring 2009 meeting, the Accelerator had came together, became integrated, got a director and budget. We signed up more members, including Kaiser, First DataBank and Catholic Healthcare West. Others came. We created an annual code-a-thon.

For this Fall, we wanted to choose fewer companies. We wanted to show how it would benefit patient, care-giver & provider. That’s why we built a scenario about a patient, her daughter and her doctors.

How is the Accelerator related to the Health 2.0 Conference ?

We are part of the H2.0 family. It also includes H2.0 advisors, the conference, the Accelerator and the Developer Challenges.

How do you compare the Accelerator with the NHIN Direct ?

[note: The Direct Project is a federally supported project, with the goal of specifying "a simple, secure, scalable, standards-based way for participants to send encrypted health information directly to known, trusted recipients over the Internet."]

I keep learning about this. In ecommerce, when Marty co-founded Commerce One, they had to develop their own standards. At that time, XML was brand new. He said, in order to get companies to work together beneficially, certain companies will emerge which will take on the task of building the infrastructure. This is in contrast to one organization building the infrastructure.

Thus he was pushing the Accelerator network as a place where companies can come together. The strategy is not to build new standards. We already support SNOMED, NDC, HL7. We learned how to work around the problems that will inevitabily arise. We did not want to scale up to a standards organization like IEEE, WC3 [World Wide Web Consortium].

What keeps companies in the Accelerator ?

We always have interested parties. We always have companies that are willing to complement their offering with something else.

Initially, when ad rates for consumers health web sites were high, we considered that we could share traffic and ad revenue. We are now in the process of reinventing the Accelerator for the larger community that inextricably involves the patient, caregiver, provider and payer. We came out of the consumer focus since we were born in the health 2.0 community. Because of the shift with Meaningful Use, etc, we are taking more interest in the providers and plans.

It seems that rate of change in the health IT is glacial

We at SURVEYOR Health have noticed a swing in the industry in terms of adoption in HIT. Many of the big indigenous players, such as GE, Eclipsys, Epics are losing market share. New “upstarts”, with web savvy are growing. Will large hospitals wait for 3 years for the next generation of Centricity when lighter weight players are evolving more quickly ? We see a huge rate of change from our perspective.

The Accelerator Apps Network is laying the foundation for interconnected medical apps of the future [Health 2.0]

[cross-posted from iMedicalApps]

At this past October’s Health 2.0 meeting in San Francisco, many great new ideas about the future of health care were presented with a special emphasis on technology. For a great overview check out the keynotes by Jeff Goldsmith & Tim O’Reilly. The conference, organized by Matthew Holt & Indu Subaiya started in 2007 and bills itself as the “the leading showcase of cutting-edge technologies in health care”. Those not lucky enough to attend the conferences can follow along on the Health 2.0 blog.

Besides exploring the overarching themes of the future of health care in general and health IT in particular, many innovative companies, young and old, gave on-stage demos at the conference. One demonstration in particular stood out for me. This was the demo by the Accelerator Apps Network which showed the future of interconnected companies and applications seamlessly exchanging patient information. The Health 2.0 Accelerator Apps Network is a non-profit industry consortium launched by the Health 2.0 company.

We have discussed before the untapped potential of medical apps that exist as isolated data islands. Here was a vision where applications, small and large, collaborate across the internet to create a powerful mesh of services that simultaneously serve patients and doctors. From the description:

The Health 2.0 Accelerator Apps Network is a growing ecosystem of web applications and services that work together – collaborating 2, 3, 4 and more at a time, serving as platforms for other apps and as interoperable bridges between apps – all to connect and support patients, caregivers and providers

The demo was created around a story of a patient visiting a doctor after a syncopal episode. In it, the patient’s daughter “pushes” her personal health record to the doctor she is about to see from her mobile device (iPhone), giving him access to her records before her arrival. The doctor uses other apps on his iPad to see the patient’s risk profile based on medications and another app to check her medication compliance. Using Enhanced Medical Decision’s Natural Language Processing Engine, her doctor is able to predict potential side effects of any newly prescribed medications.

The patient then uses another app to pre-register for surgery using information in her Microsoft Health Vault (PHR) which is then populated again afterwards with information from the surgery. A Shared Care Plan after surgery contains her discharge instructions, adding items to her calendar where necessary.

While large electronic health record (EHR) vendors such as Practice Fusion and Eclipsys (now part of Allscripts) have announced methods (APIs) of integrating outside applications to their data stores, what is exciting about the Accelerator Apps Network is that it is vendor neutral and thus participating companies can potentially interact with multiple EHRs as well as other health IT innovators.

Overall, the range of participating companies and communicating applications, both web and mobile, was quite impressive. It will be very interesting to see what new ideas and companies will come out of the Accelerator Apps Network over the next year.

To see the demo yourself, check out the video below. The clinical scenario begins about minute 13.

http://www.health2con.com/mediaplayer/player-licensed-viral.swf