How Doctors Think About New Technologies

From the post by Leslie Kernisan at The Health Care Blog

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My questions when considering a new technology

To begin with, here are the questions that I think about when considering a new technology:

Does it help me do something I’m already trying to do for clinical reasons? Examples include tracking the kind of practical data I describe here (sleep, pain, falls, etc), helping patient keep track of — and take — medications, helping caregivers monitor symptoms, coordinating with other providers…my list goes on and on, although I’ll admit that I prioritize management of medical conditions, with issues like social optimization being secondary. (Social optimization is crucial, it’s just not what physicians are best at, although I certainly weigh in on how an elder’s dementia or arthritis might affect their social options.)

What evidence is there that using it will improve the health and wellbeing of an older adult (or of a caregiver)? Granted, the vast majority of interesting new tech tools will not have been rigorously tested in of themselves. Still, there is often related and relevant published evidence that can be considered. For instance, studies have generally found that there’s no clear clinical benefit in having non-insulin dependent Type 2 diabetics regularly self-monitor blood glucose. (And it is certainly burdensome for older people with lots of medical problems.) Hence I would be a bit skeptical of a new technology whose purpose is to make it easier for older adults to track their blood sugar daily, unless it were targeted towards elders on insulin or otherwise at high risk for hypoglycemia.

How does the data gathering compare to the gold standard? Many new tech tools gather data about a person. If we are to use this information for clinical purposes, then we clinicians need to know how this data gathering compares to the gold standard, or at least to a commonly used standard. For instance, if it’s a consumer wrist device to measure sleep, how does it compare in accuracy to observation in a sleep lab? Or to the actigraphy used in peer-reviewed sleep research? If it’s a sensor system to monitor gait, how does it compare to the gait evaluation of a physical therapist? If it’s the Scanadu Scout Tricorder, which measures pulse transit time as a proxy for systolic blood pressure, where is data validating that pulse transit time as measured by this device accurately reflects blood pressure? (BTW I can’t take such a tricorder seriously if it doesn’t provide a blood pressure estimate that I can have confidence in; blood pressure is essential in internal medicine.)

How exactly does it work? Especially when it comes to claims that the product will help with clinical care, or with healthcare, I want to know exactly how that might work. In particular, I want to know how the service loops in the clinician, or will facilitate the work the clinician and patient are collaborating on.

How easy is it to use? Tools and technologies need to be easy to use. Users of interest to me include older adults, caregivers, and the clinician that they’ll be interfacing with. BTW, all those med management apps that require users to laboriously enter in long drug names are NOT easy to use in my book.

How easy is it to try? Let’s assume a new technology is proposing a service to the patient (or to me) that offers plausible benefits, either because it’s a tech delivery of a clinically validated service, or because it passes my own internal common sense filters. How easy is it to actually set up and try? I’m certainly more inclined to explore a tool that doesn’t require a large financial investment, or training investment.

How cost-effective is using this technology? I’m interested both in cost-effectiveness for the patient & family, and also for the healthcare system. Sometimes we have simpler and cheaper ways to get the job done almost as well.

Can this technology provide multiple services to the patient? My patients are all medically complex, and have lots going on. Products that can provide multiple services (such as socializing with family off-site AND monitoring symptoms), or that can coordinate with another product — perhaps by allowing other services to import/export data — are a big plus.

Does this technology work well for someone who has lots of medical complexity? I always want to know if the product is robust enough to be usable by someone who has a dozen chronic conditions and at least 15 medications.

What I’d like to see on the websites

These days, a website is the generally the place to start when looking into a product or service.

It’s a great help to me when a product’s website addresses the questions I list above. Specifically, I find it very helpful when websites:

Have a section formatted for clinicians in particular. I’m afraid I don’t have much time for gauzy promises of fostering a happier old age. I just want to know how this will help me help my patients. Specific examples are very very helpful.

Have a “how it works” section with screenshots and concise text. Personally, I have limited tolerance for video (videos can’t be skimmed the way text and pictures can) and find it a little frustrating when most information is in videos. Note that it’s probably best to have separate “how it works” sections for clinicians and for patients/caregivers.

Provide a downloadable brochure for patients/families, and another for clinicians.Although it’s annoying when information is presented ONLY in a pdf brochure, I’ve discovered that I quite like having the option of a brochure. Brochures are much easier to read than websites, in that you don’t have mentally decide how to navigate them, or search through them in quite the way you do with websites. Also, brochures can be conveniently emailed to colleagues or patients, which is nice when you want to suggest that your patient try something new…..

 

Read the entire blog post here

 

Related articles

• 4 ways to make IT clinician-friendly (healthitplus.wordpress.com)
• Readers Write: Healthcare’s Crystal Ball – Predictions for 2013 (histalk2.com)
• Physicians’ websites are more “electronic brochures,” than online health resources (medcitynews.com)
• Capturing clinical innovation to improve patient care (siliconrepublic.com)
• Health, Technology and the Forgotten Stepchild of Innovation (forbes.com)

 

Patients Can Emit Small, Influenza-Containing Particles Into the Air During Routine Care

From the 31 January 2013 article at KevinMD.com

[The]majority of influenza virus in the air samples analyzed was found in small particles during non-aerosol-generating activities up to a 6-foot distance from the patient’s head..

Vaccination of health providers remains a fundamental and key part of protecting them from influenza

 

A new study suggests that patients with influenza can emit small virus-containing particles into the surrounding air during routine patient care, potentially exposing health care providers to influenza. Published in The Journal of Infectious Diseases, the findings raise the possibility that current influenza infection control recommendations may not always be adequate to protect providers from influenza during routine patient care in hospitals…

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The current belief is that influenza virus is spread primarily by large particles traveling up to a maximum of 3 to 6 feet from an infected person. Recommended precautions for health providers focus on preventing transmission by large droplets and following special instructions during aerosol-generating procedures. In this study, Dr. Bischoff and his team discovered that the majority of influenza virus in the air samples analyzed was found in small particles during non-aerosol-generating activities up to a 6-foot distance from the patient’s head, and that concentrations of virus decreased with distance. The study addressed only the presence of influenza-containing particles near patients during routine care, not the actual transmission of influenza infection to others.

Fitted respirators are currently required for health care providers during aerosol-generating procedures with patients. During routine, non-aerosol-generating patient care, the current precautions recommend that providers wear a non-fitted face mask. Based on their findings, Dr. Bischoff and investigators are concerned that providers may still be exposed to infectious dosages of influenza virus up to 6 feet from patients with small wide-spreading particles potentially exceeding the current suggested exposure zones.

These findings suggest that current infection control recommendations may need to be reevaluated, the study authors concluded. The detection of “super-emitters” raises concerns about how individuals with high viral load may impact the spread of influenza, they noted. “Our study offers new evidence of the natural emission of influenza and may provide a better understanding of how to best protect health care providers during routine care activities,” the study authors wrote. However, studies of influenza virus transmission will be necessary before the role of super-emitters can be firmly established, they noted…

Whatever protective equipment or infection control practices are used for preventing influenza transmission, vaccination of health providers remains a fundamental and key part of protecting them from influenza, noted Dr. William Schaffner, professor medicine and chair of the department of preventive medicine at Vanderbilt University School of Medicine in Nashville, Tenn., who was not involved with the study. “Influenza vaccination, although not perfect, is the best tool we have to protect health care workers — and their patients — from influenza illness.

 

Related articles

• Health care providers may be at greater risk of flu exposure (eurekalert.org)
• Stand Back: Flu Virus Travels 6 Feet (livescience.com)
• People with flu can release small, flu-filled particles into air: Study (sunnewsnetwork.ca)
• 2012-13 Influenza vaccine effectiveness: a preliminary estimate (bio230fall2010.wordpress.com)

 

Virtual Superheroes: Using Superpowers in Virtual Reality to Encourage Prosocial Behavior

Figure 1. Participant flying in VR.  This figure shows: (A) The labels the Head Mounted Display, which renders the virtual world on two screens, one for each of the participant’s eyes; (B) The optical tracking markers are labeled. One marker is placed on the participant’s head and two are placed in the participant’s hands. These markers track X,Y, Z position; When the participant raises her hands above her head, she flies higher in the virtual city; (C) One of the eight motion-capture cameras that track the optical marks; and (D) The orientation tracker for head rotation.     doi:10.1371/journal.pone.0055003.g001

 

From the summary at Full Text Reports

Background

Recent studies have shown that playing prosocial video games leads to greater subsequent prosocial behavior in the real world. However, immersive virtual reality allows people to occupy avatars that are different from them in a perceptually realistic manner. We examine how occupying an avatar with the superhero ability to fly increases helping behavior.

Principal Findings

Using a two-by-two design, participants were either given the power of flight (their arm movements were tracked to control their flight akin to Superman’s flying ability) or rode as a passenger in a helicopter, and were assigned one of two tasks, either to help find a missing diabetic child in need of insulin or to tour a virtual city. Participants in the “super-flight” conditions helped the experimenter pick up spilled pens after their virtual experience significantly more than those who were virtual passengers in a helicopter.

Conclusion

The results indicate that having the “superpower” of flight leads to greater helping behavior in the real world, regardless of how participants used that power. A possible mechanism for this result is that having the power of flight primed concepts and prototypes associated with superheroes (e.g., Superman). This research illustrates the potential of using experiences in virtual reality technology to increase prosocial behavior in the physical world.

Related articles

• Video games ‘can encourage real superhero behaviour’ (itv.com)
• Study: If We Could Fly, We Would All Be Superheroes (theatlantic.com)