Sunday, December 30, 2012

New Limb-Lengthening Tech May Reduce Complications

New Limb-Lengthening Tech May Reduce Complications for Sufferers of Crippling Deformities
By Mollie Bloudoff-Indelicato
Scientific American

Screaming woke Lanz Ellingsworth. The piercing cries were loud, they were shrill — and they were coming from his daughter’s bedroom.

At 8:30 p.m., Ellingsworth and his wife had tucked their youngest, Lindsay, in for the night. They read her a bedtime story, kissed her on both cheeks and crept out of the room. Six hours later, their little girl was a mass of quivering agony.

In the middle of the night Lindsay had shifted slightly in her sleep. The abnormally brittle femur in her left leg splintered into multiple pieces. She woke from her dreams and plunged into a living nightmare.

“When I woke up that night, what I kept repeating was that ‘somebody hit me with a sledgehammer,’ Lindsay says. “That’s how it felt. Somebody literally smashed my leg with something. And I just screamed.”

Lindsay, a tiny, freckled eight-year-old, was used to pain. She was born with a congenital limb deformity called “underdeveloped femur condition,” in which one leg is shorter than the other by more than two centimeters. Up to 100,000 people are diagnosed with limb-length disorders in the U.S. each year, according to Bart Balkman, vice president of Ellipse Technologies, an Irvine, Calif.–based orthopedics company.

Left untreated, the condition can result in chronic pain, loss of mobility, degenerative arthritis and debilitating scoliosis, an abnormal and painful curvature of the spine that typically progresses throughout one’s lifetime. At birth or shortly thereafter parents whose children have a severe discrepancy (estimates range from a two- to three-centimeter or more differential) must make a decision—amputate the shorter limb or commit to a lengthening regimen to equalize them.

“Can you ever imagine having a child and loving that child and being told that part of your child’s leg had to be amputated?” says David Hootnick an orthopedic surgeon in Onondaga County, N.Y., who studies congenital abnormalities. “Can you imagine the emotional stress you’d have to go through?”

Limb-lengthening technology has progressed significantly from the early 1950s when a handful of doctors first began the practice. Gavriil Ilizarov invented the external fixator in Russia, a device he modeled after a horse harness. Now, about 100 surgeons in the U.S. perform limb-lengthening procedures, and a new internal approach offers patients expanded mobility and promises fewer complications. The device, called “Precice,” received U.S. Food and Drug Administration approval for consumer use but is still relatively unknown within the greater medical community.

By far the most common procedure for children with leg discrepancies—and the one used in Lindsay’s surgery—is an external “fixator.” Surgeons break a patient’s bone in half and pull it apart, allowing the body’s natural healing capabilities to fill in the gap with new bone, thereby lengthening the limb.

John Blanco, a specialist in pediatric orthopedics and scoliosis at the Hospital for Special Surgery in New York City, has been performing the operation for years. With the patient under a general anesthetic, Blanco drills screws into the top and the bottom of the afflicted bone. The screws are fastened into a metal frame that will stabilize the leg during and subsequent to the procedure. After cutting a small incision in the leg, Blanco takes a hammer and breaks the bone in two. It’s a dull sound, he says, like hitting wood—more of a thwack than a snap. The finished product resembles an Erector Set construction covering the leg.

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Location:Georgetown ,Tx

Saturday, December 29, 2012

Graft Helps Nerves Regrow

Graft Helps Nerves Regrow

By MELINDA BECK - Wall Street Journal

Edward Bonfiglio was on a routine patrol with a Marine unit in Afghanistan in 2009 when it was hit by small-arms fire and rocket-propelled grenades. A round smashed through the Navy medic's left leg, leaving him unable to move it or feel anything but pain.

A few weeks later, at a military hospital in Bethesda, Md., Mr. Bonfiglio was given a choice: try a new technique to regrow his severed sciatic nerve, or have his leg amputated below the knee.

"I was pretty adamant about keeping my leg," he said.

Three years and hundreds of hours of physical therapy later, the 26-year-old Mr. Bonfilgio has regained much of the use of his leg. He has graduated from a wheelchair to a cane and can even jog slowly. His leg isn't perfect and never will be, but, he said, "I never saw myself being able to walk with just a brace on my leg."

More than 300,000 Americans suffer severed peripheral nerves in their hands, arms, legs and feet every year, often due to highway accidents or mishaps with tools or knives. Combat injuries also are big contributor.

Traditional nerve repair involves using a piece of healthy nerve from the patient—usually from the back of the ankle. But that requires a second surgical incision and often leaves a numb spot where the nerve was removed.

Some gravely wounded soldiers don't have a lower-extremity nerve to spare. Surgeons also can use synthetic tubes, but they are most effective for repairs smaller than one centimeter (about 0.4 inch).

A new type of nerve graft made from processed cadaver nerves is giving surgeons another option for rebuilding nerves, sometimes in limbs that previously couldn't be saved.

"It has become the standard of care for our group," said Lt. Commander Patrick Basile, director of microsurgery at Walter Reed National Military Medical Center, who operated on Mr. Bonfiglio. Since that operation, the division of plastic and reconstructive surgery there has used the new nerve allografts, as this type of graft is called, in about 20 other patients.

Surgeons are using the allografts to repair nerves damaged in other situations as well, including oral surgery and cancer operations. Houston urologist Kevin Slawin uses them to reconnect erectile nerves when they can't be spared during prostate-cancer surgery.

Not all severed nerves can be repaired. Injuries to the central nervous system, in the brain and spinal cord, are almost always permanent.

But parts of the peripheral nervous system, which facilitates movement and feeling in the rest of the body, can regenerate. The section beyond the break dies, leaving just the original sheath. The other side can regrow into the sheath at a rate of about one millimeter a day. But if there is a gap, the nerve needs a bridge to grow back correctly, or it can create a dysfunctional bundle that causes pain.

Allografts use cadaver nerves that are treated to remove cells and other tissue, leaving hollow nerve channels for the patient's own nerve to grow into. The segments come in a variety of widths and lengths—up to seven centimeters currently.

"We can take the exact size we need out of the freezer," said Greg Buncke, director of the Buncke Clinic in San Francisco, who said the clinic uses allografts almost exclusively now in trauma cases.

Registered for use with the Food and Drug Administration in 2007, the allografts are made by AxoGen Inc., AXGN -4.73% of Alachua, Fla., and have been used to date in about 7,000 patients, according to Erick DeVinney, AxoGen's director of clinical and transplantation sciences. Most have involved nerves that control feeling, but allografts increasingly are being used to repair nerves that control movement as well.

Some veteran clinicians aren't yet convinced that allografts are as reliable as a transfer of a patient's own nerve (known as an autograft).

Surgeons say no randomized trials comparing the two types of grafts directly have been published, but several studies have shown that results with allografts are as good as those reported historically with autografts, and better than with tube conduits, with no complications or rejections.

Using an allograft costs about the same as a tube conduit, and less than an autograft since less surgical time is needed.

"Autograft is the gold standard, so some surgeons don't like to deviate from that," said Steven Moran, an orthopedic and plastic surgeon at the Mayo Clinic in Rochester, Minn. But Dr. Moran said he much prefers allografts to harvesting a patient's nerve. "That's another big incision, another area to heal and some patients get a painful nerve scar on that site," he said.

Repairing Mr. Bonfiglio's sciatic nerve required a five-centimeter graft—the biggest ever used at the time. The nerve had to grow back, millimeter by millimeter, from his thigh to his toes and he had to constantly exercise his leg muscles so they didn't atrophy.

"I wasn't the greatest patient—I was a pain in butt. But I got it done," said the former medic, who now is studying to be a physical therapist himself.

Write to Melinda Beck at

A version of this article appeared December 27, 2012, on page A3 in the U.S. edition of The Wall Street Journal, with the headline: Graft Helps Nerves Regrow.

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Location:Georgetown, Tx

Friday, December 28, 2012

Here it comes, the change nobody expects

From the Georgetown Advocate
The Tech Savvy Patient - Webster Russell

Catherine the Great once said "A great wind is blowing. It will either give you imagination or a headache.” Even though she lived in the late 18th century, there are times when I think she was referring to today's life and times specifically the technological growth we have seen in the last fifty years. I know technological advances are wonderful things and for the most part they make our lives better. The problem is that these advancements come in fits and starts. Just about the time you finally get use to the new fangled thing, it is changed and you are back to square one.

I started traveling this circular path when I bought a programmable Texas Instrument calculator in the late '60s for use in the interpretation of a type of blood test. From that point until today I have been fascinated with healthcare/medicine's technological revolution and how it affects the delivery of this important part of our everyday life.

About ten years ago I had an ah ha moment when I discovered that something else was going on. These changes harbored a stealth like evolution in the patient/physician relationship. I don't want to get to deep into the weeds, but let me explain what I mean. The patient, that's you and me, has become far more sophisticated in our choice and use of the healthcare system. We are transforming from the quiet, non participative patient to an activist customer/consumer. As innocent as this appears on paper, it is an extraordinarily powerful shift. This shift in control may be best summarized by Kenneth Hammond when he wrote. “A generation ago, individuals gratefully accepted whatever information they were given….The doctor…was the source of all knowledge and data. Today we expect the network of information will be there and made available to us. Now in almost every action we have with a professional, we take it for granted that we are also a partner and decision maker.”

The information we need to achieve this new status is out there for the harvesting, and the means of gathering it, storing it and recalling it is literally at our fingertips. Over the next weeks and months I will try to help you discover these tools, as well as the information you might need to help you become more of a partner in the management of your healthcare.

Now to peak your curiosity, something happened on January 10, 2007 that started this revolution, what was it?

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Location:Georgetown Tx

Ten Ways Patients Get Treated Better

Ten Ways Patients Get Treated Better
Laura Landro - The Wall Street Journal

Even healthy people worry about the quality of care they can expect to receive when they become ill. Will a cancerous tumor be spotted early enough? Will hospital staff move fast enough to save my life? What is the worried-looking doctor scribbling in my chart?

Health-care innovations aren't limited to drugs and devices. Experts increasingly are adopting new ways to treat patients that studies show are better at healing the sick, preventing disease, improving patients' quality of life and lowering costs. Here are 10 innovations that took root in 2012 and are changing the care patients will get in 2013.

Doctors Are Adopting a Better Bedside Manner

Hospitals increasingly have a new focus: keeping patients happy. Surveys sent home after a hospital stay are asking patients to rate everything from whether nurses and doctors seemed attentive to their concerns to how clean their room was. The institutions are putting doctors, nurses and other employees through customer-service training, hiring "patient experience" consultants and designating staff ombudsmen to handle complaints. The moves follow prodding from Medicare, which now ties payments in part to how patients feel they were treated. The changes, though, benefit all patients.

Heart Attacks Are Being Treated Faster

Speed is of the essence in surviving a heart attack, and in many cities now treatment starts before the patient reaches the hospital. Emergency medical technicians perform electrocardiograms and transmit results wirelessly to the emergency room. New guidelines from the American Heart Association and the American College of Cardiology aim to quickly restore blood flow when an artery is blocked, the most severe type of attack known by the acronym STEMI. Guidelines call for balloon angioplasty and stents as preferred treatments for STEMI, and clot-busting drugs as a stopgap measure. Also recommended: Chilling the patient in cases of cardiac arrest, a practice that reduces subsequent brain injury. In new research, survival rates were higher among cardiac-arrest patients who received CPR longer—a median of 25 minutes versus 16 minutes. For patients, the message is: Don't delay calling 911 when you have symptoms, and avoid going to the hospital in a private car.

ERs Are Getting Better at Handling Medical Mysteries

A growing number of hospital emergency rooms are opening observation units to keep an eye on patients who show up with complaints that can't be quickly or conclusively diagnosed. This reduces crowding in harried ERs. It also allows emergency staff to closely monitor at-risk patients and conduct tests more quickly and cheaply than by admitting them as an inpatient to a hospital room.

You Can Finally See What Your Doctor is Writing About You

Patients who have access to the notes their doctor makes about them are more likely to understand their health issues, recall what the doctor told them, and take medications as prescribed, according to a trial program called Open Notes initiated by several big hospitals and now spreading across the country. Although patients have the right to view doctors' notes, these often aren't included in patient requests for medical records and doctors don't make it easy to see them. In the Open Notes trial, some patients picked up errors. Other patients became more diligent about follow-up actions that eliminated the need for additional office visits, says Thomas Delbanco, a physician at Beth Israel Deaconess in Boston and lead investigator of the study.

Health Apps Are More Sophisticated

Rather than just count calories and monitor exercise, new apps take on more serious concerns. "Is it Contagious?" from the Nemours Foundation has information on some 85 childhood infections and conditions, including info on when to seek immediate medical care. An app from the Centers for Disease Control and Prevention enables searches of health information. Carolinas Medical Center has an app to calculate the risk of pain and discomfort after hernia surgery. MyIBD, from Toronto's Hospital for Sick Children helps those with irritable bowel disease track symptoms and food intake. The nonprofit Pew Research Center says some 19% of smartphone users have at least one health app on their device.

Tests for Colon Cancer Are Less Arduous

Colonoscopy is the gold standard for detecting colon cancer. Yet millions of people who should have one don't, whether out of distaste for the laxative prep regimen or fear of the procedure. Alternatives include a "virtual" colonoscopy, using CT scanning to examine the colon. A new version of the fecal occult blood test analyzes stool samples gathered at home to find polyps, abnormal growths that can become cancerous. Randomized controlled trials have shown the technique reduces colon cancer death rates. Kaiser Permanente mails test kits to its Northern California patients and gets 3,000 samples a day. If test results are positive, colonoscopy is advised.

Talk of Dying Gets a Little Less Daunting

Families and patients are getting help with one of the most difficult care decisions: When to stop invasive and costly treatments and focus on a dignified and comfortable pathway to the end of life. A program known as POLST—Physician Orders for Life-Sustaining Treatment—has been adopted in a growing number of states. It offers a template doctors and patients can use to discuss and record which types of care patients want and which they would rather forgo. Another program, the Conversation Project, created by writer Ellen Goodman, is a way to help people talk about these issues with loved ones around the kitchen table. A starter kit, available free online, helps map out how to think about what matters most, such as being able to recognize family members, and how to talk to family about tough care decisions.

The Hospital Is Less Likely To Make You Sick

The problem of hospital patients who contract potentially fatal infections has dogged providers for years. Medicare has stopped paying to treat some infections acquired in the hospital.A breakthrough came in September with news that a program in 1,100 intensive care units in 44 states reduced the rate of a deadly hospital bloodstream infection by 40% over four years. The remedy seems simple: Doctors and staffers follow a checklist of routine precautions, including washing hands and removing catheters from patients as soon as possible. Peter Pronovost, the Johns Hopkins patient safety expert who oversaw the program, estimated it has saved more than 500 lives and $34 million and will lead to more programs to reduce harm.

Robots Are Helping Your Surgeon

In a growing number of medical schools and hospitals, trainees and staff are learning procedures on lifelike electronic robots that bleed, have seizures, and give birth—all while simulating emergency complications. that requireCare providers practice critical thinking and decision-making under pressure, "without risking the well-being of actual patients," says George Halvorson, outgoing chief executive of Kaiser Permanente. A robot named Noelle can simulate a birth emergency while the multitalented SimMan has the ability to present realistic human responses to heart attack, stroke or respiratory distress. Studies show that simulation leads to enhanced teamwork and crisis-management skills of health-care providers.

Vetting a Hospital Gets Easier

Data on hospital quality and safety has been available online for some time, but not in a very user-friendly way. This year, the Leapfrog Group, a coalition of public and private purchasers of employee health coverage, graded hospitals, from A to F, based on measures of patient safety. Some hospitals got poor grades and took issue with the methodology, which was subsequently altered slightly. Leapfrog CEO Leah Binder says it is "the toughest standard-bearer and provides the most complete picture of a hospital's quality and safety." The list of 1,200 hospitals, released Dec. 4, ranks only 89 of them as top facilities. Patients can use a free website or a mobile app to compare hospitals based on overall safety or based on selected procedures such as heart bypass surgery. A research team at Johns Hopkins' Armstrong Institute for Patient Safety and Quality will provide scientific guidance in future.

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Location:Georgetown, Tx

Tuesday, December 18, 2012

Heart Gadgets Test Privacy-Law Limits

Heart Gadgets Test Privacy-Law Limits -
The Wall Street Journal by AMY DOCKSER MARCUS

A recent swell of digital-medical data collected on devices outside of a doctor’s office is raising some thorny questions: Who owns the rights to a patient’s digital footprint and who should control that information? WSJ’s Linda Blake reports.

The small box inside Amanda Hubbard’s chest beams all kinds of data about her faulty heart to the company that makes her defibrillator implant.

Ms. Hubbard herself, however, can’t easily get that information unless she requests summaries from her doctor—whom she rarely sees since losing her insurance. In short, the data gathered by the Medtronic Inc. implant isn’t readily accessible to the person whose heartbeat it tracks.

“This is my health information,” said Ms. Hubbard, 36 years old. “They are collecting it from my chest.”

Amanda Hubbard’s defibrillator collects an array of data about her heart, and she is troubled that she can’t gain direct access to it. ‘This is my health information,’ she says. ‘They are collecting it from my chest.’

The U.S. has strict privacy laws guaranteeing people access to traditional health files. But implants and other new technologies—including smartphone apps and over-the-counter monitors—are testing the very definition of medical records.

Medtronic says federal rules prohibit giving Ms. Hubbard’s data to anyone but her doctor and hospital. “Our customers are physicians and hospitals,” said Elizabeth Hoff, general manager of Medtronic’s data business. Medtronic would need regulatory approval to give patients the data, she said. It hasn’t sought approval because “we don’t have this massive demand.”

At the same time, companies including Medtronic are pushing to turn the data into money. Ms. Hoff said the company is contemplating selling the data to health systems or insurers that could use it to predict diseases and possibly lower their costs. At a July industry event, a senior Medtronic executive, Ken Riff, called these kinds of data “the currency of the future.”

In April, Medtronic created Ms. Hoff’s unit in part to look for business opportunities like these.

The primary purpose of the defibrillator implant in Ms. Hubbard’s body is to zap her irregular heartbeat back to normal if the need arises. The Big Sandy, Tenn., resident first started experiencing heart-disease symptoms in 2009 while in Samoa for the Peace Corps and has had her defibrillator since 2010. Her implant collects details of her heart-rhythm changes, device performance and hundreds of other data points.

The implant works like this: It records and stores data onboard. Wireless monitors in patients’ homes download the files and send them to Medtronic. Doctors can log in to a Medtronic website to review patient reports.

How to Read an Implantable Defibrillator Report

Amanda Hubbard’s implantable defibrillator electronically tracks her heart, and when it beats too fast or too slow, zaps it back to normal. The tiny computer also collects a wealth of data beamed over the internet to the company that makes her device. Whether patients could make use of this data is a topic of hot debate.

View excerpts from a doctor’s summary report, obtained by Ms. Hubbard through her physician, for a glimpse of what patients would get if they had direct access to the data.

Device makers are in a race to design data-gathering implants. Medtronic and its rivals already collect heartbeats from more than one million people with defibrillators. St. Jude Medical Inc. is seeking approval for an implant that crunches numbers to help doctors and patients adjust medication levels.

This would be new territory: Unlike, say, a defibrillator, the St. Jude implant doesn’t deliver treatment itself. Instead, it simply gathers data to be used in making treatment decisions—such as whether a patient should increase medicine dosages.

Medtronic officials say they know some patients want to be more active in their care. “This is the direction where things are going,” said Tim Samsel, vice president of regulatory affairs for the cardiac-rhythm unit.

But to offer reams of data to patients in a useful format, he said, Medtronic “would actually have to design such a thing” and seek Food and Drug Administration approval. That costly process, he said, could take years.

The summary reports seen by doctors highlight measurements such as instances of arrhythmias that increase stroke risk. The devices also gather large amounts of raw data—for instance, measurements used by engineers to assess device performance—that isn’t available to doctors.

Other defibrillator makers also balk at giving data directly to patients. St. Jude said it has no way for patients to access defibrillator data and declined to comment on whether it would give a patient data if asked. Biotronik SE said it would refer patients to their doctors.

Erica Jefferson, an FDA spokeswoman, said the agency supports patient access but would need to review any plan to provide data directly to patients. “In the current format, the data collected from implantable cardiac devices should be relayed through the physician to ensure proper interpretation and explanation,” she said.

Doctors themselves debate whether patients could make use of the data. Some worry it could cause anxiety or even harm if a patient misunderstood the signals. Still, some say that doesn’t matter. “They should have it,” said David Lee Scher, a retired cardiologist who is leading efforts among doctors to help connect patients with device data.

Some legal experts say the 1996 U.S. law governing patient access to their health files—HIPAA, or the Health Insurance Portability and Accountability Act—hasn’t kept up with technology. The law gives patients the right to access information held by doctors and hospitals.

However, the raw data gathered by an implant isn’t held by a doctor or a hospital: Typically it goes directly to the device maker, which provides a summary report to the doctor. Because of this, the raw data falls outside the scope of HIPAA’s patient-access requirements. In addition, Medtronic said, business agreements with doctors and hospitals restrict it to relaying information only to them.

“Is the device itself a depository for medical records?” said Paul C. Zei, a cardiologist at Stanford University Medical Center with a patient, Hugo Campos, who wants the same access to his cardiac-device data as the doctor gets. “Or is it part of the patient, and an extension of vital signs that we download into a medical chart?”

“Sixteen years after the enactment of HIPAA, a lot of changes are probably warranted,” said Paul DeMuro, a Portland, Ore.-based health-care attorney for Schwabe, Williamson & Wyatt.

Device makers do face restrictions on use of this information. They couldn’t, for instance, sell identifiable information to a marketing company.

A community of patients nationwide is fighting for access, arguing the data would help them manage their disease. “If anyone should have the data, it’s me,” said Mr. Campos, 47, a San Francisco Web designer and Dr. Zei’s patient.

Five years ago, he fainted on a train platform. Diagnosed with a heart condition called hypertrophic cardiomyopathy, he got a Medtronic defibrillator.

Mr. Campos says he has gone to lengths to understand the data the device collects. “The geek in me was interested,” he said. He took a two-week, $2,000 class that trains technicians how to read the reports.

Mr. Campos says he wants to track his heart data the same way he does information from other devices he uses, including a Fitbit gadget that counts steps taken and calories burned, a Zeo monitor he wears on his head to analyze sleep patterns and a blood-pressure monitor.

He keeps a spreadsheet to record arrhythmia symptoms and the circumstances—intensity, activities, his mood. He says he has cut out drinking whiskey and coffee based on his spreadsheet.

Currently, his only option is to see his cardiologist, Dr. Zei, who gives Mr. Campos a report. Even with insurance, Mr. Campos says he pays around $350 out-of-pocket, per visit, for two doctor’s visits and device checks per year. “It is like being coerced into paying to get information I should have myself,” he said.

After discussions between Mr. Campos, Dr. Zei and Medtronic, a compromise was reached. Still, it is less than what Mr. Campos sought. While Medtronic won’t give Mr. Campos his summary report directly, or any raw data, Dr. Zei’s office agreed to email Mr. Campos his reports as soon as the office receives them.

Medtronic declined to discuss details of its communications with Mr. Campos but said it was pleased to work with him and other patients “to determine the best path to providing meaningful data to patients.”

Tolu Odomusu, a research fellow at Harvard University’s Science, Technology and Public Policy program, says people have no idea what information their devices collect. He learned only last year after seeing a physician for severe apnea and being given a “continuous positive airways pressure” machine, or CPAP—a mask that delivers oxygen at night—to improve his sleep.

The device, made by Koninklijke Philips Electronics NV, logs sleeping habits. At a six-month follow-up, Dr. Odomusu said he was shocked when his doctor told him, based on the machine, that he slept fewer hours than he believed.

He worries that data he doesn’t know about could somehow be used to his disadvantage. For instance, if he were in a car accident and an insurer wanted to try to blame his sleepiness, “could they get the data from the machine at my home?” he said. “Would that be allowable?”

Privacy law typically would prevent that, said Nicolas Terry, a law professor at Indiana University’s law school. Specifically, he said, laws prevent third parties that aren’t involved in health care, such as auto insurers, from accessing health data collected by prescribed devices unless they get a patient’s OK.

But that isn’t necessarily the case with nonprescribed devices. “You get a very different scenario if you take your iPhone and buy the sleep-monitoring app,” he said. “There is no real law that protects that data.”

A Philips official said a patient who wants data from a CPAP machine can be set up to access from home the same data the doctor sees. The company doesn’t use the data, she said.

Smartphone apps, meanwhile, are now available to collect everything from medical images, such as X-rays, to electrocardiography readings. There is even iDry, an app to help patients manage incontinence.

Apps like these, by definition, collect health-related data about people. But because they don’t necessarily require FDA approval or a doctor’s participation, most fall outside the boundaries of HIPAA restrictions on data use.

The developer of iDry, Jeff Pepper, says for instance that he will provide researchers with detailed, but anonymized, data covering instances of incontinence logged by customers. He said he is voluntarily using HIPAA guidelines to eliminate identifiable information about his users. “Nobody’s going to be able to sell diapers to a particular customer,” Mr. Pepper said.

Apple Inc., which makes tablets and smartphones for which many apps are designed, declined to comment. Its guidelines require app-makers to publish data policies and to obtain users’ permission before transmitting their data to third parties.

Michael Seid, a researcher at Cincinnati Children’s Hospital Medical Center, has been wrestling with privacy in a clinical trial he is running. Twenty teenagers with Crohn’s disease and ulcerative colitis have agreed to have their cellphone use tracked. Doctors want to see if changes in social interaction—decreases in texting and calls—correspond to feelings of sickness.

In 2010, MIT researchers used similar methods to predict health. Studying early-morning and late-night call and text patterns, they could discern if a person was suffering from colds, stress or mild depression.

A company founded by some of the researchers,, is working with Dr. Seid. “Your smartphone leaves a trail of data exhaust wherever you go,” Dr. Seid said, calling it “a continuous measure of health.”

Some members of his research team expressed discomfort with what they see as “Big Brother” aspects of the experiment. He said they raised concerns that insurance companies might insist on such tracking. These are areas of continuing discussion, he said.

At Medtronic, officials say they are looking into ways to capitalize on patient data. The company is developing a matchstick-size monitor, implantable without surgery, that could track measures such as heart rate and arrhythmia that can predict heart disease.

Medtronic’s Ms. Hoff said she can envision a future where employers might require insured workers with a family history of heart disease to have the device implanted or face higher insurance premiums. She said the company has also contemplated whether it could sell analytics services to hospitals seeking to predict worsening heart disease. But those efforts are nascent, she said.

“I would love to build a more consumer-oriented business,” Ms. Hoff said, but the company doesn’t believe demand for such a service yet exists.

Ms. Hubbard, the Tennessee patient, says she didn’t think about any of this until she saw posts by Mr. Campos online describing his efforts to get Medtronic reports. Ms. Hubbard has Long QT Syndrome, which causes rapid heartbeats that can trigger a seizure, fainting or death.

Ms. Hubbard, whose insurance ran out in mid-2011, when her eligibility for Peace Corps coverage expired, said she began wondering, if she wasn’t regularly seeing a doctor, “Who gets my information? What happens to my data?” In August she asked Medtronic for the data. The company told her to talk to her doctor.

When she called the cardiologist at Vanderbilt University Medical Center who put in her implant, the office told her she must come in for a checkup to get her reports, which she did.

The doctor who implanted her device, Pablo Saavedra, said that since Ms. Hubbard hadn’t been coming in for checkups, the information sat in the Medtronic system without doctors knowing what was there. At her checkup, diagnostic tests detected a problem: The electrode attached to her heart had become dislodged. Dr. Saavedra says there was a chance it wouldn’t have shocked her heart when needed.

Ms. Hubbard had surgery last month to fix that. And she plans to keep trying to get reports sent to her directly. “If I had been able to follow my own reports, I would not have walked around for an entire year with a potentially dangerous problem,” she said.

A version of this article appeared November 29, 2012, on page A1 in the U.S. edition of The Wall Street Journal, with the headline: Heart Gadgets Test Limits Of Privacy Laws on Health.

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Location:Georgetown ,Tx

Friday, December 14, 2012

A personal insight into cancer

I have been married for going on 51 years, I always knew this woman was tough as most nurses are, but that spiritual stamina was sorely tested 6 months ago with the diagnosis of lung cancer.

Since that time she has completed one four month tour of Chemo Therapy, with the trials and tribulations that entails. It wasn't the nausea, there was none, nor was it sleep issues that got her down, it was the fatigue and neuropathy that pressed her spirit down, but she kept pushing on.

It has been four months since the port was put in and chemotherapy was started. The therapy plan the oncologist used delivered results and she is now on a chemo “vacation” for three months.

I do not write this to expose our personal battle with this disease, but to emphasize the wonders of modern medicine. What was once the scourge of chemo therapy, nausea, is all but eliminated today. What once was treating cancer with a shotgun approach, is now treated with a proton beam. What was once a sure death sentence is a conclusion that in many cases may no longer be true. Finally what was a one size fits all approach is moving toward individual based approach.

We may or may not win this battle only time and the good Lord will tell. What I can say with certainty is that we will have more quality time together then we would have had a decade ago. That being true, just think what the case will be in the next decade.

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Location:Georgetown TX

Tuesday, November 20, 2012

Cancer detection takes another step forward

Cancer-Detection Device Wins Top Asian Innovation Award


HONG KONG—Technology for detecting cancer cells in blood, developed in Singapore, took the top prize in The Wall Street Journal's Asian Innovation Awards, which were announced Tuesday.

The second prize went to light, flexible padding for body armor, also from Singapore, while an outsourcing company bringing jobs to rural India came in third.

The three winnersreflect some of the broader issues that the Asia-Pacific region's entrepreneurs are trying to tackle, such as health-care-related challenges and ways to improve the living conditions of the underprivileged in emerging economies.

This year, the Journal received more than 240 applications. A team of Journal editors narrowed the pool to 52, before an independent panel of judges from the private sector and academia worked with the editors to select 12 finalists. From among the 12 finalists, the judges chose the Gold, Silver and Bronze Prize winners, as well as the Technopreneur of the Year award for an entry that best applies technology with the greatest potential for commercial success.

One of the prominent themes among this year's applicants was how to find solutions to health-care-related problems, often linked to social issues such as population aging, economic disparity and poverty.

While some applicants deal with health-care issues that are closely tied to socioeconomic conditions specific to their countries, Singapore-based Clearbridge BioMedics Pte., whose entry won the Gold Prize as well as the Technopreneur of the Year award, is contributing to world-wide efforts to detect and fight cancer.

Clearbridge said it is developing a way to isolate circulating tumor cells—stodgy cancer cells that spill out of the malignant tumor and flow into the bloodstream—using a biochip that it says will physically trap such cells with its microscopic structure. Those cancer cells in the bloodstream could provide clues about the spread of the disease and possibly help in early detection, scientists say.

Clearbridge—spun off from the National University of Singapore, which provided funding for the venture—hasn't yet run clinical trials for the ClearCell biochip, but plans to do so in coming years.

The Silver Prize went to Sofshell Pte. Ltd., another Singapore-based startup, which has developed body-armor padding using lightweight material that is soft under normal conditions but hardens upon impact. The company, spun off from the Institute of Materials Research and Engineering at Singaporean government research agency A*STAR, says the material enables the wearer to maneuver more easily, without sacrificing the level of protection. Possible applications include sportswear as well as police and military body-armor products. Other than protecting the human body, the material could also be used for protective cases for electronics devices and other fragile items, the company says.

Another common theme among this year's applicants was how businesses could help create opportunities for underprivileged communities.

RuralShores Business Services Pvt., the winner of the Bronze Prize, runs outsourcing services such as data entry, bookkeeping and expenses at offices in small towns and villages in India, providing rural youth with job opportunities. While most outsourcing firms in India operate in urban centers, some, like RuralShores, are trying to take advantage of untapped talent in rural areas, allowing local youth to find jobs without relocating to cities. Still, such operations often face difficulties due to underdeveloped infrastructure, particularly Internet connectivity and power supply.

Entries for the awards came from all around Asia. Of the 12 finalists announced in August, three were from Singapore, while another three came from India and another three from Hong Kong. The other three finalists were from the Philippines, Pakistan and Australia.

The judges were selected by journalists at The Wall Street Journal, and coverage of the event and its winners is the sole responsibility of the Journal's news department.

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Location:Georgetown, TX

Friday, November 16, 2012

Been gone for a while

Sorry I have been gone for a while. As many of you know my wife is fighting Cancer, and as you can imagine that takes up a lot of time. I will get back on the blog soon.

For those in the Georgetown Texas area I have a column in the Georgetown Advocate. You might check it out.

Wednesday, October 17, 2012

Now Less Painful Bone Marrow Biopsies

Vidacare Wins WSJ Bronze Award -
The Wall Street Journal by SHIRLEY S. WANG
For many cancer patients, the pain of a bone-marrow biopsy can add to the anguish of the diagnosis and treatment.

Vidacare Corp. aims to ease that pain with the OnControl Bone Marrow System. The Bronze winner of The Wall Street Journal’s Technology Innovation Awards, and winner of the Medical-Devices category, the product allows doctors to more quickly and precisely take samples from inside the bone.

Biopsies of bone marrow, the spongy tissue and fluid that helps make red and white blood cells, are used to detect and monitor such conditions as leukemia and other cancers of the blood. Bone marrow also is extracted from healthy individuals to donate to patients who need transplants.

But for decades, marrow has been extracted by doctors using strong force to manually insert a needle deep into the bone. Patients sometimes have to be stuck several times if the needle isn’t properly inserted.

The OnControl device, which is already on the market, bores like a household drill into the so-called intraosseous space inside the bone. When the device reaches the correct point in the bone for the sample, changes in resistance and how the motor sounds offer cues for the doctors. It’s a faster process, with less pain, and the quality of the samples raises the likelihood that just one puncture will be needed, according to Mark Mellin, chief executive of the privately held, San Antonio, Texas-based company.

Darlene J.S. Solomon, a competition judge and chief technology officer at Agilent Technologies Inc., in Santa Clara, Calif., calls the innovation a “superb contribution.”

“We’re learning that bone marrow is an increasingly important bodily material,” says Dr. Solomon, who adds that the product has the potential not only to make biopsies easier for patients, but to lower the barrier to marrow donations by healthy individuals for transplants.

The product was based on the earlier success of Vidacare’s EZ-IO Intraosseous Infusion System, which allows for quick and easier intravenous administration of fluids, also by penetrating inside the bone. The EZ-IO device was the Gold Winner of The Wall Street Journal’s 2008 Technology Innovation Awards contest.

After the success of the IO device, Vidacare began thinking about other medical opportunities inside the bone that could be aided with a power device, and they saw one for a product that extracted bone marrow rather than infusing fluid, according to Mr. Mellin.

—Shirley S. Wang

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Location:Georgetown TX,United States

Monday, October 8, 2012

The Future Of The Patient-Physician Relationship

Healthy Consumers And The Future Of The Patient-Physician Relationship | TechCrunch
TechCrunch October 4, 2012
Michelle Snyder

It’s hard not to read an article about the healthcare system these days without some reference to the demise of the patient-physician relationship and the risk this poses to us as individuals and the collective health of our nation. Unfortunately this is old news.

For many people it’s either been gone for awhile or it never existed. And longing for “the good old days” is, in many cases, the wrong goal to be working toward. What most people want is to get better in the fastest, most convenient way when they are sick and not have to think about their health when they are well. Physicians and other healthcare providers are an important piece in the puzzle, but having a “relationship” does not necessarily guarantee getting what you really want or need.

It’s time to start a new conversation. Let’s stop lamenting the end of Marcus Welby and instead get excited about the opportunities to reinvent healthcare delivery, as well as the technology, people, and services needed to be successful. This article examines some of the most interesting opportunities within the digital health space for healthy consumers. Though it’s not an exhaustive list, it provides a framework that begins to look at new healthcare models that can meet their needs.

Not to be confused with the Quantified Self movement (which is a separate topic of discussion), the healthy consumer is your average healthy “Jane” who engages with the healthcare system infrequently, and, when she does, seeks convenience, service, and value. Though Jane and others like her are not likely to make the biggest impact on healthcare-system costs compared with addressing the problems of chronically ill patients, I find this population exciting from an investor and entrepreneurial perspective. They are likely to pay for convenience and are open to new models of care that may or may not include a “relationship” with a provider.

Remote Diagnosis And Treatment

Thanks to the X Prize and Qualcomm’s $10 million, we may have a Tricorder in the not-too-distant future. In the meantime, however, it has been exciting to see companies making consumer convenience a cornerstone of their value propositions by helping them avoid a physician visit or getting faster access to care. Though widespread telehealth adoption has been slow due to reimbursement and credentialing issues, dermatology is emerging as a breakthrough area, as it lends itself well to algorithms and mobile technology advances. In addition, access to dermatologists is particularly challenging given the relatively small clinician population (only 12,000 dermatologists in the U.S.) and growing interest among many of those specialists in focusing on self-pay cosmetic procedures.

Direct Dermatology is among the more interesting companies in this emerging space. Its focus is to improve access in rural areas (six-month waits for a dermatologist visit are not atypical) via its network of top dermatologists from Stanford and UCLA. Other newcomers, such as RockHealth graduate NoviMedicine, target specific markets — acne in this case.

Another area is home tests. It’s been more than 35 years since women were liberated from having to see a physician for a pregnancy test. It’s time for the next generation of home tests, and companies like QuickCheck Health are looking to make routine rapid diagnostic tests for flu, strep, and UTI available at the pharmacy or through insurers. Tests could provide an alternative to a physician visit (especially if the results are negative, which happens the majority of the time) and/or you would have the option to pay a small fee for an online consult if the results are positive.

Service-Oriented Primary Care

Maybe it’s the marketing data geek in me but I get excited when I hear providers talk about their net promoter scores. We are finally moving to an era where providers are listening to their customers and are concerned with how many of them will “refer them to a friend.” Several different care providers are changing the way people think about primary care. They range from insurance-based, technology-savvy practices, such as One Medical Group and monthly fee-based membership models like Qliance and MedLion to those that provide home visits, such as WhiteGlove. While the business models vary, these companies believe that you must put the consumer first and meet their needs in terms of convenience, access, and value.

While it’s more prevention-focused, another interesting company to keep an eye on is Ella Health. Though the bar is low in this care sector (ask most women about their mammography experiences), Ella is starting to raise it by providing a more consumer-friendly, spa-like experience with better outcomes. I am still waiting, however, for the day when you don’t have to get your body squished into a machine.

Search, Scheduling, And Referrals

If you are a healthy consumer, there is a good chance you don’t have a close relationship with a primary care doctor, let alone a specialist. What you really need is information to help you pick the best provider based on what you value the most at that time – convenience, cost (low or high – some people equate price with quality), and/or quality (ranging from outcomes to a nice office setting).

One of the reasons ZocDoc has been successful is that it has tapped into the healthy consumer market and helped Gen Y, among others, have a more consumer friendly experience with the healthcare system. By allowing consumers to find highly reviewed MDs and scheduling appointments within 1-2 days, ZocDoc fulfills their desire to get what they want (an appointment), when they want it (now). Health In Reach is another interesting company in the space providing a Hipmunk-like experience. Consumers can select the degree to which features like bedside manner, office atmosphere, and discounts are important to them when looking for a provider.

While “Dr. Google” is used by all segments of the population, if you are a healthy patient, it’s likely to be your first and possibly only stop (since most of your friends are healthy, too). And while I use Google as much as anyone, my friend Dr. Jordan Shlain from HealthLoop likes to say that “Dr. Google is an oncologist – most symptoms take you to a cancer diagnosis.” We are not where we need to be with healthcare search, but we are starting to see companies attempting to create tools to make search more meaningful and actionable.

Meddik, a Blueprint Health company still in beta, is using a sophisticated analytics engine to find out what other people like you are searching for, what articles are most valuable, and identify other potential co-morbidities through search (e.g. back pain sufferers are searching on topics for gout, as well). Another early stage company, Pokitdok, seeks to use analytical modeling to identify the healthcare products and services that would be of interest to you based on your preferences and others like you.

Prevention For At-Risk Consumers

Unfortunately, millions of people at any given time are at risk for graduating into the episodic and perpetual patient segments. To make matters worse, these consumers are one of the toughest groups to influence, because they haven’t had an event yet which fundamentally changes their lives.

Omada Health is an example where successful disease prevention, not just management, could have huge financial and societal benefits (there are over 42 million pre-diabetics in the U.S. alone). Omada and a handful of others represent a new generation of health IT companies incorporating behavioral science and human-centered design to create more fun and engaging consumer experiences that motivate at-risk people to care about their health.

While not as sexy as “social,” many within the healthcare system are recognizing the power of text messaging to not only reach the greatest number of at-risk patients but also to change behavior. Results from Voxiva, HealthCrowd, and others in this space are showing the ability to positively impact a variety of measures from immunization rates and prenatal care to medication compliance.

The beauty of these models is that you can automate aspects of the patient/provider relationship via smart messaging systems — the best of these customizes the messaging based on how different people respond to different messages over time — with minimal involvement from a healthcare professional.

Disclosure: I do not have a direct relationship with any of the companies mentioned in this article except HealthLoop, where I serve as an advisory board member. Two of the companies listed, Meddik and NoviMedicine, are part of accelerator programs for which I serve as a program mentor/advisor (RockHealth, BluePrint Health).

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Location:Georgetown TX,United States

Wednesday, October 3, 2012

Screen shots of chemotherapy log project

Yesterday I told you about the Chemo Therapy Log being developed. Today I will show you a few screen shots of this developing project.

This is the data input form

This graph represents the calculated distress quotient. This number represents the potential distress the chemo may be causing.

This graph represents the patients appetite.

Needless to say these few screen shots only represent a portion of the log's output.

Again it will be ready for prime time in November as will the Oxygen Therapy Log for people with COPD.

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Location:Georgetown,United States

Tuesday, October 2, 2012

New Push to Treat Cancer Distress

This subject is near and dear to me as my lovely wife, a retired RN, is undergoing Chemo Therapy. We noted that the oncologist's assessment of her well being was based solely on the visit observation and the antidotal information she provided.

As we all know antidotal data is usually based on a relatively short time duration, and is centered usually on a single problem area. To that end we wanted our oncologist to have a greater degree of information over a longer term combined with the test data in his measure of her ability to contend with her disease and therapy.

Using his criteria as a guide we developed a “computerized log” that allows the patient to evaluate daily, 10 areas. Using a simple form to enter their information, the information is automatically graphed and a distress quotient determined and graphed as well.

When we visit the oncologist, we give him a printed version of the graphed results to assist him in ascertaining just how my wife is coping with her therapy and at the same time generate his questions for her.

This log is compatible with iPhone, iPod Touch, and iPad and will be available for free at in November.

If you have a friend or family member under going Chemo therapy, I strongly recommend you read this article.

New Push to Treat Cancer Distress -
The Wall Street Journal

There is a new national push to screen and treat cancer patients for distress - emotional and psychological trauma that interferes with the ability to cope with cancer treatment but is often overlooked by doctors.

Hospitals and oncology practices around the country are adding programs to help patients with a side effect of cancer that often goes unnoticed and untreated by doctors: emotional and psychological distress.

With growing evidence that distress can negatively affect patient outcomes, there’s a new mandate to make screening for it part of routine care. Starting in 2015, the Commission on Cancer, which accredits centers that treat about 70% of all new cancers diagnosed in the U.S., will require providers to meet a new standard to evaluate patients for distress and refer them to programs for help.

“Identifying people in need of support is an integral step for modern oncology care,” says Stephen Edge, chair of the commission, a consortium of cancer organizations established by the American College of Surgeons.

More than half of cancer patients may suffer from distress, studies show—ranging from normal feelings of vulnerability and sadness to extreme, disabling anxiety and panic. Specific concerns include how they will be perceived by friends and family, whether they can resume work, how well they will cope with illness and treatment and how to pay their medical bills.

While it may not be surprising that cancer can prompt distress, what is striking is that distress can affect a patient’s physical progress. Not only can such feelings interfere with the ability to cope with the rigors of cancer therapy, experts say, but they can lessen one’s motivation to complete treatment. They can also interfere with the body’s immune system and have a negative impact on the course of the disease.

While some patients seek out support groups and other aid on their own, many “fall through the cracks,” Dr. Edge says.

Pressure to improve supportive care for cancer patients has been mounting since 2007, when the Institute of Medicine, which advises the federal government on health-care issues, warned in a report that cancer care often fails to address patients’ psychological and social problems. The National Comprehensive Cancer Network, an alliance of 21 of the world’s leading cancer centers, developed guidelines for distress screening in 1999, but by 2005, only three of its members reported routinely screening all patients.

Among other providers, standardized screening tools—including a distress “thermometer” that lets patients rate their distress on a scale of zero to 10—are still not widely used. In one survey of oncologists, only 14% reported screening for distress with an evidence-based tool and one third reported that they didn’t routinely screen for distress at all.

Because doctors are often focused on physical symptoms and treatment, studies have found, emotional and psychological issues may be overlooked or discounted. Patients, for their part, may be too embarrassed or reluctant to report their concerns. And while large cancer centers have the resources and staff to screen for distress and provide help, community hospitals and oncology practices—where about 85% of cancer patients in the U.S. get their care—often don’t have the time or funding.

One program the Commission on Cancer recommends to providers: CancerSupportSource, a new distress screening and referral program developed by the nonprofit Cancer Support Community. Using a Web-based, 25-item questionnaire, it asks patients to rate concerns in seven categories and identifies the type of support they want to receive, such as group meetings or one-on-one counseling, links to helpful websites or written information.

“The resources to help cancer patients deal with distress already exist in communities across America, so cancer centers don’t have to hire a whole new psychosocial staff,” says Kim Thiboldeaux, chief executive of the Cancer Support Community, which was formed in 2009 by the merger of support groups Gilda’s Club and the Wellness Community. It has more than 150 locations in the U.S. that offer counseling, classes and online aid, and links patients to such help as free taxi rides to chemotherapy appointments and copay assistance for medications.

Cindy Dalen, 52 years old, trained as a combat medic during a stint in the Army before becoming a hair salon manager. But she says nothing prepared her for her own medical crisis: a diagnosis of Stage 2 breast cancer last December.

At first she kept her emotions in check, especially in front of her family, but the first time she went to a doctor’s appointment without her husband, the tears came pouring out. A sympathetic nurse suggested she might benefit from the CancerSupportSource program, which was being offered at a hospital near her home in the Quad Cities area of Iowa as part of a pilot test.

After she completed the questionnaire online at home, the results indicated a struggle with depression and financial worries—as well as concern about hair loss from treatment. “There were all these things making me depressed and anxious that I hadn’t really thought about,” she says. After the screening, she spoke with her primary-care doctor, who helped treat her depression with medication. And she began attending group sessions at a Cancer Support Community center, where she connected with a financial adviser and someone who helped her with a wig.

More doctors and hospitals are beginning to acknowledge the importance of addressing patients’ broader needs. Last month, Greenville Hospital System University Medical Center in Greenville, SC, for example, announced plans to open a hospital-based Center for Integrative Oncology and Survivorship in partnership with the Cancer Support Community. The center plans to offer screening and referral programs, as well as oncology rehabilitation services including exercise, massage, acupuncture and nutrition counseling.

Mark O’Rourke, medical director of the Greenville survivorship program, says distress evaluation can identify patients with overwhelming distress and mental-health issues so they can be immediately referred to the right professionals. He also hopes it will comfort patients with the knowledge that their concerns are normal and that physicians care about helping them cope. “It reminds them we are on their side,” says Dr. O’Rourke, and “concerned about things besides the exact dosage of the drug and the results of their surgery.”

Write to Laura Landro at

A version of this article appeared August 28, 2012, on page D3 in the U.S. edition of The Wall Street Journal, with the headline: To Treat the Cancer, Treat the Distress.

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Location:Klondike Dr,Georgetown,United States

Coming Soon: Artificial Limbs Controlled by Thoughts

Coming Soon: Artificial Limbs Controlled by Thoughts: Scientific American
Scientific American

In Brief

Brain waves can now control the functioning of computer cursors, robotic arms and, soon, an entire suit: an exoskeleton that will allow a paraplegic to walk and maybe even move gracefully.

Sending signals from the brain’s outer rindlike cortex to initiate movement in the exoskeleton represents the state of the art for a number of bioelectrical technologies perfected in recent years.

The 2014 World Cup in Brazil will serve as a proving ground for a brain-controlled exoskeleton if, as expected, a handicapped teenager delivers the ceremonial opening kick.

In 2014 billions of viewers worldwide may remember the opening game of the World Cup in Brazil for more than just the goals scored by the Brazilian national team and the red cards given to its adversary. On that day my laboratory at Duke University, which specializes in developing technologies that allow electrical signals from the brain to control robotic limbs, plans to mark a milestone in overcoming paralysis.

If we succeed in meeting still formidable challenges, the first ceremonial kick of the World Cup game may be made by a paralyzed teenager, who, flanked by the two contending soccer teams, will saunter onto the pitch clad in a robotic body suit. This suit—or exoskeleton, as we call it—will envelop the teenager’s legs. His or her first steps onto the field will be controlled by motor signals originating in the kicker’s brain and transmitted wirelessly to a computer unit the size of a laptop in a backpack carried by our patient. This computer will be responsible for translating electrical brain signals into digital motor commands so that the exoskeleton can first stabilize the kicker’s body weight and then induce the robotic legs to begin the back-and-forth coordinated movements of a walk over the manicured grass. Then, on approaching the ball, the kicker will visualize placing a foot in contact with it. Three hundred milliseconds later brain signals will instruct the exoskeleton’s robotic foot to hook under the leather sphere, Brazilian style, and boot it aloft.

This scientific demonstration of a radically new technology, undertaken with collaborators in Europe and Brazil, will convey to a global audience of billions that brain control of machines has moved from lab demos and futuristic speculation to a new era in which tools capable of bringing mobility to patients incapacitated by injury or disease may become a reality. We are on our way, perhaps by the next decade, to technology that links the brain with mechanical, electronic or virtual machines. This development will restore mobility, not only to accident and war victims but also to patients with ALS (also known as Lou Gehrig’s disease), Parkinson’s and other disorders that disrupt motor behaviors that impede arm reaching, hand grasping, locomotion and speech production. Neuroprosthetic devices—or brain-machine interfaces—will also allow scientists to do much more than help the disabled. They will make it possible to explore the world in revolutionary ways by providing healthy human beings with the ability to augment their sensory and motor skills.

In this futuristic scenario, voluntary electrical brain waves, the biological alphabet that underlies human thinking, will maneuver large and small robots remotely, control airships from afar, and perhaps even allow the sharing of thoughts and sensations of one individual with another over what will become a collective brain-based network.

Thought Machines

The lightweight body suit intended for the kicker, who has not yet been selected, is still under development. A prototype, though, is now under construction at the lab of my great friend and collaborator Gordon Cheng of the Technical University of Munich—one of the founding members of the Walk Again Project, a nonprofit, international collaboration among the Duke University Center for Neuroengineering, the Technical University of Munich, the Swiss Federal Institute of Technology in Lausanne, and the Edmond and Lily Safra International Institute of Neuroscience of Natal in Brazil. A few new members, including major research institutes and universities all over the world, will join this international team in the next few months.

The project builds on nearly two decades of pioneering work on brain-machine interfaces at Duke—research that itself grew out of studies dating back to the 1960s, when scientists first attempted to tap into animal brains to see if a neural signal could be fed into a computer and thereby prompt a command to initiate motion in a mechanical device. Back in 1990 and throughout the first decade of this century, my Duke colleagues and I pioneered a method through which the brains of both rats and monkeys could be implanted with hundreds of hair-thin and pliable sensors, known as microwires. Over the past two decades we have shown that, once implanted, the flexible electrical prongs can detect minute electrical signals, or action potentials, generated by hundreds of individual neurons distributed throughout the animals’ frontal and parietal cortices—the regions that define a vast brain circuit responsible for the generation of voluntary movements.

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Location:Georgetown TX,United States

Patients want to email, access EMRs, but physicians still can’t

The great healthcare chasm: Patients want to email, access EMRs, but physicians still can’t | MedCity News
MedCity News by Arundhati Parmar on September 20, 2012

When it comes to consumer use of health IT, demand seems to be outstripping supply and it’s creating the great healthcare chasm.

Results of a new survey show that while three out of four patients are eager to access health records online through EMRs and more than 60 percent want to communicate with their doctor via email or other Internet technology, only 40 percent of physicians said they had the capability to interact with patients through email or give them access to their online health records. This despite the fact that 70 percent of surveyed physicians said they had basic electronic medical records capability within their organizations.

The data comes from Optum Institute, part of health insurance giant UnitedHealth Group’s health IT and services division Optum, and Harris Interactive, which surveyed 1,000 physicians, 2,870 U.S. adults and 400 U.S. hospital executives between May 20 and June 12.

Consumers’ desires for online communication and access of health records is not limited to the young. The survey found that 57 percent of the seniors who participated in the survey said that they want to go online to interact with care providers and manage their health.

“While hospitals and physicians have made considerable progress in adopting new technologies, our research underscores the pressing need to increase the level of patient-facing technology to create strong, two-way patient-physician communication,” said Carol Simon, director of the Optum Institute, in a news release.

Here are some more results:

76 percent of patients are willing to go online to view test results
65 percent want appointment reminders via email
62 percent of patients want to communicate online with their primary care physician
Physician use of EMRs has increased sharply t0 70 percent from 55 percent since November 2011
Only 46 percent of physicians currently haveEMRs that provide patients with tailored information to assist patients in decision-making and self-management

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Location:Georgetown TX,United States

Wednesday, September 12, 2012

Hospitals work to cut down door to balloon time

Hospitals Work to Improve 'Door to Balloon Time' for Angioplasty Patients - Laura Landro at

The Wall Street Journal

Every second counts for patients receiving angioplasty, a lifesaving treatment for the most serious types of heart attack, in which a catheter with a small balloon at the tip is inserted and inflated to open a blocked artery.
For years widely accepted practice guidelines have recommended getting a heart-attack patient into the cardiac catheterization lab for an angioplasty within 90 minutes of arrival at the hospital. While some hospitals still struggle to meet that standard, it is now considered outdated, as Laura Landro explains on Lunch Break. Photo: University Hospitals Case Medical Center.

There is growing evidence to show that every minute hospitals can shave off “door to balloon” time lowers a patient’s risk of death and serious damage to the heart muscle.

Among the biggest timesavers are sophisticated portable electrocardiograms in ambulances, which record 12 different electrical signals from the heart. More than half of emergency medical systems in an American Heart Association survey reported having the devices in their vehicles, with 35% of those able to wirelessly transmit the results ahead, enabling hospitals to mobilize the cardiac catheterization team before a patient arrives.

Each year, an estimated 400,000 to 500,000 patients have the most serious kind of heart attack, called a “STEMI” (stands for myocardial infarction with St-segment elevation), which is caused by a prolonged decrease in blood supply due to a blocked artery and affects a large area of the heart.

Guidelines developed over the past decade call for hospitals to meet a 90-minute or less time standard for treatment with angioplasty, starting from the moment a patient enters the hospital until the balloon is inflated and blood flow is restored.

Researchers who studied Medicare data from more than 300,000 patients at 900 hospitals found so-called door-to-balloon times fell from a median of 96 minutes in 2005 to 64 minutes in 2010. The best-performing hospitals regularly achieved times under 60 minutes, which “may become the new standard,” the study, published last year in the journal Circulation, concluded.

But hospitals can do even better than that, suggests Harlan Krumholz, the Yale University cardiologist who led the study and whose research has been used to set door-to-balloon time guidelines. “Rather than set a new, lower threshold, we are now saying the time to treatment should be as short as possible, so we treat everyone as quickly and safely as we can.” At Yale, door-to-balloon times have been as low as 14 minutes, he says.

Door-to-balloon times improve when emergency medical services call in or wirelessly transmit ECG results to hospital emergency rooms ahead of arrival, Dr. Krumholz says.

An ECG, which checks for problems with the heart’s electrical activity, is used to distinguish whether a heart attack is the result of a blockage that needs to be opened as soon as possible. With ECG results in hand, the hospital can take additional timesaving measures.

Rather than wait for a cardiologist to review results, which can take a half-hour, ER doctors are making the diagnosis and activating pager systems that scramble cardiology doctors, nurses and technicians with a single call. They are expected to drop what they are doing if in the hospital. During off hours, on-call teams are expected to rush to the hospital, usually within a half-hour, to prepare the cardiac catheterization lab where angioplasty—also known as percutaneous coronary intervention—is done, often followed by placement of stents to keep the artery open.

About 1,100 hospitals are members of the Door-To-Balloon Alliance, launched in 2006 by the American College of Cardiology to provide assistance in meeting the 90 minutes-or-less goal. Patients can check their own hospital’s performance on Medicare’s Hospital Compare website.

University Hospitals Case Medical Center, in Cleveland, began a door-to-balloon improvement project at its Harrington Heart and Vascular Institute after finding it was missing the under-90 minute mark too often.

The medical center’s heart institute donated a wireless transmission system and training worth more than $50,000 to a large EMS systems it works with, to equip more ambulances with portable machines to send ECG results ahead of arrival. The hospital set minute-by-minute goals for individual team members and continues to provide feedback on how well they do for each patient.

The medical center now meets the 90 minute-and-under standard 100% of the time, compared with less than 60% at one point in 2010. Median door-to-balloon time is 47 minutes for patients arriving at the ER on foot or by ambulance, says the institute’s director, Daniel Simon.

Last January, Janice Flint, a 54-year old nursing-home assistant in Cleveland, was feeling what she thought was severe heartburn as she was walking to the bus stop on her way to work. She threw up, and her boyfriend walked her back home.

After she began to feel pain in her jaw, they called 911. Paramedics arrived, loaded her into an ambulance, performed an ECG en route and transmitted the results, indicating a STEMI, to the Case Medical Center emergency department. Within two minutes, doctors there paged the catheterization lab, and staffers were preparing for the procedure.

First, Ms. Flint went to the ER to receive blood-thinner medication, according to Todd Harford, UH Case’s system director of invasive cardiology; then she was sent up to the lab.

A balloon was inflated in her artery within 19 minutes of her arrival, enabling doctors to remove the clot and insert two stents to hold the artery open. Total door-to-balloon time: 35 minutes.

False alarms are a concern. It’s possible a patient rushed to the lab would turn out to have something other than a serious heart attack. At the University of Michigan Health System, a program to improve door-to-balloon performance cut the median time from 67 minutes in 2007 to 55 minutes in 2011. The false-alarm rate increased to 40% of all cases from 15%, according to a study by cardiologist Geoffrey Barnes. Such false alarms can be a drain on staff and a poor use of resources, he says.

The process was modified at the beginning of this year, Dr. Barnes says. Now, if an emergency-room doctor doesn’t have “high suspicion” of a heart attack but still wants another opinion, an on-call cardiologist reviews the case promptly—”without having to activate the entire cardiac catheterization laboratory each time,” he says.

Sahil Parikh, an interventional cardiologist who performs angioplasty at UH Case and is on its 24/7 on-call team, says for every 20 cases he sees one false alarm, including those patients with less-serious heart attacks and those with coronary issues that don’t require an angioplasty. “We always err on the side of caution because we don’t want to risk a heart attack, and most of the time we get it right,” Dr. Parikh says.

Patients often bypass the ER and come directly into the catheterization lab, Dr. Parikh says. If the tables are full they are monitored in the adjacent coronary intensive care unit, where teams start asking questions, administering medications and getting paperwork started.

Patients with other complications, or who need treatment to be stabilized before the angioplasty, don’t count against door- to-balloon time calculations. Delays from staff who hit traffic on their way to the hospital from home do get factored in.

Dr. Harford, the invasive-cardiology director, says while everyone on staff is aware of the importance of saving time, “whether we make it or not, the main thing we are worrying about is saving the patient.”

Write to Laura Landro at

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Location:Georgetown TX,United States

Monday, August 27, 2012

NASA's mini lab may change testing

NASA to launch mini lab, test for cancer and disease in space -- Engadget by Steve Dent on August 26, 2012

It’s hard to find a good specialist on earth, let alone when you’re floating 240 miles above it. That’s why NASA will test the Microflow, a breadbox-sized device that instantly detects cancer and infectious diseases, and can even sense the presence of rotten food. The Canadian-made device is a “flow cytometer,” which works by analyzing microparticles in blood or other fluids and replaces hospital versions weighing hundreds of pounds. Here on Earth, the device could let people in remote communities be tested more quickly for disease, or permit on-site testing of food quality, for instance. It will be particularly advantageous in space, however, where Canadian astronaut Chris Hadfield will test it during his six-month ISS mission, allowing crew to monitor, diagnose and treat themselves without outside help. Now, if we could just get it down to a hand size, and use some kind of radio waves instead — oh wait, that’s not until Stardate -105352.

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Sunday, August 26, 2012

New non-invasive method for diagnosing epilepsy

New non-invasive method for diagnosing epilepsy |
Science Blog by sb on August 26, 2012

A team of University of Minnesota biomedical engineers and researchers from Mayo Clinic published a groundbreaking study today that outlines how a new type of non-invasive brain scan taken immediately after a seizure gives additional insight into possible causes and treatments for epilepsy patients. The new findings could specifically benefit millions of people who are unable to control their epilepsy with medication.

The research was published online today in Brain, a leading international journal of neurology.

The study’s findings include:

Important data about brain function can be gathered through non-invasive methods, not only during a seizure, but immediately after a seizure.
The frontal lobe of the brain is most involved in severe seizures.
Seizures in the temporal lobe are most common among adults. The new technique used in the study will help determine the side of the brain where the seizures originate.
“This is the first-ever study where new non-invasive methods were used to study patients after a seizure instead of during a seizure,” said Bin He, a biomedical engineering professor in the University of Minnesota’s College of Science and Engineering and senior author of the study. “It’s really a paradigm shift for research in epilepsy.”

Epilepsy affects nearly 3 million Americans and 50 million people worldwide. While medications and other treatments help many people of all ages who live with epilepsy, about 1 million people in the U.S. and 17 million people worldwide continue to have seizures that can severely limit their lives.

The biggest challenge for medical researchers is to locate the part of the brain responsible for the seizures to determine possible treatments. In the past, most research has focused on studying patients while they were having a seizure, or what is technically known as the “ictal” phase of a seizure. Some of these studies involved invasive methods such as surgery to collect data.

In the new study, researchers from the University of Minnesota and Mayo Clinic used a novel approach by studying the brains of 28 patients immediately after seizures, or what is technically know as the “postictal” phase of a seizure. They used a specialized type of non-invasive EEG with 76 electrodes attached to the scalp for gathering data in contrast to most previous research that used 32 electrodes. The researchers used specialized imaging technology to gather data about the patient. The findings may lead to innovative means of locating the brain regions responsible for seizures in individual patients using non-invasive strategies.

“The imaging technology that we developed here at the University of Minnesota allowed us to tackle this research and gather several thousand data points that helped us determine our findings,” He said. “The technical innovation was a big part of what helped us make this discovery.”

He, who was recently appointed the director of the University of Minnesota’s Institute for Engineering in Medicine, said this study was also a good example of a true partnership between engineering and medicine to further medical research.

“The innovations in engineering combined with collaborations with clinicians at Mayo Clinic made this research a reality,” He said.

In addition to He, members of the research team included University of Minnesota biomedical engineering Ph.D. student Lin Yang; Gregory A. Worrell, Mayo Clinic, Neurology and Division of Epilepsy; Cindy Nelson, Mayo Clinic, Neurology; and Benjamin Brinkmann, Mayo Clinic, Neurology. The research was funded by the National Institutes of Health.

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Location:Georgetown TX,United States

What health care can learn from the military

What health care can learn from the military by John Lee on August 26, 2012

While the typical physician is now accepting of the IT changes that are intruding into their work environment, he often does not understand the reasons or the strategic underpinnings for the push for the digitalization of healthcare. Being a typical modern consumer, he understands smartphones, online shopping and email, but doesn’t understand concepts such as clinical data repositories, data warehouses, decision support and business intelligence. Analogies can help, but carts, horses, sticks and carrots are a bit tired.

Being an amateur historian, I realized that the modern military is rife with models that can be used to make the point. These analogies are not meant to be comprehensive of the broad strategic goals of health information technology, but they do help the rank and file physician understand why there is such a push to integrate information technology into the healthcare world.

Carpet bombing

One example highlights the broad “high level” view in more ways than one. In World War II, the US Air Force generally relied on eyeballs on target to bomb surface targets. Objectives previously were targeted with squadrons of bombers, risking the lives of the pilots and also creating all sorts of collateral damage. It was terror in the air and on the ground. Then in Vietnam, the Air Force began utilizing “smart bombs,” or precision guided munitions. The contrast was illustrated by the Air Force’s campaign against the Thanh Hoa bridge in Vietnam. It was the target of 800 unsuccessful sorties with unguided munitions, but was finally successfully dispatched by a single flight of 12 planes with microchip enhanced bombs.

If you think about how we practice medicine now, we are essentially carpet bombing our patients. This sort of approximated, empiric “targeting” occurs when we treat pneumonias with broad spectrum antibiotics, tumors with chemotherapy, and asthma with steroids and leukotriene inhibitors. These treatments are quite effective, most of the time. Relative to the alternatives, they are also safe, most of the time. However, physicians frequently encounter the “collateral damage” of well-intended treatment such as C. difficile, allergic reactions and drug interactions which are certainly not intended, but occur because we clinicians are constantly barraged by so much data that there is no possible way to avoid all such incidents.

So how do we “smart-bomb” illness and injury? The modern bomber flying at 30,000 feet hitting a small target miles away on the ground does not do this in isolation. It relies on huge amounts of data that is processed by multiple entities from satellites in space to targeting resources on the ground and complex systems within the plane and munitions themselves. We in medicine also rely on large amounts of data that we are required to apply at the point of care. Unfortunately, more often than not, this data is difficult to access (ie. locked as text on paper) and even more difficult to aggregate so that it can be usable and the time and point of care. We need to collect this data, put it together, and use it in real time to affect our clinical decisions. Examples of this are using allergy and medication interaction information to reduce the risks of medication.

However, such information is just the low hanging fruit because medication information is easy to store as discrete data. The vast majority of medical knowledge is locked as unusable data. We need to codify this bulk of clinical data so that is usable by digital systems and patterns can be dredged, enabling our therapies to be more nuanced and accurate.

Integrated systems

There are anecdotes describing how Navy destroyers saved the day at the Omaha beach landing on D-Day. The planned landing Omaha Beach on D-Day was a failure. The infantry that had landed on the beach were in chaos and impotently pinned by German firepower in protected positions. However, despite not being part of the plan, these smaller ships were able to move in close to shore and noticed that a lone Sherman tank was pounding in vain against a German gun battery encased in concrete. They were able to provide tactical fire support using their larger 5 inch guns and neutralized the battery.

Noticing this, the tank went on to “target” other batteries and the destroyers apparently were happy to use this information. Despite not having direct communications, resourceful soldiers and sailors cobbled together a makeshift communication system. It didn’t occur to the US military that facilitating tactical communications between the branches (in this case, the Navy and Army) would amplify their effectiveness. Today, the military has embraced the concept of combined arms and integrated systems. Well known example are the AWACS and Aegis combat systems that coordinates various military assets. Such coordination allows military command and control to see data from multiple sources, allowing them to direct their forces efficiently and in a time sensitive manner.

Likewise, our healthcare environment is currently a victim of information isolation. It is quite common to have patient information from separate sources inaccessible to the providers who are actively taking care of a patient. A patient can be hospitalized with much of his data locked in a doctor’s office or vice versa. Obstructions to information flow can even occur in the same physical plant. It is quite common for doctors, nurses, and other ancillary providers to record and document information in different ways and on separate parts of the chart or even separate physical charts. Because of this, it is even common for the patient to go through their inpatient clinical course without doctors even looking at any nursing documentation. The eventual goal is a single common electronic patient document. The patient information then is simultaneously available to all providers as a single merged source of truth, allowing a coordinated approach to the care of the patient rather than multiple strategies that are blinded to other practitioners.

Force multipliers

The US military uses Special Forces teams (typically 12 men) to train a larger size (100-200) of indigenous fighters to engage in guerrilla warfare. Thus, the Special Force unit has multiplied their effective size. The GPS technology we now take for granted in our cars allowed the US led coalition forces to outmaneuver the Iraqi forces in the first Gulf War, allowing the Allied forces to choose when and where they wanted to fight, again, making a fighting force more potent than their pure numbers. These tactics and technology were force multipliers, amplifying the strength of a single unit or soldier.

We often hear about the silos of data and information in health care. However, we also have silos of knowledge. It took 15 years for 50% of patients to receive beta-blockers after myocardial infarction and 25 years to reach 90%. The studies and knowledge that beta-blockers improved outcomes was readily available, but the academics failed to reach the trenches of real world medicine. If this clinical knowledge had been presented at the appropriate times, compliance would have reached 90+% much sooner. Reading about evidence based recommendations and filing them away is one thing.

Trying to remember and implement them during the chaos of the real world medicine is more difficult. Decision support allows such recommendations and reminders to be delivered at the point of care, where we wage the real fight. Discovering evidence based practices is not enough. We must use technology enhanced decision support to amplify and accelerate evidence based academic findings when and where the clinician needs them, not locked up in a journal.

Our healthcare environment and national economic circumstances dictate that we take care of patients better with fewer resources. Although it may seem odd to relate strategies used by an organization to exert physical power to the healing purposes of healthcare, the US military has evolved its technology and tactics to be a leaner but more potent force. Healthcare can learn from their evolution to be leaner and more potent as well.

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Location:Georgetown TX,United States

Thursday, August 16, 2012

A High-Tech Fix for Broken Schools

I know this blog is pointed towards technological changes in healthcare, however this article by Juan Williams looks at the changes technology is bringing to our schools. These changes will eventually bring these students into the entrepreneurial world.

A High-Tech Fix for Broken Schools


Mooresville, N.C., is best known as "Race City, U.S.A.," home of Nascar. But these days Mooresville is leading the nation in a different way—by using digital technology to improve public education.

"Fixing Our Schools," a documentary I am hosting for the Fox News Channel this Sunday, looks at how digital learning is being used by schools like those in Mooresville to help fix our broken education system.

Our schools are undoubtedly in crisis. Prize-winning documentaries such as "Waiting for 'Superman'" have revealed the terrible cost of losing young minds to failing schools. Dropout rates are particularly high among minority children in urban schools. But even parents in the best suburban schools are alarmed by the fact that the U.S. now ranks 30th world-wide in math, 23rd in science, and 17th in literacy.

This is why the modestly funded schools in Mooresville are drawing national attention. The school district ranks 100th out of 115 school districts in North Carolina on per-pupil spending. But in the last 10 years, its test scores have pushed it from a middling rank among North Carolina's school districts to a tie for second place.

Three years ago, 73% of Mooresville's students tested as proficient in math, reading and science. Today, 89% are proficient in those subjects.

The big change in Mooresville began when Superintendent Mark Edwards took the radical step of cutting back on teachers and using the money to give every student from third grade through high school a laptop computer.

All of their textbooks, notes, learning materials and assignments are computerized, allowing teachers and parents to track their progress in real time. If a student is struggling, their computer-learning program can be adjusted to meet their needs and get them back up to speed. And the best students no longer wait on slow students to catch up. Top students are constantly pushed to their limits by new curricular material on their laptops.

Nearly every phase of students' education is a data-point that can be tracked, analyzed and compared with their peers. Thanks to the data system, Mr. Edwards says, "our teachers are better informed, our parents are better informed, and our students are understanding what they're doing and why they're doing it." He notes, by the way, that digital learning hasn't increased costs.

Some 600 miles north of Moorseville, New York City's "School of One" in Brooklyn has had similar success with a digital-learning program. The mathematics-centered middle school has reported significant gains in the test scores of its students since it was founded in 2009. Joel Klein, the former chancellor of the New York City public schools, helped initiate the program and is now one of the leading proponents for digital learning. (Mr. Klein is CEO of Amplify, News Corp.'s educational division. News Corp. owns The Wall Street Journal.)

"Think about how different the world is today in terms of the media, in terms of medicine, in terms of the way people really experience their lives, and education is stuck in a 19th-century model," Mr. Klein explains. "So I'm convinced that we can [use computers to] change the way we educate our kids." He adds that the computers don't remove the need for good teachers but help "teachers do their work in a much more effective way."

In Florida, former Gov. Jeb Bush pioneered large-scale digital learning as part of his education-reform efforts. "If you want to take an [advanced placement] class, you can do this online, and people flock to that opportunity. So, it has improved learning and they don't get paid unless the course is complete," Mr. Bush says. "Imagine if the public schools accepted that idea. You would have a lot more children gaining the power of knowledge."

Some critics charge that digital learning is a boondoggle, a way for the private companies that make the technology to profit by selling their products to school districts. Messrs. Klein and Bush respond that we must support new ideas and budding solutions that show promise to fix schools—regardless of their origins.

Mr. Bush puts it this way: "If it's for-profit or not-for-profit or it's developed by the schools inside a district or by teachers inside of schools, does it matter?"

The bottom line is that bringing more technology into the classroom shows tremendous promise to improve schools. And any doubters should take a look at the little school district now speeding along in Mooresville.

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Location:GeorgetownTX,United States