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