Electronic Medical Records

Efficiency. If technology can make health care records more efficient, through an integrated system of electronic health care records, an immense amount of time currently wasted due to incompatibility between systems can be saved.

Less than 10% of health care providers use electronic records, and there are hundreds of programs currently marketed (1). The problem is, many of these programs do not share records between each other, so individual health care providers often have to resort to recopying and scanning records.

To reduce health care costs, it’s crucial that computers are used to do the tasks that they do much much better than humans; which includes storing data and making it quickly retrievable and transmittable. Humans manually copying and filing records is not efficient, and raises costs.

The US government is taking steps to increase efficiency in medical records. 17 billion dollars in stimulus money is being allocated toward electronic health records, and the ability to transmit and share records is required. Additionally, Congress may start cutting the Medicare and Medicaid payments to health institutions who haven’t instituted interoperable electronic health care records (records that can be transmitted and shared) by 2014 (1).

Hopefully, software will soon be available to allow the different electronic health care record programs used by medical practices to share patient records, reducing errors and administrative costs.

1. Work Begins on National E-Health Record Network. By David Twiddy, Associated Press. 9/31/2009

Technology with the Potential to Lower Health Care Costs:

Preventative medicine and psychological wellness can be improved by internet based, personal feedback programs without a health professional, according a review article in the American Journal of Preventative Medicine (1). Such programs often use technology that allows alcoholics to record the amount of alcohol they consume, which is often greater than they think, and compare it to the amount the average person drinks. This single-session, personal feedback session, low-cost because of the lack of a professional in most cases, was found to be effective, according to the review article, which reviewed publications of 14 studies. If these programs can get alcoholics to recognize they have a problem and seek further help, drunk driving, domestic violence, liver disease, and many other personal and public health issues can be averted.

Trusted.MD, a medical blog (2), discusses the possibility of microcomputers and biosensors that monitor vital signs to determine how patients are reacting to medication, and predict acute symptoms before they occur, reducing the need for 911 calls and emergency hospital visits. These mobile sensors and processors could use existing cellphone networks to interface with doctors.

Technology can do specific medical tasks better than health professionals, at a drastically reduced cost. Physiological data monitoring technology can monitor patients around the clock, and can warn them about changing or abnormal findings. Internet based, personal feedback programs might be more likely to be used by alcoholics than full scale sessions with health professionals and rehabilitation programs.

Sources:

1. Curbing Problem Drinking with Personalized-Feedback Interventions: A Meta-Analysis. Heleen Riper, PhD, MSc, Annemieke van Straten, PhD, Max Keuken, BSc, Filip Smit, PhD, Gerard Schippers, PhD, Pim Cuijpers, PhD. 2009 Mar;36(3):247-55. American Journal of Preventative Medicine

2. “Will Medical Technology Reduce Healthcare Costs?” Adrienne Carlson, Trusted.MD Network, http://trusted.md/feed/items/mdjosephkim/2009/08/08/will_medical_technology_reduce_healthcare_costs. Note; this is a medical blog site, not a scientific journal.

What I've Realized Since Starting BE 100

Being innovative and influential requires more than great ideas. It requires the sharing of your ideas with others. It requires the meticulous documentation of your decision-making process and rigorous testing and citation of your sources.

So far in my life, I haven't worried about checking my work and documenting my decision making progress. For example, when I do math and physics problems, my work is often disorganized and incomprehensible to anyone but myself. As an engineer, especially when I'm doing real life work, I'll have to document my work clearly so others can understand it and learn from it.

Potential Biotechnology to Manage the H1N1 Pandemic

Doctor’s appointments and Student Health services appointments take time and are inconvenient. However they are the primary method through which contagious diseases are diagnosed, and contagious patients are treated and instructed to remain at home to limit passing on their disease. If technological methods for providing preliminary diagnoses of patients more conveniently and expediently than doctor's visits, patients could be alerted to go to a doctor and stay home from work, when the would not otherwise have done so. This would reduce the spread of the swine flu pandemic.

Technologies such as this already exist; the photo below looks like its from a science fiction movie, but it’s really a Chinese health official using a infrared thermometer to screen airline passengers for fever to prevent the spread of swine flu. However, I believe biotechnology has much more potential for the noninvasive monitoring of physiological data and diagnosis of disease than infrared thermometers.

Source: Montreal Student Returns to Morocco with A(H1N1) Swine Flu, montrealgazette.com, June 12, 2009

I wrote previously (blog entry “Bioengineering?”) about pulse oximeters that can measure physiological date non-invasively using beams of light. I believe this technology has the potential to non-invasively and expediently screen patients for many different physiological signs indicating many different diseases.

In the future, health screening machines located in the college houses at Penn could measure physiological data from students to help them decide whether their symptoms warrant a visit to the doctor or not.

Issues Surrounding Swine Flu Vaccination

My first reaction to the question, ‘should I get a swine flu vaccine?’, is that I don’t need one. Based on personal experience, and the fact that I’m a healthy 18 year old, there’s only a tiny chance that I will have serious complications or die due to swine flu. I don’t recall getting a flu shot in previous years, and swine flu doesn’t personally worry me.

However, I began to think about my responsibility, as a member of society, to get vaccinated. If everyone was vaccinated for swine flu, the disease would theoretically be eradicated. Getting vaccinated is an action that benefits everyone, not just yourself. Additionally, I recently was certified as an EMT and am a member of my ambulance corps. at home in New York. As a health care provider, I have a higher probability of contracting swine flu, and even if I personally don’t get seriously ill, I could potentially then pass the virus on to patients who would get serious complications. Additionally, The Centers Disease Control name emergency medical services personnel as a group for which an H1N1 vaccine is most important.

In conclusion, I should get vaccinated for H1N1, due, in part, to my potential to contract the virus and then pass it on to others.

Today, Barak Obama pledged to be vaccinated for H1N1 only when the CDC recommends his population demographic be vaccinated. The president is setting an example, by saying that people should not act selfishly in demanding that they receive the vaccine first, but should also get vaccinated in turn, to prevent the spread of the disease.

The highest hospitalization rates due to H1N1 virus are greater in patients under 65 than for patients over 65 (2). This distinguishes swine flu from the regular seasonal flu, and has led to special recommendations for the administration of vaccines, in the event of a shortage. The Centers for Disease Control (Sept. 15, 2009) (1.) recommend that, in the case of an H1N1 vaccine shortage, the most important candidates for a vaccine are; "pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical services personnel with direct patient contact, children 6 months through 4 years of age, and children 5 through 18 years of age who have chronic medical conditions."

These specific populations are at a higher risk for serious and life threatening complications of the virus, such as pneumonia (children 6 months to 4 years and older children with chronic medical conditions), or have a higher likelihood of passing the virus along to vulnerable individuals (in the case of health care and EMS personnel, and pregnant women and caretakers of infants, because infants and fetuses can’t be vaccinated themselves. (1.)

If a very limited number of vaccinations were available (50,000), I believe health care providers should receive them, because health care providers have a high probability of both becoming infected and passing on the virus (because they see many patients). Health care providers are also crucial for responding to a pandemic.

The CDC does not expect that a vaccine shortage will exist for the fall flu season, so the issue of rationing out H1N1 flu vaccines most likely will not emerge.

In BE recitation, we discussed the role government should play in terms of vaccinations for diseases. Should government pay for everyone’s vaccinations? Should government mandate that everyone get vaccinated?

I believe that government should play a role in distributing vaccinations, particularly for children, and people who cannot afford vaccinations. My reasoning is, if someone gets a vaccination, it benefits not only them, but everyone, because they won’t pass on the virus to anyone either. Contagious disease and vaccination is a concern for everyone.

1. Centers for Disease Control, 2009 H1N1 Vaccination Recommendations, http://www.cdc.gov/h1n1flu/vaccination/acip.htm

2. Use of Influenza A (H1N1) 2009 Monovalent Vaccine

Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. Prepared by National Center for Immunization and Respiratory Diseases, CDC

3. Obamas to Get Swine Flu Vaccine. American Free Press. 9/20/2009. http://www.google.com/hostednews/afp/article/ALeqM5h1GU2ja31-jRQG62kKiwbrNAGHzA

A Manned Mission to Mars

A manned mission to Mars will require engineers to create a self sustaining capsule capable of housing humans for years. Food, air, and wastes will have to be recycled. The crew will have to be kept healthy, both physically and mentally.

Research is currently being done on remote medical diagnosis and treatment for lengthy space flights. The National Space Biomedical Research Institute is currently working on a portable, lightweight, ultrasound-based device that can diagnose conditions and perform treatments such as treating internal bleeding, removing some tumors, and reducing the size of kidney stones. (1.)

Bioengineering research related to space exploration and a manned mission to Mars is a personal interest of mine, and one of the reasons I’m excited about bioengineering.

Source:

1. Smart Therapeutic Ultrasound Device for Mission-Critical Medical Care, Lawrence A. Crum, Ph.D., Lawrence A. Crum, Ph.D., University of Washington. National Space Biomedical Research Institute

Bioengineering?

Hi, I’m David Restle, a freshman bioengineering student at the University of Pennsylvania. Welcome to my blog. Here are some of my thoughts on what it means to be an engineer, and how I got interested in bioengineering.

Engineers use their creativity and problem solving ability to design and build things. We get the satisfaction of creating something that serves a purpose. Bioengineers have the additional challenge designing things that interface with the complexity and unpredictability of living organisms.

As a volunteer ambulance crew member, I learned that treating patients is very challenging, but also potentially very rewarding, and I first contemplated a career involving health care.

I was also intrigued by the equipment on the ambulance. I saw how technology could save lives, but I also saw the ingenious ways that machines, particularly the pulse oximeter and the heart monitor/defibrillator, could non-invasively monitor crucial life processes.

I think the pulse oximeter is especially interesting. It consists of a finger clip; which, by detecting the tiny changes in finger diameter due to the pulse, measures a patient’s heart rate. In addition, two beams of light with wavelengths of 650nm and 805nm are shown through the finger. Hemoglobin that is saturated with oxygen absorbs these wavelengths of light differently than hemoglobin that is not saturated by oxygen. The pulse oximeter compares the absorption of light during systole and diastole, and determines the percent of hemoglobin that is saturated with blood. (1)

A pulse oximeter is now available that uses 7 wavelengths of light to monitor oxygen and carbon monoxide saturation in hemoglobin, as well as other physiological data. (2)

I believe that further technological advances will be made in the future in the field of non-invasive diagnosis of illness. Based on my experiences as an EMT, I think that bioengineers have the potential to make many lifesaving technological advances, and I'm excited to start studying bioengineering myself.

Bibliography:

1. Pulse Oximetry, Dr SJ Fearnley,
Department of Anaesthetics, Torbay Hospital, Torquay, UK. http://www.nda.ox.ac.uk/wfsa/html/u05/u05_003.htm

2. Miasmo Corporation Web Site: http://www.masimo.com/rad-57/