e-HealthExpert.org - Primum non nocere

By Matthew Holt This week we've announced the line up (or the first chunk of it) for the 4th annual Health 2.0 Conference in San Francisco Oct 7-8. The conference is the climax of Health Innovation Week -- a week...

By JANE SARASOHN-KAHN Electronic health records (EHRs) broaden access to patient data and provide the platform for pushing evidence-based decision support to clinicians at the point-of-care. This promotes optimal care for patients, reduces medical errors, optimizes the use of labor,...

By Matthew Holt Today at 12 noon PST Aneesh Chopra, Federal CTO will be at the Commonwealth Club in San Francisco talking about health care and health care IT. Indu and I saw him last night talking about technology before...

By MARGALIT GUR-ARIE All the laws have been passed and all the final rulings have been published. In the spirit of the times, you went out and got yourself an EHR. You did your due diligence and sat through many...

By JOHN GOODMAN The release of this year’s Medicare Trustees report was unprecedented. As noted in previous posts here and at my blog here and here, Medicare’s chief actuary not only refused to sign off on it, he disowned it...

Last week, we sat down with Steve Downs, Assistant Vice President, Health Group, Robert Wood Johnson Foundation to discuss the 3 New Challenges they've announced for the Health 2.0 Developer Challenge. Steve explains RWJF's current areas of focus in health...

By Matthew Holt Unplatforms is the term I've been using to describe the multitude of devices that people are using to collect and receive information. And also to cover the different channels they are using often on the same device...

By DAID HARLOW The Queen of Soul famously wailed about being a link in a chain of fools. Today's lead story in the Boston Globe tells us about another sort of link in the chain -- the weakest link in...

By Matthew Holt Saturday's New York Times portends more trouble for big Pharma. The headline is wrapped up in an examination of foreign corrupt practices, but the bigger issue is that clinical trials have hidden serious adverse events. The recent...

By Matthew Holt Ingenix, the arms dealer that's been supplying all sides in the health care information war for the past decade or so, built itself up by buying lots of little companies in the data analytics space. Now it’s...

IBM and Aetna's ActiveHealth Management subsidiary have unveiled a new clinical information management system based on cloud computing architecture. The Collaborative Care Solution, as the product is called, aims to bring together information from disparate sources like "electronic medical records, claims, medication and lab data" for easy access by any relevant party during a patient's clinical regimen. Additionally, the system features ActiveHealth's evidence-based clinical decision support CareEngine which can signal to clinicians when suspected abnormalities creep up in the data. Some details from IBM: With all healthcare data and IT resources managed in a cloud environment, the system will enable the coordination of patient care among teams, so doctors, nurses, nurse practitioners, aides, therapists and pharmacists can easily access, share and address information about patients from a single source. The solution can also show trends in how patients are responding, for example, to treatment for chronic asthma or adhering to drug regimens and automatically alert doctors to conflicting or missed prescriptions. For one fixed monthly fee, healthcare organizations have access to all the tools and services without having to make significant upfront investments – avoiding the challenge of updating systems when clinical guidelines or reporting requirements change or when patient loads grow. Additionally, the solution provides advanced analytics that help physicians or entire healthcare organizations measure their performance against national or hospital quality standards. Press release: ActiveHealth and IBM Pioneer Cloud Computing Approach to Help Doctors Deliver High Quality, Cost Effective Patient Care...... Michael

By DAVID ERICKSON, Federal Reserve Bank of San Francisco and JAMES S. MARKS, Robert Wood Johnson Foundation We all have a vision of the “Main Street” we would like to live near – tree-lined, friendly and safe. But our “Main...

Microsulis Medical Limited out of Denmead, England has received FDA 510(k) clearance to bring to the US the company's Acculis Accu2i percutaneous microwave tissue ablation (pMTA) system. The applicator is administered via a 1.8 mm puncture of the skin to deliver microwave energy at 2.45 GHz for coagulation of soft tissue during endoscopic procedures. Features from the product brochure: Product • 1.8mm shaft, ceramic trocar cutting tip • Internally cooled • 14cm and 27cm shaft lengths • 2m cable reach (cooled cable) • 2.45GHz operating frequency • Generator powers from 30W to 180W • Ablation time 0 - 6 minutes (per use) • Multiple use per patient Performance • Up to 5.6cm coagulation zone in 6 minutes at 180W based on ex-vivo tests (nb in-vivo performance may be greater) • Scaleable near spherical coagulation zones • Power and time controls for coagulation rate and size • Real time visualisation with IOUS / CT Technical • 1.4cm emitting tip length • Integrated coolant and microwave supply cable • High pressure manifold handle with coolant visualisation • Closed loop sterile saline coolant • Independent tissue temperature measurement probes Press release: Microsulis Medical Limited Receives FDA 510(k) Clearance of Accu2i Percutaneous Microwave Tissue Ablation Device... Product page: pMTA ...... Michael

Revolutions Medical out of Charleston, South Carolina has developed an image processing technology that brings a bit of color to MRI images. Color MRI uses proprietary algorithms to segment and colorize regions of the scan to hopefully make the images more readable, and the firm has partnered with the Philadelphia College of Osteopathic Medicine to apply the technology to differentiation and characterization of intracranial hemorrhages and characterization of intracranial masses From the product page: The technology consists of software, which uses various color masks to produce full-color composite images from gray-scale MRI output. The resulting color images can be quickly viewed individually or all together as a “riffle stack”. A riffle stack consists of the individual MRI images assembled to create a single composite image that contains the data from the individual images. The riffle stack allows a radiologist, using a computer mouse, to page through the images, creating a 3-D appreciation of the colorized MRI output even though the images themselves are not 3-D. The software program can also segment the data and create a true 3-D image of the area to be examined. For instance, bone, fluid and other tissue displayed in an MRI scan of the head can be electronically eliminated to allow a 3-D rendering of just the brain. Press release: Revolutions Medical Corporation Begins Clinical Applications and Validation Process of Its MRI Software Tools... Product page: Rev ColorMRI...... Michael

Diamond-like carbon (DLC) coatings are commonly used in medical implants to greatly improve their resistance to environmental factors. Though impressively strong and impermeable, DLC will often break off from the implants to become a nuisance within the body. Now scientists at Empa, a Swiss research institution, have discovered why that happens and what can be done to prevent the chipping. "When two materials are placed in contact with each other, the result is a reaction layer at the interface between them, which is only several atomic layers thick. Thus a new material is formed, which we investigated now for the first time", explains Roland Hauert of Empa's "Nanoscale Materials Science" laboratory. His team showed that the so far barely considered reaction layer, which is not always completely corrosion resistant, is responsible for the detachment of the DLC layer. On the one hand, stress corrosion cracking occurred in the reaction layer. The mechanical load in conjunction with the penetration of body fluids led to slow-growing cracks, which in turn caused the DLC substrate to detach little by little. In other cases, crevice corrosion was responsible for the damage. Over time, an aggressive, acidic medium develops in fine crevices and slowly dissolves the reaction layer or the additional adhesive layer, likewise leading to detachment. But the Empa team didn't stop there; together with their industry partners Synthes and Ionbond, they developed a corrosion-resistant intermediate layer at the interface to the DLC layer. What's more, the researchers also developed a process that can determine a crack's growth rate under conditions similar to those experienced in the human body as well as the dissolution rate of the reaction layer in cases of crevice corrosion. Full story from Empa: Nanocorrosion causes implants to fail...... Michael

Scientists from Case Western Reserve and Vanderbilt universities are reporting a surprising finding that lasers can be used to pace the contractions of embryonic quail hearts. It has been reported previously that light can excite cardiac tissue, but this is the first time that a heart rate was set to a particular frequency using light. According to the scientists, this non-invasive device may prove an effective tool in understanding how environmental factors that alter an embryo's heart rate lead to congenital defects. It may also lead to investigations of cardiac electrophysiology at the cellular, tissue and organ levels, and possibly the development of a new generation of pacemakers. "The mechanisms behind many congenital defects are not well known. But, there is a suspicion that when the early embryonic heart beats slower or faster than normal, that changes gene regulation and changes development," said Michael Jenkins, a postdoctoral researcher in biomedical engineering at Case Western Reserve. Jenkins came up with the idea to try the infrared laser on an embryonic heart. He stumbled on an obscure paper from the 1960s in which researchers found that continuous exposure to visible light accelerated the heart rate of an embryonic chicken. He also knew of the success that Eric D. "Duco" Jansen, a professor of biomedical engineering at Vanderbilt University, had using an infrared laser to stimulate nerves. He then hypothesized that pulsed infrared light may enable pacing of the embryonic heart. Case Western press release: A heart beats to a different drummer... Article in Nature Photonics: Optical pacing of the embryonic heart... Michael

A new discovery, reported in the latest Nature, hints at higher universal laws of the physical world, as well as new ways to approach and understand life in general. Even though the European discovery actually dealt with superconductors, it has an interesting twist with implications for the life sciences. A group of physicists from London Centre for Nanotechnology at UCL and their collaborators at Sapienza University of Rome and European Synchrotron Radiation Facility in Grenoble, France were studying properties of so-called high-transition-temperature (high-Tc) copper oxide superconductors. They were looking at the microstructures that these superconductors form as they are cooled down. To the surprise of investigators, they discovered that microstructures, exhibited by oxygen atoms, seemed to organize into self-repeating fractals. Moreover, these fractal shapes, some extending almost to the millimeter scale, were correlating to superconductivity. In fact, larger fractals correlated with higher superconductivity temps. What does it have to do with life? We think, plenty. Fractals, known for their geometric morphologies that are made up of patterns that repeat themselves at smaller scales infinitely, were first discovered by mathematician Benoit Mandelbrot in 1960s. Since then, they took the world of natural sciences by storm. As mathematicians and physicists discovered more and more interesting properties of these unique constructs, we started to notice fractals' ubiquitous presence everywhere we look. Whether in the living world or in inorganic one, they seem to pop up in unexpected places. Somehow, there are laws of physics that favor these structures for whatever reason. To us, the discovery of fractal function is eerily reminiscent of polarization in pre-quantum mechanical physics. Not until Niels Bohr, Albert Einstein and others laid the foundations of quantum mechanics, polarization of light has remained a mystery. Now we have a new puzzle to answer. Fractals are ubiquitous in the physical and living world for some unknown reason, and there is a function to them. Paper in Nature: Scale-free structural organization of oxygen interstitials in La2CuO4+y UCL press release: Fractals make better superconductors ... More from Wired: Inexplicable Superconductor Fractals Hint at Higher Universal Laws... Side image: Heat treatment improves the superconductivity of a ceramic copper oxide by creating a fractal network of connected channels of ordered oxygen defects. The green and red spheres represent the paired electrons responsible for superconductivity. Artwork by Manuel Vogtli (LCN).... Michael

By JANE SARASOHN-KAHN Best Buy is teaming up with Cardiac Science, targeting potential purchasers of electronic health records (EHRs) and noninvasive cardiac devices. The venture looks to take advantage of economic stimulus funding available through the HITECH Act aimed at...

It has been known for a while now that cooling the body after cardiac arrest improves neurological outcome, and therapeutic hypothermia has become a standard measure in many hospitals. However, in a study in this month's Circulation, a new nasopharyngeal device was used to initiate cooling during cardiac arrest. The RhinoChill Intra-Nasal Cooling System from BeneChill (San Diego, CA) uses a non-invasive nasal catheter that sprays a rapidly evaporating coolant liquid into the nasal cavity, adjacent to the major vascular structures of the brain. The system is compact, battery operated and easy and fast to insert, making it more practical in emergency situations than surface or intravascular cooling devices. In the study witnessed cardiac arrest patients were randomized to either intra-arrest cooling with the RhinoChill device while CPR was being conducted (n=96) or standard care (n=104), with both groups being cooled after hospital arrival. The target temperature of 34°C was reached much faster in the RhinoChill group. Although the study was not powered to detect outcome differences, in subgroup analysis nasal cooling and early CPR within 10 minutes after arrest, when combined, resulted in a 27% absolute increase in survival over CPR alone and a 26% increase in neurologically intact survival. These are pretty impressive results for such a simple device and we are sure you will hear more about this one when larger trials are able to confirm these results. Article abstract in Circulation: Intra-Arrest Transnasal Evaporative Cooling. A Randomized, Prehospital, Multicenter Study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness)... Product page: RhinoChill Intra-Nasal Cooling System...... Wouter Stomp

The UK supermarket chain Sainsbury's is running a trial with two different drug vending machines in two of its West Sussex stores. Basically you can drop your prescription at the machine, the pharmacy will collect the prescriptions and deliver the medications which you can later pick up. As the machines are placed in stores with an in-store pharmacy service, the only benefit seems to be the lack of face-to-face contact (for those people who consider that a benefit). The trial will run for a year after which it will be decided whether they will be rolled-out across all of England. Some UK hospitals plan to trial a more useful drug vending machines this winter, which have a video-link and can dispense medication directly. Patient and pharmacists can talk to each other and a photograph of the prescription is sent over at the same time. The pharmacist can then authorize the machine to deliver drugs from an internal stock. This might prove a useful application for remote places and to provide coverage during evenings, nights and weekends. Although law currently only permits use of these machines in hospitals and healthcare centers, PharmaTrust, the company supplying the machines, hopes that in the future they will be able to place them in High Streets, shopping malls and rural locations. Source: BBC News...... Wouter Stomp