NYT

Patient Money


Planning for Temporary Home Care After the Hospital Stay

John Marshall Mantel for The New York Times

Annie Brumbaugh, 65, who lives alone in Manhattan, with a knee walker while recovering from foot surgery. Recuperating without help isn’t easy, she said. “Most people have no idea what they are in for.”

By LESLEY ALDERMAN

Published: November 19, 2010

ANNIE BRUMBAUGH has become a bit of an expert on recuperating at home. Over the last two years, the 65-year-old wardrobe consultant has had two serious operations on her foot, plus a bone graft, each of which left her homebound for weeks at a time. “This is not easy,” said Ms. Brumbaugh, who lives alone in Manhattan. “Most people have no idea what they are in for.”






Even straightforward procedures, like C-sections and hip replacements, can involve longer-than- expected recuperations. Preparing for these requires more than stocking up on novels, DVDs and plenty of frozen entrees (though such supplies certainly are useful). After a hospitalization, you will need help doing things that you’re unable to do for yourself — even with performing basic tasks like cleaning and dressing. You may need a nurse to change the bandage on a wound or to administer intravenous drugs. You may need equipment, too: a walker, a bath seat or a commode to ensure you don’t injure yourself during recovery.




Equipment and support services will help speed up your recovery, but they also can put a dent in your savings. That’s because most insurers pay for home health care by skilled professionals only during the first, acute part of your recovery. Insurers do not pay for care provided by home care aides, often needed for both short and long recuperations.



The gap often comes as a shock to patients and their families. “There’s a big misconception about what home health care is and what services are covered by insurance,” said Heather McKenzie, senior director of clinical education and quality initiatives for the Visiting Nurse Associations of America. “Most people think all home services will be covered on a long-term basis.”



Every recovery is different, of course, but the more you know and the better prepared you are, the easier it will be to make cost-effective decisions. Whether you are entering the hospital for a planned surgery or just want to be better prepared for an emergency, a few strategies can help guide your way.



PLAN AHEAD Many patients wind up in the hospital as a result of an emergency. For them, lining up home care is likely to be a haphazard process. But a surprising number know in advance that they will be convalescing, yet fail to consider the need for help once they return home.



If you plan to go to the hospital for, say, elective surgery, have a frank talk with your doctor about how long your recovery may be and what you will and will not be able to do. Then call your insurer, whether it’s Medicare or a private carrier, and ask about your policy’s home care benefits.



The insurer can give you a general sense of the services you are entitled to. Be sure to check out your long-term care policy, if you have one; it should cover temporary home care. If you’re covered by Medicare, you can find information on covered home health care services on its Web site.



Elderly patients in assisted living may need skilled aides, as well. While the staff can most likely help with showers and dressing, they probably cannot perform medical tasks, like emptying surgical drains. Don’t leave it up to the hospital to figure out what the facility can provide.



“Hospitals often make false assumptions about what assisted living facilities can and cannot do,” said Maribeth Bersani, senior vice president of public policy at the Assisted Living Federation of America. Check with the assisted living facility directly.



APPROACH HOSPITAL STAFF Let’s imagine you land in the hospital as a result of a sudden emergency. The moment you are able, begin talking to the discharge manager or the social worker about what comes after the hospitalization. Better yet, designate a family member to speak on your behalf, someone who can get the ball rolling even if you’re not up to it.



Whoever does the talking should detail the situation at home for the hospital discharge manager or social worker, including who lives with you and how much help can be provided.



“Health professionals frequently assume there is more support at home than there is,” Ms. McKenzie said. It’s important to make clear that there may not be full-time support. The hospital will have to authorize skilled nursing care for your insurer to pay; discharge planners may consider someone living alone to be more qualified for services than someone living with a spouse.



If you feel you are being hustled out the door too quickly, or that more time is needed to make arrangements, say so. If the discharge planner balks, ask to speak to the supervisor or the hospital’s patient advocate.



“Discharge managers are under the gun to get people out when an individual’s insurance company indicates denial of further coverage and may overlook aspects of your case,” said Vanessa R. Bishop, founder of Elder Care Consultants Inc. in Reston, Va.



Ask, too, if the hospital can order equipment, like a walker or commode, so it is there when you arrive home.



DETERMINE YOUR NEEDS There are two basic levels of home care: skilled and unskilled. Most insurers will pay only for skilled care, but even then you must be homebound and require only temporary care. The hospital should have arranged for short-term nursing care, if needed, before you were discharged. But typically a nurse will also come to your home and evaluate your continuing needs.



Private insurers almost never pay for unskilled help, like a home health aide. If you decide you need more help than your insurer will authorize, first consider whether you need a nurse (who may charge $50 or so an hour) or whether a home health aide will suffice (more like $10 to $38, depending on where you live).



If you do want a skilled nurse, you must get a prescription from your doctor ordering the services, even if insurance is paying.



How do you find a home health aide? It’s usually less expensive to find someone on your own than to go through an agency, so start by asking friends and family for referrals. If you do opt to use an agency, call a few and ask for price quotes. Ask, too, whether they do background checks on their workers. (They should, of course.)



A good place to start is the local visiting nurse agency. These agencies are nonprofit and privately operated, so each one offers slightly different services, but some can provide the services of both nurses and home health aides. For tips on selecting health care agencies, go to the V.N.A.A. Web site at vnaa.org.



HIRE A MANAGER If you don’t have the time or stamina to figure out an ideal home health care plan for yourself or a loved one, turn to a health care advocate or, in the case of elderly patients, a geriatric care manager.



These consultants charge an hourly fee of $90 to $160, which is not reimbursed by insurers. But a one-hour consultation could potentially save you hours of precious time.



A nurse advocate or geriatric care manager can explain how insurance and Medicare work and the services you may be entitled to, and they can speak to doctors on your behalf. If you’re interested in hiring a geriatric care manager, contact the National Association of Professional Geriatric Care Managers. If you want to find an advocate, you’ll have to ask around for referrals, as there is no central resource.

NYT

A Guided Tour of Your Body



Changes in our health are inevitable as we get older. But while doctors tell us to focus on the basics — eat right, exercise and keep cholesterol and blood pressure in check— is there more that we need to know about staying well as we age?




In this special section, you'll be able to learn the best that science and medicine can offer for taking care of yourself. You can also test your knowledge and read more health news at the Well blog.

Technology Monitoring

Wired Up at Home to Monitor Illnesses


By MILT FREUDENHEIM

Published: November 22, 2010

As an aging population threatens to overwhelm the nation’s hospitals and doctors, thousands of seriously ill patients are relying on computerized health trackers to help keep them safe at home.



Rachel Hofstad, 94, of Rochester, Minn., has one hooked up in her bedroom. A retired teacher with chronic lung disease, Ms. Hofstad is one of 200 patients in a randomized trial of a home monitoring system being conducted by doctors at the Mayo Clinic.

The device is about the size of a coffee maker. “First thing in the morning,” she said, “a light comes on and a beeper sounds.”

She touches a screen to log in and is cued to slip on a blood pressure cuff and push a button. Her pressure and pulse readings are displayed. Next, she slides a forefinger into a sensor that measures blood oxygen. Then she checks her weight on a scale linked to the machine.

“The machine tells me I’m well,” she said. On the other hand, a pattern of “yes” replies to questions like “Are you coughing more than usual today?” will alert a nurse to contact her.

Researchers say devices like these can help motivate elderly patients with chronic conditions like heart or lung disease, advanced diabetes or depression to follow advice from their doctors and nurses and to take part in their own care.

Big multinational companies including G.E., Phillips, Intel, Honeywell and Bosch are stepping up their commitment in what some experts call “telehealth”; last month AT&T said it would offer a diabetes monitor accessible by phone to some of its 1.2 million employees, retirees and their dependents.

While the goal of home monitoring is to avert costly visits to hospitals, studies so far have shown mixed results. Earlier versions of the technology did not demonstrate savings in Medicare studies, and just last week in The New England Journal of Medicine, Yale researchers reported disappointing results from a study of high-risk heart patients who had monitoring devices in their homes.

Still, Dr. Douglas L. Wood, a cardiologist and health policy expert at the Mayo Clinic, said he expected remote monitoring to develop rapidly. “It is amazing to see how quickly older people are taking up the technology,” he said.

Advocates for in-home care, like Dr. Steven H. Landers, head of the Cleveland Clinic’s home health care unit, say it is often less costly and produces better health results than occasional checkups and repeated hospital stays. In a New England Journal article last month, Dr. Landers listed forces driving health care into the home: the aging population, “epidemics” of chronic diseases, technological advances, health care consumerism and rapidly escalating health costs.

He added that “ health care organizations that do not adapt to the home care imperative risk becoming irrelevant.”

The paper in last week’s New England Journal, by Dr. Sarwat I. Chaudhry, an assistant professor at the Yale School of Medicine, and colleagues said a six-month study found no significant differences in health status between patients who were monitored at home and a control group receiving the usual care.

But Dr. Gregory J. Hanson, a Mayo geriatrician who is running the trial in which Ms. Hofstad is enrolled, said there were many types of monitoring systems and devices that might vary in effectiveness.

Using daily reports from patients at home is “a different way to practice,” he said. The average age of patients in the Mayo trial is 80, and most have been in a hospital frequently.

“We are learning how to interact with the patient and tie in with their primary care provider,” Dr. Hanson said, “so everyone is on the same page.”

Eric Dishman, head of digital health strategy for Intel, which has a different system, noted that the monitoring system in the Yale study relied on the patients to phone in their daily results. Many failed to do so. A number of other monitoring systems transmit the patient’s information automatically. Some systems provide personalized feedback that helps keep the patient in the loop.

Mr. Dishman said he hoped that large-scale pilot projects under the new health law would “prove out the best options” in home monitoring. Intel and G.E. Healthcare are putting up $125 million each in a venture to develop new telehealth systems.

“We found our home care patients will tell things to those telehealth units that they hesitate to tell the nurse,” said Bridget Gallagher, a senior vice president at Jewish Home Lifecare in New York. “Sometimes they don’t tell a nurse or a family member about a fall,” she said. “They are scared they will be told, ‘You can’t stay in your home.’ ”

In one of the largest programs, more than 48,000 veterans are participating in home monitoring. The Department of Veterans Affairs said hospital admissions were reduced by 19 percent in a 2007 study of 17,025 patients using home monitors.

The department plans to have 92,000 patients on home monitoring by 2012, said Dr. Adam Darkins, its chief consultant on coordinating care for veterans.

Alere Inc., a health management company based in Waltham, Mass., has 90,000 patients using its home monitoring devices, including 45,000 who are taking blood thinner drugs, said Dr. Gordon Norman, the company’s chief innovation officer.

One of them is Michael L. Johnson, 72, a retired lieutenant colonel who commanded Army medical units in Vietnam and who has congestive heart failure. He checks his own blood at home instead of driving to a V.A. lab. He e-mails the results to Alere, which relays them to his doctor.

National health systems in Europe and Japan are ahead of the United States in home health monitoring, industry experts say, but the gap may narrow as pressure builds to slow the increases in Medicare costs. For one thing, the Obama administration plans to cut back on generous payments to insurance companies for the nearly 11 million members of Medicare Advantage health plans.

Advocates say telehealth, if carefully focused, could help reduce costs for the 5 percent of patients in the United States who account for most of the spending. OptumHealth, a unit of UnitedHealth Group, is already monitoring more than 12,000 home-based Medicare heart patients and 7,000 more in private employer health plans. They weigh themselves twice a day and answer health status questions on a keypad.

Humana plans to sign up 2,000 high-risk elderly congestive heart failure patients next year in a study using a monitoring device from Intel like the ones in the Mayo Clinic trial.

Aetna has completed a trial using the Intel device with 330 Medicare members who have heart problems. It is getting ready to report results in a peer-reviewed journal, said Dr. Randall Krakauer, an Aetna national medical director. The stakes are high: 68,000 Aetna Medicare members have high blood pressure.

One physician who says he is cautious about telehealth is Dr. Daniel Einhorn, medical director of the Scripps Whittier Diabetes Institute in La Jolla, Calif., and president of the American Association of Clinical Endocrinologists.

Even though WellDoc, which makes devices for AT&T, has said its monitoring system significantly reduced A1C, a blood sugar indicator, in a yearlong randomized trial of patients with Type 2 diabetes, Dr. Einhorn said he would wait to read the final report in a peer-reviewed journal. Treating diabetes “depends entirely on multiple details,” he said. “We need to know: Are there patterns of glucose levels, the patient’s age, medications, other medical problems?”

Dr. Suzanne Clough, a diabetes specialist who is a founder of WellDoc, said she agreed that “a physician needs to know a lot about the individual.”

“A phone message cannot replace that,” she said. But it can “provide additional information, insight and contextualized data.”

Decision Trees, Wired Magazine, Tom Goetz

http://www.wired.com/magazine/2010/01/ff_decisiontree/

Decision Tree: How Smarter Choices Lead to Better Health

By Thomas Goetz January 19, 2010
12:37 pm
Wired Feb 2010
 
Life is complicated — especially when it comes to our health. Once we reach a certain age, we start to realize that health is a variable, not a constant. Our knees ache, our pace slows, and we’re diagnosed with diabetes or even cancer. And because the stakes are so high and the options so dizzying, we may stop engaging with our health altogether. We let doctors and insurance companies decide on our care, and we focus our energies on what we can control — our bank accounts, our relationships, but not, alas, our health.




That’s too bad, because health is really just a system of inputs and outputs. The inputs include the choices we make: what we eat, whether we exercise, how much we sleep, whether we heed our doctors’ orders. These decisions combine with other inputs, things that we may not even consider information and that we probably know much more about than our doctors, like our family history, where we live, our jobs, our stress levels, and so on. All of these inputs create one primary output unique to us alone: our health, for good or ill.




This means we have more control over our health than we might have thought. By monitoring and tweaking our inputs, we can influence and even determine our well-being. Taken all at once, our health may seem inscrutable; laid out in a sequence, it becomes a series of decisions, each with risks, benefits, and trade-offs. In other words, we can organize our health options into a decision tree, a method for factoring in our inputs, mapping out our options, and guiding us along the best possible path.



A decision tree is a simple idea — many of us learned to draw them (in the form of flowcharts) in elementary school. And decision trees are already all around us. They’re common in engineering and industry, where they’re known as algorithms. The pharmaceutical industry uses them to plan safe clinical trials. Financial-service quants use them to root out credit card fraud. They’re even used by city planners to design street patterns and map bus routes. In these cases, decision trees can be complicated tools, laden with mathematics and computer science.



But they needn’t be only for the experts. In an age of too much information and too little illumination, a decision tree can be a tool that nudges any of us to think through our options and to act consciously and with consideration. A decision tree can be as straightforward as a list of the pros and cons of a particular option that we complete before we act. It can be a simple and useful way to turn the health data we already have into a system for better choices and better outcomes.

And auspiciously, we’re at a moment when more data than ever lies within ready reach. Whether it’s personal genomics services like 23andMe or screening tests or self-tracking iPhone apps, each of us can draw on a wealth of personalized data sources that turn generic medical advice into customized health equations. And this is always-on data: Instead of checking in on our health episodically — when we visit the doctor or get lab test results — we can now tap into a constant stream of information and opportunity. We can minimize our uncertainty and maximize our control. We can build ever more sophisticated, and useful, decision trees.



In the following pages, you’ll meet three individuals, each facing a different medical quandary. As their experiences show, the right decision tree can bear the fruit of a better life.





Should Teri Smieja have preemptive surgery to protect against breast and ovarian cancers?


Teri Smieja had a choice to make. A mother of two living in the small town of Ridgecrest, California, she learned in February 2009 that she has a much higher risk of developing breast and ovarian cancers than the typical American woman. And she needed to figure out what to do about it.




It had happened very fast. In late 2008, her aunt went on a trip to Israel. When she came back to the States, she explained to Smieja that Ashkenazi Jews like themselves were more likely to have mutations in two genes known as BRCA1 and BRCA2. Those mutations put women at a much higher risk for breast and ovarian cancers. Sixty percent of women who have mutations in one or both of the genes will develop breast cancer, and up to 40 percent will develop ovarian cancer. (The average American female has about a 12 percent risk of breast cancer, and a 1.4 percent chance of ovarian cancer.) For Smieja, who didn’t really identify as Jewish, this was all new. “I had never heard of Ashkenazi anything before,” she says, let alone BRCA genes. But she did know that ovarian cancer ran in her family — her grandmother had it, her aunt had it, her mother has it. “I always figured I had a higher chance of getting cancer,” she says, but she hadn’t known there was a way to measure that risk.



So Smieja took a genetic test and learned that she was positive for the BRCA1 mutation. That finding, combined with her family history, made it more than a possibility that she would develop breast or ovarian cancer — it became a likelihood. In a term that reflects the age we live in, women like Smieja are known as previvors — they don’t have a cancer yet, but they surely have something. The question now was what to do next. “I had this paper in my hand that said I have up to an 87 percent risk of getting cancer by age 70. And, of course, I started crying; I was really upset. But then it hit me: It didn’t say I had cancer; it said I could get cancer. So I said, ‘Stop feeling sorry for yourself. This is good news. I can do something about this.’”




Slowly, her decision tree began to emerge. Estrogen promotes cell division in women and therefore spurs the proliferation of cancer cells. Since the ovaries produce most of the estrogen in the female body, it’s often recommended that women with an increased risk have their ovaries and uteruses removed. An oophorectomy and hysterectomy, then, not only brings the risk of ovarian cancer close to zero but also reduces the breast-cancer risk by about 50 percent. After spending a lot of time on the Internet and visiting a genetic counselor (“They said I did it wrong. I was supposed to go to the counselor first,” she recalls), Smieja decided to have the oophorectomy and hysterectomy.




As far as surgeries go, oophorectomy with hysterectomy is relatively straightforward and can be performed laparoscopically in just a few hours. One downside was that she wouldn’t be able to have any more children, but Smieja wasn’t planning to anyway. (Doesn't that minimize the emotional aspect of what this means?)



The next choice facing her was whether to have a preemptive double mastectomy (also known as a bilateral prophylactic mastectomy). This one was more difficult. Some women with high risk opt for this procedure because estrogen receptors in the breasts make them susceptible to cancer. But it is a more traumatic procedure, both in terms of recovering from the wounds and for social and psychological reasons. (For Smieja, it meant she could no longer breast-feed her second child.) And while it would further reduce the risk of breast cancer — by about 90 percent — the benefits were not as pronounced as with the oophorectomy.



For Smieja, the decision was traumatic to navigate. But ultimately it came down to her desire to reduce her risk through all available means. That meant waiting a few months to wean her baby, then having the procedures. “I’m done with that decision,” she says. “This is what I need to do. I need to be around for my kids. I am not my ovaries. I am not my breasts.”

Should Frank Kozik give up smoking, or does the pleasure of lighting up outweigh the consequences?


Frank Kozik knows how hard it is to quit smoking. He smoked for 39 years, off and on — and he’s just 48 years old. You read that right: Kozik, a renowned poster designer since the heyday of alternative rock, has been smoking since he was 8 years old.




Like so many smokers, Kozik has quit several times. When he began bicycling in the 1980s, he kicked the habit for five years — until he started seeing a woman who smoked. A few years later, when he started dating a more health-conscious woman, he quit again — only to resume after they broke up about a year later. Kozik has always been well aware of the risks — but he also knows the benefits. “Smoking is a really pleasurable thing,” he says. “It’s like a little high every time you light up. Of course, with every cigarette I also thought, ‘Is this the one that’s going to give me cancer?’ But that was an abstract thought, and that little high was so much more real.”



Kozik’s description is spot-on. Of all our bad health habits, smoking is one of the worst of all possible worlds: It’s among the least healthy and the hardest to stop. Half of all lifelong smokers will die of a smoking-related illness; nearly a third of all cancer deaths are caused by smoking. Very few health behaviors are so strongly associated with such lethal results. So what keeps smokers puffing away? Neurologically, smoking activates the mesocorticolimbic dopamine system in the brain, which drives the reward circuit, the motivational circuit, and the learning/memory circuit. (This means that smoking is a learned behavior, self-rewarding, and motivational all at the same time!) Each individual node in the smoker’s decision tree pits an immediate tangible benefit against a longer-term abstract one.




This tension exemplifies the paradox of behavior change: We know what we are supposed to do, but we find all sorts of reasons not to do it. As a result, more than 85 percent of Americans don’t eat enough fruits and vegetables, two-thirds are overweight — and 20 percent continue to smoke cigarettes. We don’t lack for information. We lack for incentives.



For Kozik, those incentives finally started to register when he hit his mid-forties and he began to feel the effects of so many years of smoking. “All these health issues began to pop up,” he says, and in early 2008, when he found it “harder to carry stuff up the stairs,” he started to cut back from his two-pack-a-day habit to about 15 cigarettes a day.



But last year, Kozik faced a starker trade-off than a little shortness of breath. His dentist told him that smoking had severely aggravated his gums. If he didn’t quit smoking, he was likely to start losing his teeth. “Right there, it became something real,” Kozik says. “What do I value more: my teeth or smoking cigarettes? I mean, cancer was always this vague thing; you can’t see your lungs. But you can see your teeth. It was a pretty clear decision.” Kozik quit cold turkey last October and is resolved to never light up again.



“My entire life has been motivated by the possibility of what comes next,” Kozik explains. “I’m a selfish person — we all are — and every decision I make comes down to which choice will benefit me more. But most of these choices are totally abstract, toward some idealized goal. Every once in a while, though, you’ll hit a choice that’s real. Having your teeth fall out is real. At that point, the value of a mild narcotic stimulant is zero.”

Alexandra Carmichael has chronic pain. What’s causing it, and how should she treat it?


There are roughly 50 million Americans living with chronic pain, and for them, the hardest thing may be identifying the true cause of their problem. Scans and blood tests often only leave people in the dark and in distress. Pain sufferers may want to build a decision tree, but discovering what the true inputs are can be a lengthy and frustrating process.




At 20 years old, all Alexandra Carmichael knew was that she was in pain. Constant, steady pain — burning, stabbing, soreness — in her pelvis and genitals. For the next 10 years, she bounced among gynecologists who told her not to worry and specialists who couldn’t specify anything. She endured endless tests, including an ultrasound to rule out polycystic ovary syndrome and blood panels to rule out hypothyroidism, adrenal fatigue, and a high testosterone level. Time after time, the tests revealed nothing abnormal or conclusive. As a diagnosis eluded her, she got married and had two children. “I just wanted some ideas, some clue, some information. But there wasn’t any that I could find,” she says.



Finally, in 2006, a new doctor gave her an accurate diagnosis: vulvodynia, a condition characterized by persistent pain in a woman’s pelvis and genitals. It can be intermittent or constant, and it makes many aspects of day-to-day life, including sex, seem almost impossible. Despite the fact that about 16 percent of women will suffer from it during their lives, it is a woefully understudied condition. “It was a huge validation that it was not all in my head, that there was actually a name for what I had and that other women had had it,” Carmichael recalls. “It freed me up to focus on how to treat my body rather than try to figure out what I had.”



But her ordeal wasn’t over. She’d spend another two years sorting through various treatments, each one a Hobson’s choice between trying something or trying nothing. After a battery of other tests — cholesterol, thyroid, blood panels — she discovered that her estrogen levels were low. Eventually, she and her doctor came up with the right level of hormone replacement therapy to allow her to live “95 percent pain free.”



Carmichael’s experience led her to cofound CureTogether, an online health community where people can share their experience with more than 400 conditions and compare their symptoms, treatments, and results. The information is robust enough that the site has actually advanced research into vulvodynia and several other conditions. “It took me 10 years to find out what I had, and it took two years to find the right treatment,” she says. “That simply wouldn’t be the case anymore. It would not take anywhere near that long for somebody who finds CureTogether. Now there are other women like me, sharing ideas and data. It shortens the decision tree considerably.”

Diabetes & Iphone

Innovation by Design: Taking Cues from Apple and the iPhone Share


Could diabetes-management devices someday resemble or even interact with iPhones?

Back in 2007, Amy Tenderich, founder of the popular blog DiabetesMine, attracted national attention when she wrote an open letter to Apple CEO Steve Jobs requesting that his innovative team try its hand at medical product design. The creative forces at Apple had managed to fuse functionality with feature-rich and attractive designs for its consumer products, Tenderich noted. Why then, she asked, can't that sensibility be translated to the design of life-critical devices? Although this concept of taking design cues from consumer electronics is not a new one, Tenderich's plea helped to initiate an industry-wide dialogue that is still going strong today.

In the wake of Tenderich's 2007 open letter, everyone weighed in, including my predecessor at MPMN. I put in my two cents a year later when Tenderich took matters into her own hands and launched a device design contest. And just this week, a Chicago Tribune health blog referenced Tenderich's frustrated sentiments and described some 'dream' diabetes device designs suggested by patients and inventors.

According to the blog post, Apple is still regarded as the paragon of design. However, its design influence has apparently gone beyond serving as the model for what medical device design should be; rather, a demand for iPhone apps or medical devices that interface with iPhones directly are cropping up.

This desire should come as no surprise, though. “If a medical device uses some of the same interaction metaphors as a consumer electronics product, then the medical device may be easier for the patient to learn and safer to use,” Matthew Jordan of Insight Product Development (Chicago) told me in 2008 for my editorial. “Similarly, consumer electronic aesthetics, when applied to medical devices, may make the device seem more familiar and approachable for the patient.” And what's more familiar and approachable these days than the iPhone?

The impact that iPads, iPhones, and smartphones in general have had on medical device design was actually a topic of conversation that arose when I recently visited the offices of design firm Logic PD while in the area for MD&M Minneapolis earlier this month. Brad Löhrding, vice president of product design, commented on how clients now frequently point to consumer products such as cell phones and iPads when describing what they want in their products: a sleek, modern user interface, intuitive features, and a slim form factor. Basically, they want a critical device with all of the bells and whistles of a consumer one. While we were treated to eye-catching examples from the company's product portfolio, the evolution of product design and influence of consumer electronics became increasingly obvious. These were sexy devices, sure to be fawned over by end-users. But, as Löhrding pointed out at our meeting, applying consumer product design elements to medical devices is great for marketability and compliance. But if you don't have the functionality, someone's life is at stake.

What do you think about the impact of consumer product design on the device industry? Let me know in the comments section. --Shana Leonard


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Samsung senior phone’s “medical” services
Wednesday - July 28th, 2010 - 11:16pm EST by Brian Dolan | Jitterbug Live Nurse | Jitterbug mobile health | medical apps | Samsung Haven | Verizon Wireless mobile health | well-being mobile services |
Those in the market for a “senior-friendly” phone just got another option: Samsung’s Haven, available to Verizon Wireless subscribers as of today. The Haven features a dedicated In Case of Emergency (ICE) button, adjustable fonts to make it easier to read text on the phone’s screen, speech recognition software and well-being and medical management tools.

The well-being and medical management tools apparently consist of “reminder alarms,” “fitness guide” and “stress relieving music.” Not exactly a comprehensive suite of mobile health services, but perhaps fairly representative of the majority of health and medical smartphone apps intended for use by consumers/patients and available in app stores today.

Here’s the pitch for the phone on the Verizon online store site: “The Samsung Haven makes it easy to speak, hear and be heard. Featuring a slim design and large keys for easy dialing, the Haven is ideal for anyone seeking a phone that’s easy to use. One–touch access to emergency numbers, voicemail, speakerphone and voice commands offer effortless execution, and built–in lifestyle applications like reminder alarms, fitness guide and stress relieving music are perfect for maintaining and organizing an active lifestyle. With such manageable features, the Haven is the right phone for those who want the easy life.”

Jitterbug’s phone services for seniors, which runs on Verizon Wireless’ network by the way, offers a growing list of health and medical services for its subscribers: Live Nurse, Heart Healthy Tips, Wellness Calls, 5Start Emergency (PERS coming in the fall). It has also tinkered with a diabetes management service (D-Coach by WellDoc) and a Medication Reminders service with Meridian Health. (more on Jitterbug’s services here.)

Check out the Samsung Haven phone over at Verizon’s site


http://www.linkedin.com/news?viewArticle=&articleID=161066343&gid=1996303&type=news&item=161066343&articleURL=http%3A%2F%2Fmobihealthnews%2Ecom%2F8505%2Fverizon-samsung-senior-phones-medical-services%2F&urlhash=exo_&goback=%2Egde_1996303_news_161066343

Siemens Innovation

Innovations 10 News & Events Education Discussion Forums
https://www.shsusers.org/Innovations/Innovations10/Keynote.asp
Keynote Presenters
Monday, August 9
8:30 a.m. – 10:30 a.m.

Energizing Opening Session
You won't want to miss this opportunity to hear this dynamic keynote on ways to meet the challenges of changing technology by understanding the power of human technology.

Keith Harrell, "Attitude is Everything"

Known across "Corporate America" for his energetic, innovative presentations, Keith Harrell is a dynamic life coach who specializes in changing behaviors through a positive attitude. Harrell shares his powerful message, "Attitude is Everything" with audiences around the world. While growing up in Seattle, Washington, he aspired to become a professional basketball player. Although he never realized that dream, an article in The Wall Street Journal refers to him as a "Star With Attitude." The newspaper says, "What sets him apart from less successful speakers is driving ambition, and an attitude that refuses to flag." His signature keynote focuses on ways to meet the challenges of changing technology by understanding the power of human technology.

As president of Harrell Performance Systems, Harrell has created a firm specializing in helping the corporate marketplace achieve and maintain their goals through the power of a positive attitude and is a certified speaker, trainer and consultant.

His book, Attitude Is Everything: Ten Life Changing Steps to Turning Attitude Into Action, was released in March 2000. Harrell gives readers a 10-step program for tuning up your attitude and improving your professional and personal life.

Harrell earned his bachelor's degree in community service from Seattle University before embarking on a 14-year career with IBM where he was recognized as one of the top sales and training instructors. In 1997, Harrell received the Certified Speaking Professional designation from the National Speakers Association. In August 2000, Harrell was inducted into the Speaker Hall of Fame, a lifetime award for speaking excellence and professionalism.

Thomas J. Miller
CEO, Workflow and Solutions
Health Services
Siemens Healthcare

Tom Miller will present insightful and intriguing views on "Predicting the Future: The World of Healthcare Innovation."





John Glaser
Incoming CEO
Health Services
Siemens Healthcare

John Glaser will address the Innovations '10 audience as the incoming CEO of Siemens Health Services. Formerly the CIO at Partners Healthcare in Boston, John was also advisor to David Blumenthal, the national coordinator for healthcare IT, providing counsel to the Office of the National Coordinator and the Department of Health and Human Services on the HITECH portions of the federal government's stimulus bill, particularly regarding national efforts to adopt electronic medical records.

Dr. Max Rogers
Wednesday, August 11
8:30 a.m. – 9:30 a.m.

Exciting and Practical Closing Day Session
Don't miss this high-energy, multimedia keynote focused on healthcare.

Afterburner, Former Fighter Pilots, including a practicing physician, on achieving Flawless Execution in the healthcare industry.

"Learn how focus on the mission by defining strategy, assessing risks, communication and execution are key elements in aerial combat – and in the business."

Join us on August 11th for an event that will change the way you and your team execute strategies and meet your goals to succeed in today's healthcare environment. The Afterburner team of Brig General (Ret) Charles 'Chaz' Campbell and Dr. Max Rogers, are real Fighter Pilots who understand how critical it is to know how to handle yourself and your team in hostile, fast-changing environments every single day. The Flawless Execution ModelSM is the process used around the world to execute missions when the stakes are high and failure is not an option. For the last 20 years, the World Healthcare Organization and other medical organizations have recognized that the improvements in teamwork, communication and collaboration that dramatically improved aviation safety since the 1980's, directly relate to many of the challenges facing the healthcare industry. Today, many medical units are using techniques from the aviation community and specifically the Flawless Execution ModelSM to dramatically improve the way their teams perform.

Flawless ExecutionSM creates accountable actions and enables organizations to:

* Plan quickly and effectively by tapping into the power of cognitive diversity. In just six steps, your team can produce detailed plans based on individual accountability and team work;
* Brief to win by aligning and poising your team to execute initiatives flawlessly through proper communication techniques;
* Execute by creating an execution rhythm, which drives individual accountability; learn to identify and eliminate performance-draining Task SaturationSM; and
* Debrief your team on the outcome, creating a culture of learning that empowers an individual to offer and accept constructive criticism, create valuable lessons learned, and feed that learning back into future planning to be utilized by the entire organization.

Brig General (Ret) Charles 'Chaz' Campbell This process will dramatically improve small team communication and collaboration from the operating room to the medical unit. It will also provide a framework for continuous improvement that will positively impact patient satisfaction as well as medical business practices. In this rapidly changing, uncertain modern environment where quick response to change is essential to survival, a simple, scalable process that enables improved execution and accelerated learning is critical. Rare cockpit footage and state of the art graphics make for a presentation you will never forget.

Humana Innovation, Games

http://www.crumpleitup.com/#/Team

You can't put diesel in your car, but you can mistake baby tubes

Safety experts watch Las Vegas Hospital: Problems spur queries about the engineering of medical devices

[Las Vegas Review-Journal (NV)]

Published Date: July 15, 2010 09:06:00 AM EDT
Author: By Paul Harasim, Las Vegas Review-Journal

July 15--National medical safety experts are closely following news accounts of what Sunrise Children's Hospital officials have called incidents of "disrupted catheters" that have left one newborn baby in critical condition.

Another infant had to undergo an emergency operation as a result of catheter disruption, the hospital disclosed in a Friday statement that also revealed there have been 14 such incidents since February. Two Sunrise nurses, Jessica May Rice and Sharon Ochoa-Reyes, have been named in a Las Vegas police investigation into "intentional patient harm" and have had their licenses suspended by the Nevada State Nursing Board.

News of the Sunrise situation has "spread like wildfire in safety circles," said Mike Cohen, head of the Pennsylvania-based Institute for Safe Medication Practices, which sends out a regular safety bulletin to hospitals throughout the country.

"Everybody is trying to figure out what happened," he said. "Nobody knows what the hospital means by 'disrupted catheters.'?"

A catheter is a tube that can provide nutrition and medication to a patient.

While acknowledging that medical personnel have been known to act as "angels of death" in deranged efforts to relieve a patient of his or her misery, the safety experts are raising one major question based on problems found at hospitals throughout the country.

Could the disrupted catheters at Sunrise, -- which hospital officials first thought stemmed from technical problems -- have malfunctioned because outdated engineering allows human error?

The national Institute of Medicine estimates that as many as 98,000 people die each year because of preventable medical errors.

"You can't put diesel fuel in your gas tank, but you can inadvertently mix medication and nutrition for a baby through a tubing misconnection," said Debora Simmons, head of the Houston-based National Center for Cognitive Informatics and Decision Making in Healthcare. "As a safety researcher, I've been looking at this problem of tubing misconnections for seven years. The medical industry is probably the only industry that designs things where anything can connect to anything."

"It's craziness," she said. "We don't recognize in the way our medical equipment is manufactured that people can make mistakes. When it comes to public safety, when it is at all possible, you have to engineer things so they are incompatible. Don't you think a lot of people might be ruining their engines by mistake with diesel fuel if engineering hadn't made it impossible to do?"

Simmons said it is difficult to expect that busy critical care nurses, though highly trained and well intentioned, will never make a mistake. She noted that a critically ill patient has tubes of one sort of another inserted into much of his body.

Often working quickly in low light to connect IVs for medication and fluids as well as feeding tubes, nurses may sometimes forget to look at where the tubes originate, Simmons said.

"The best solution is to design tubes so that the ones that shouldn't fit together don't," she said, arguing that the cost of re-engineering equipment is largely the reason it hasn't been done.

Cohen noted that his organization reported to hospitals across the country in 2006 that tubing used to deliver breast milk to a baby was mistakenly connected to an IV delivering medications.

"The baby had seizures and respiratory distress but recovered," he said. However, many babies in that situation die, he said.

"We write about these kind of incidents a lot," he said. "Designed incompatibility is necessary to prevent dangerous misconnections of tubes and catheters."

Not only children suffer because of tubing misconnections, Cohen stressed.

Several people have died after tubing from a blood pressure machine or an oxygen mask was mistakenly connected to an IV tube supplying fluid and medicine into a vein. The wrong connection allowed air to enter the vein, causing a fatal embolism.

On July 9, the same day Sunrise officials disclosed problems with catheters in its children's hospital, officials with the nation's Food and Drug Administration wrote a letter about misconnections in medical tubing to manufacturers of medical equipment and health care authorities throughout the country.

The ease of connection has "led to misconnections that have inadvertently linked unrelated systems, and at times, have resulted in serious adverse events. In particular, misconnections with ... feeding tubes and solutions have been associated with serious death and injury," according to the FDA.

The letter suggests manufacturers make design changes that include color coding and adopt the principle "of designed incompatibility, to ensure that devices that should not be connected cannot, in fact, be connected."

On Wednesday, Sunrise officials and police investigators continued to decline comment about the disrupted catheters.

Neither Rice nor Ochoa-Reyes was available for comment Wednesday.

Both of the national safety officials interviewed by the Review-Journal want to believe that neither nurse could have hurt babies intentionally.

"I really want to believe that we're talking about accidents," said Simmons, who studies incidents around the country.

"It's highly unusual for nurses to get together to do harm to patients. But 14 of these accidents since February? That's a lot of accidents."

Contact reporter Paul Harasim at pharasim@review journal.com or 702-387-2908.

To see more of the Review-Journal or to subscribe to the newspaper, go to http://www.lvrj.com.

Copyright (c) 2010, Las Vegas Review-Journal

Distributed by McClatchy-Tribune Information Services.

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Healthed

http://healthed.com/