Tuesday, October 13, 2009

Ford Produces an Electronic Health Record for Cars

Car owners can now get a text message of their car’s health. Why can’t we get something similar for ourselves?

The Ford Motor Company offers an option for car owners to develop and track a VHR – Vehicle Health Report for several of its models. The data links to a website, http://www.syncmyride.com/ using the customer’s Bluetooth-paired and connected mobile phone.

A comprehensive report is generated from the vehicle data that includes system information and uses diagnostic software to generate recommended actions for any vehicle warning indicators, open recalls, scheduled maintenance, and unserviced maintenance and wear items from previous dealer visits.

Users can select to receive a text message or e-mail when their report is ready. They can print the report, e-mail it to others or, in one click, be at their preferred dealer’s Web site with their health report information waiting to schedule service online. Depending on the user’s preference settings, SYNC can also deliver a text message alert to the user’s cell phone if a severe issue exists with one of the SYNC-monitored systems.

A sample VHR is available at http://www.syncmyride.com/Own/Modules/VHR/vhr_pdf_sample.pdf.

Here is the bottom line:

  1. We now have access to better, faster and more consumer-firendly information including automated diagnostics for our car than for ourselves.
  2. Most of the current HIT hullabaloo focuses on agreeing on a simple electronic health record that is still primarily intended for use by a health professional, that is mostly only for static data and without any built-in capabilities for decision-support diagnostics.
  3. Electronic medical record? Electronic health record? Personal health record? We can’t even agree on a name.

Efforts to move forward have been stopped in their tracks with statements such as: "you don't understand how complicated this is" or "we need to make sure privacy is completely protected" or “we need to make sure it is compatible with every other system” or "we need to investigate the ownership of the medical data." Many say an electronic health record can't be done without millions of government dollars and years of work.

Yet somehow Ford, the company that almost went out of existence last year, came up with a solution!

Of course, this is not the first time the problems of developing an interoperable, consumer-friendly and secure record were overcome. Years ago the financial industry linked together worldwide interbank networks, which are the magic behind ATMs. They are interoperable, work consistently with a very high level of privacy and security and developed with the consumer in mind.

Finally, it is interesting to point out that the ATM networks and now VHRs were implemented without years of government investigation, research and incentives.

Sunday, October 11, 2009

Shaman-Based Triage for Telemedicine

In many parts of the world, large segments of the population still fervently believe in the powers of supernatural healers, a shaman, witch doctors and the like. This causes problems when modern medicine starts to be introduced into a culture with a history of such beliefs. In remarks at a recent meeting in Cartagena, Colombia, ATALACC President Silvio Vega recounted a story where telemedicine ran up against such a case in the indigenous community of Hato Chami in Panama. The town is too small and impoverished to afford a physician on site so a small office was set up with a video phone and a few other telemedicine devices and connected to a rural hospital in another part of the country. This provided a stark contrast between the traditional and the new, making it even harder to gain acceptance by the residents of modern healthcare.

Wary of modern technology, the town’s Ngobe-Bugle Shaman was provided a free office next door to the telemedicine office. Often the Shaman is the first one to see a patient and is a major opinion leader in the community. When a patient sees the Shaman and has a mild problem, not requiring advanced medical attention, he takes action and “heals” the afflicted. In more serious cases he can refer the case to the telemedicine office. Of course, that is especially true if the case involves a lethal snake bite or other problems that may end up being fatal! This implied endorsement by the local, trusted healer has enabled many people to accept the ways of modern technology. In this manner, the Shaman also maintains a good record with his followers.

If you have other stories of telemedicine blending the old with the new feel free to share them in the comments section.

A Report on the Status of Telemedicine from the Three C’s

Over the past ten days I have been on the road speaking and participating in a number of completely different telemedicine-related meetings including the Canadian Society of Telehealth in Vancouver, Canada, a cellular industry conference in California and the Cartagena Telemedicine Conference in Colombia. Talking with these three groups in the three “C’s” (Canada, California and Colombia) provided an interesting opportunity to get a bigger view of where telemedicine is going. Despite the global recession, the diversity of applications continues to grow and the enthusiasm is bigger than ever.


Overall, telehealth continues to grow in Canada, but there are noteworthy differences among the regions. The economic downturn has significantly affected the support of the Canadian government for Provincial telehealth programs. Consequently, some programs, especially those in the more rural provinces, have been forced to cut back. Alberta, facing the double issue of a reduction in federal funds and a decline in oil prices has reduced funding and postponed other proposed telehealth projects. On the other hand, the Ontario Telehealth Network (OTN) has grown despite the economic downturn. OTN, now operating with a staff of 200, runs a province-wide health call center for the citizens of Ontario and has significantly expanded its remote clinical services programs providing services to 660 sites across the province. A couple of the provinces have also made significant investments in home telehealth over the past two years. The meeting in Vancouver was filled with discussions and presentations about amazing number of sophisticated telehealth programs extending health care to the remote tribal and First Nation communities.

The meeting was the last official meeting of the Canadian Society of Telehealth (CST). The group has decided to merge into COACH, a Canadian health informatics organization where they will remain an identified group within the larger organization.

ATA has had a great relationship with many of the Canadian telehealth programs as well as CST. About 150 members of ATA are Canadians and I have had the pleasure of attending many of the past CST annual meetings. Dr. Ed Brown, the director of OTN, is on ATA’s Board of Directors and Dr. Mo Watanabe from Calgary is a past board member.


The Cellular Telecommunications Industry Association represents the operators, transmission companies, cell phone makers and application providers in the wireless market. The CTIA meeting in San Diego was focused on business and related applications. It was not the primary annual meeting of the association but was attended by at least 5,000 attendees. Wireless health care, mHealth, was a new focus at the meeting and was clearly a hot topic for attendees. I spoke on a panel sponsored by Mobihealthnews and ATA had a booth on the exhibit floor in an area sponsored by Qualcomm, under the direction of Qualcomm Vice President, and ATA Board Member, Don Jones. The area also included the participation of several wireless health companies.

An important highlight from the meeting was news that CTIA teamed up with Harris Interactive to conduct a nationwide survey that found 78 percent of the U.S. is interested in mobile health solutions and 15 percent of the U.S. is extremely or very interested in learning more about mHealth. About 19 percent of the people surveyed said that they would upgrade their current mobile phone plan to gain access to mHealth services, while some 11 percent admitted that they would even switch their wireless service provider to receive mobile healthcare services.

It was definitely a crazy time for ATA, even with three staff on site. Alice Watland, Del Tillman and I were overwhelmed with attendees crowding around the ATA booth asking for information about telemedicine. Many developers and technology companies are getting into the market with exciting new applications. A group of state legislators also were in attendance and ATA took the opportunity to have conversations about Medicaid, licensure and other regulations with several of them.

Two relatively new organizations interested in wireless health were also present at the meeting. The Wireless Life Sciences Alliance (WLSA) is a trade association that is described as an international think tank, although it has become much more in recent years. The WLSA is chaired by Rob McCray, who comes from major positions in the healthcare industry. Also, David Aylward, the Executive Director of the new mHealth Alliance, was also at the meeting. The Alliance is a partnership recently formed by the UN Foundation, The Vodafone Foundation and Rockefeller Foundation to support and advance mobile health initiatives in the developing world. ATA has had discussions with both organizations about possibly partnering on a variety of activities.

There are two take-away messages from the meeting:
  1. The wireless industry clearly sees healthcare applications as an important new area for investment. Speakers at the meeting, from the Chairman of the FCC to the head of Verizon Wireless to the CEO of CTIA, mentioned the importance of health applications in their speeches.
  2. ATA is in an important position with the exploding interest in wireless health. Recent ATA comments before the Federal Communications Commission regarding wireless broadband and “wireless body networks” were snatched up by many of the attendees. They are available under the Public Policy area on the ATA web site. ATA’s contribution in this area includes the fact that we represent health providers and traditional health institutions as well as our expertise and presence with a number of government bodies.


The Cartagena Telemedicine Meeting, hosted by Jorge Velez, was attended by over 100 people from around the region. Silvio Vega, the current chair of ATA’s Latin America and Caribbean Chapter (ATALACC) provided an excellent overview of telehealth activities in the ATALACC region. I was shocked at the growth and diversity and have asked Silvio to prepare a written report to be posted on the ATA web site. There are several U.S. hospitals that provide healthcare using telemedicine to areas of South America. However, more important is that almost every country in the region has at least one telemedicine program of their own and many have several. The Health Ministry of Mexico announced that they will start coordinating 17 different telehealth programs that operate throughout Mexico, which include the participation of 148 educational institutions. Government funded telemedicine centers exist in Colombia and several other countries. Panama is using telemedicine for its prison population. A program in Venezuela has extended to 17 sites within the country and four more in neighboring Equator. Plus, private remote cardiac monitoring companies are witnessing significant growth and already consider South America a profitable market for their services.

I’m looking forward to the ATALACC meeting in Puerto Rico this December. It will be very interesting to learn more about the current state and the future directions of telemedicine throughout the Caribbean and Latin America.

Monday, October 5, 2009

Are We Walking-the-Walk?

An important question that was asked at the first meeting of the ATA’s new Institutional Council was whether any of the institutions provided telemedicine as part of the employee benefits for their own organizations. Scott Simmons of the University of Miami reported on their progress in extending telemedicine for employees of the University’s Medical Center. Someone mentioned that Cisco has started such a demonstration for their employees. But no other institution raised their hand.

Thus, Walk-the-Walk was born. Walk-the-Walk is a challenge to every organization that belongs to ATA, institution and corporation, to include telemedicine benefits for your own employees. It may not be comprehensive for all health services but at least provide some form of benefit should be provided - if not by us then who?

Some organizations may think they are too small; others may face challenges with their established health care providers or insurers. But it is surprising what can be done.

Even a small staff with limited resources can make a start. Within ATA, we are trying out an agreement with a local practice, DocTalker, to provide brief telephone-based consultations for ATA staff. This is provided in addition to our regular health insurance and allows a staff member to communicate with a health provider, remotely and almost immediately, at any time. Based on an initial in-person consultation, calls are usually no more than 15 minutes long and provided at a very inexpensive rate. In addition to providing telemedicine to employees of ATA, it may reduce use of more expensive urgent care centers and emergency rooms - and may even reduce our insurance premiums.

So, over the next year let us know if your organization starts to offer such benefits. We hope to keep track of the progress.

Maintaining Balance as We Leap Ahead

ATA was originally formed with an intention to be a medical society. Members were expected to submit their credentials upon joining ATA. This quickly changed as ATA's membership expanded to include both individuals and companies. In addition to individual and corporate membership categories, a new category, institutional membership, was created for hospitals and other non-profit healthcare organizations by then ATA President Ron Weinstein.

The governance of ATA has also reflected this diversity. Members of the board have included individual providers as well as representatives of corporations, governments, academia and provider groups.

Corporate Circle members formed an Industry Council to provide a forum for discussion as well as an advisory body for the Association. This year, ATA brought together representatives from our Institutional members into a new Institutional Council. Like the Industry Council, this new group will serve as a forum and advisory body for ATA. Members have suggested a number of topics for discussion including comparing various governance and administrative structures used for telemedicine operations within their institutions. A list serve and web page is under development and more discussion will be held before the group’s next meeting at ATA 2010.

In telemedicine, the players are always changing and growing. It is critical that ATA spread our wings to bring in new voices and new approaches to provide health care using telecommunications. In ATA's programs and in ATA's governance we strive to strike a balance between traditional hospital-based telemedicine networks; home telehealth organizations; outsourced, telemedicine-based specialty services; remote cardiac and vital sign monitoring companies, MHealth wireless service developers and a growing list of others.

Over the years people have sometimes come to me complaining that ATA was just a puppet of industry, or of the U.S. military, or academia, or the institution employing ATA's current President. It's always difficult maintaining a balance. But that is what ATA is all about. Many of the members and staff of ATA like to say we are part professional association, medical society and trade association.

But with all of the changes ATA has seen since its start in 1993, one thing has remained constant: all of ATA's members are focused on the individual and providing better care, whether it is a patient in another institution, a consumer using a wireless phone or someone homebound with a chronic disease. This is what sets us apart from such related fields as health informatics. With this shared commitment, together we can all learn a lot from each other.