Kommunalminister Jan Tore Sanner lover at all statlig post skal komme digitalt, men slik strategien fremstår i dag er det oppskriften på å mislykkes. Det legges opp til at vi må forholde oss til flere ulike digitale postkasser fra det offentlige.
Samtidig ser vi at flere offentlige aktører ikke følger de beslutninger politikerne har tatt om en felles digital postkasse, og etablerer egne konkurrerende løsninger.
Ja, dette lover ikke godt. Der kan drages en parallel imellem statens manglende evne til at løse epost-udfordringen og problemerne med at udforme en fælles patientjournal, der kan tilgås af flere parter.
While I appreciate Samsung’s need to get out ahead of Apple’s expected announcement of their healthbook app, viewing portions of the keynote address showed Samsung’s clear disconnect with how wearables are currently being used, and even more concerning — their lack of understanding in the health metrics that doctors actually care about.
Nothing really new here. Samsung is well known for throwing incomplete products at the wall just to see what sticks.
I’m more interested in how Google Fit and Apple Health are going to fair. Especially since the FDA made it clear that Apple’s Health app in itself would be exempt from FDA certification.
At the outset, it’s important to note that these findings were presented in an abstract format but have yet to be published in a peer review journal. With that in mind, the researchers reported a lower 3-year mortality in patients utilizing remote monitoring that was statistically significant (HR=0.67; 95% CI, 0.64-0.7) even when controlling for factors like age, gender, ischemic vs. nonischemic disease, and more. Similarly they identified a lower risk of rehospitalization when looking at the subset of Medicare patients for whom that data was available (HR=0.81; 95% CI, 0.79-0.83).
These results are very impressive, but as iMedalApps states, there’s a few caveats that need to be considered:
A phone line is required. In some dense city or sparsely populated rural areas this could be a problem.
Not all patients may be health literate enough to be able to use the device.
Use of the device has an added cost.
There is also confounding factors to be considered:
There are also conceivable ways that a mortality benefit could perhaps be achieved. Perhaps, for example, the use of remote monitoring leads to a consistent reduction in inappropriate shocks or in device malfunctions that would prevent appropriate shocks. Alternatively, maybe by catching inappropriate device activity earlier, there are less iatrogenic complications or effects on the heart or maybe there is some other mechanism at play here that has yet to be identified.
If you’re looking for poor people who have been paid to test experimental drugs, Philadelphia is a good place to start. The city is home to five medical schools, and pharmaceutical and drug-testing companies line a corridor that stretches northeast into New Jersey. It also has one of the most visible homeless populations in the country.
Today’s Kannapolis does not offer as many good blue-collar jobs as it used to—unemployment still hovers at 10 percent—but it does provide plenty of opportunities for locals to serve as human research subjects. At any given time, Kannapolites can take part in studies of nutrition, longevity, or cognitive or physical performance; eat a standardized diet; or spend time in a metabolic chamber while their vital signs are monitored—sometimes for $30 to $250 and up.
Some difficult questions need to be answered before one can commit to a whole-sale biobank study of this scale.
Indeed, it’s not clear how well Kannapolites even understand what they’re agreeing to when they elect to participate in the MURDOCK Study. Not because they’re unsophisticated, especially, but because biobanking itself, in the eyes of some bioethicists, entails notable departures from the established tenets of research on human subjects.
Just a quick follow-up to my post on RFID tagging [Danish]. The adhesive “tattoos” pictured above are a nice representation of what will eventually become mainstream in hospitals.
The tattoo is best placed where you can easily touch it with your phone, so I put it on the underside of my right wrist. (Being a lefty, I usually hold my phone in my left hand.) The idea is to tap the phone on the tattoo to unlock it instead of using a traditional pattern or PIN lock code. The Moto X sees the tattoo as if it were a Skip device, and once you’ve set up the lockscreen to unlock via NFC, the phone’s security screen can be bypassed with just a tap.
It’s a neat parlor trick and amusing to show off to others, but practical use is limited. The phone will only recognize the tattoo when the screen is on, so you either have to press the power button before tapping or rely on the Moto X’s motion sensing to wake the screen up when you pick up the phone. The whole process actually takes longer than just typing my PIN or drawing my swipe code. It also requires two limbs to accomplish, whereas the traditional methods can be easily done with one hand. That’s not to mention that you need to set the whole thing up again every time you replace the tattoo on your body. Unless I specifically thought about using the tattoo to unlock my phone, I quickly forgot about it and would use the other, more traditional methods most of the time. Old habits are hard to break, after all.
A plastic bracelet or ID-tag would probably work better than a sticker. One could of course go all in on becoming a psyborg but that requires diving into territory most people wouldn’t be comfortable with.
Norway has both a comprehensive IT-infrastructure and health care system. Practically all Norwegians have an internet connection as well as a smartphone, and the Norwegian health care system is ranked as one of the best in the world. For some reason though, Norway isn’t at the forefront of digital health innovation.
No Flair
Currently, the Norwegian digital health market is cornered by a few companies. They are comfortable with the status quo, ignoring the BYOD movement, as well as disregarding the pace at which digital health is evolving. Their users should wake up and demand a higher level of quality products. Unfortunately, health care workers are so starved of proper software, that they accept any improvements, no matter how slight or out of date they may be.
Government agencies are even worse: Experts philosophize about interop, and the ownership of data, without these discussions resulting in any practical solutions. In addition, the agencies somehow manage to spend several millions on developing superfluous apps, which never get downloaded.
Ripe for Disruption
The stage is set for the next generation of digital health companies. They won’t conform to old ideas and challenge the existing status quo. They are efficient, reflective, and innovative. They must be in order to become successful.
The Road Ahead
Discussions on standard adoption need to be open, focused and efficient. There should be a strict deadline for practical conclusions.
Private companies should be allowed to compete on an even playing field with government companies; e.g. competition from Fürst Medical has forced Stavanger University Hospital’s Clinical Chemistry department to finally digitize their workflow.
The government should continue to develop the IT-infrastructure, but also supply developer APIs for easy, and secure access to core functionalities; such as drug store data, connection to hospitals for lab data and treatment schedules, as well as secure digital communication with health care professionals. In addition, they should help diversify the digital health market by adapting the BYOD movement for health care, hosting developer conferences & hackathons, and promoting innovative digital solutions by third parties.
Fitbit supports more than 100 mobile devices, with 72 Android, 9 iOS, and 17 Windows devices.
This is great for Microsoft, but it shows how much work needs to go into development if you want to cater to everyone. Governments, hospitals, etc. cannot hope to become relevant on grants alone.
Jeg er enig i det meste i denne artikel. Mennesker er hverken Toyotaer eller fly.
Helseministeren har bestemt seg for å nedsette en havarikommisjon for helsevesenet. Modellen og retorikken er hentet fra luftfarten. Pasientene er passasjerer i et helsevesen der legene er piloter som forventes å bringe folk trygt og forutsigbart fra A til B. Logikken synes å være omtrent slik: Det skjer skrekkelige ting i helsevesenet som gjør at folk dør, mens fly nesten aldri faller ned. Det kan med andre ord ikke være så innmari vanskelig å gjøre verden mindre farlig for norske pasienter når man tydeligvis greier det for flypassasjerer!
Det eneste sted hvor patienten er et fly er indenfor akutmedicin hvor ABC-tankegang og triagering går fint sammen med “havarikommitionmetoden”.
Den lille computerchip ligner dem vi kender i nøglekort, og den digitale mærkning er utrolig effektiv, fortæller Michael Wallin, strategisk chef på Herlev Hospital.
- Vi kan følge medicinkasser hele vejen, og det er en stor fordel, hvis medicinen for eksempel skal holdes kold. Nu kan vi spore medicinen, så den ikke går tabt, og det betyder, at vi undgår tab på op mod 400.000 kroner, som medicin let koster, forklarer han.
Herlev hospital tænker dog ikke stort nok. Kastrup lufthavn har f.eks. brugt RFID tags til at spore passagerer:
Det nye system er baseret på trådløs teknologi, der registrerer, når mobiltelefonen kommer ind i en ny zone. På den måde får lufthavnen et præcist billede af, hvordan passagerer bevæger sig rundt. Københavns Lufthavn er den første lufthavn i Europa, der tester netop denne kombination af trådløst teknologi:
“Vi investerer løbende i ny teknologi, der kan forbedre forholdene for vores passagerer og samarbejdspartnere. Teknologien skal bruges til at give passagererne en mere rolig og afslappende start på rejsen, fordi de får en sms, når de skal bevæge sig ud til gaten afhængig af, hvor de befinder sig i lufthavnen. Flyselskaberne derimod kan bruge informationerne til at mindske antallet af forsinkelser, fordi de får at vide, hvor passagererne opholder sig, og om de kan nå flyet,” udtaler Brian Petersen, administrerende direktør i Københavns Lufthavne A/S.
RFID tags burde bruges til at spore og identificere patienter og personale på sygehuset. Man ville da spare tid og opnå bedre sikkerhed ved f.eks. blodtransfusioner, blodprøvetagning, opsporing af patienter og personale samt personalelogin på hospitalets IT-system.
P1 teknologiprogrammet Harddisken havde et afsnit om RFID tags i 2012 og det afsnit er fortsat et lyt værd. Desværre virker dr.dk’s eget link ikke - men man kan fortsat finde afsnittet på iTunes.
Great idea for a general use wearable, especially when the technology becomes so inexpensive and compact that one can simply have several socks with similar, built in technology.
There are around 285 million visually-impaired people in the world, according to the World Health Organization, and most of them are in India. While testing the shoes, the company realized its potential for the sighted as well. For example joggers, mountain bikers or even tourists can plug in their destinations and not have to stop to check their phones as they move because the buzzing in their shoes will let them know when to turn.
Of course, cheaper glasses, access to opticians, ophthalmologists, and cataract operations would go a long way for helping the visually impaired.
Danes have always been good at spinning straw into gold.
In Denmark, companies make 34 % for each extra Danish krone they invest, while companies in Norway and Finland make 23 % and Swedish companies make about 16 %.
I fagkredse er der uenighed om hvor stort fokus man skal lægge på health apps, men en ting er sikkert: De er fremtiden.
I disse agurketider har både Dagbladet og VG skrevet app guides. VG lover nok lidt for meget, når de skriver at deres 10 helseapps vil give dig et bedre liv, mens Dagbladet har et mere nuanceret budskap. Tilfældigvis blev jeg også interviewet af Dagbladets Jorun Gaarder.
Her følger links (mest til iOS - men enkelte findes også til Android) til de anbefalede apps:
Fra myndighetene og pasientene stilles det stadig større krav til fastlegers tilgjengelighet. Man ønsker:
møte hos fastlege samme dag
at telefonen svares innenfor få minutter
elektroniske resepter må fornyes på dagen
hurtig elektronisk svar på undersøkelser
elektronisk timebestilling - og avbestilling
påminnelse om time på SMS
Myndighetene mener at mer IKT skal hjelpe legene ved å øke deres tilgjengelighet. På tross av mye IKT, bruker leger mer tid på papirarbeid enn på pasienter. I motsetning til dette, står den omtalte betalingsterminalen frem som et eksempel på god IKT. Vi har endelig et teknologisk hjelpemiddel, som gjør at leger og legesekretærer kan bruke mer tid på pasientene sine.
Erfaringer fra min egen klinikk viser at vi nå får mer tid til det mellommenneskelige aspekt av arbeidet. Det medfører bedre miljø for pasientene, et bedre arbeidsmiljø, og muligheten til å prioritere de kliniske oppgavene.
Juridisk duell
Selskapet bak betalingsterminalene forsvarer grunnlaget for kortgebyret slik:
Kortgebyret er ikke en egenandel, men betaling for en oppgjørsform. Slike gebyrer er vanlig, og er etter vår mening hjemlet i finansavtaleloven
Denne saken er et fint eksempel på hvordan byråkrati fort kan overvelde – og til tider kvele – de beste innovasjonsspirer. Saken blir enda mer absurd når man tenker på at pasienter helt kan slippe gebyr hvis de betaler kontant, har frikort eller er under 16 år.
Tid Til Deg
De årlige utgiftene til IKT øker raskere enn fastlegenes honorartakster. De fleste IKT-løsningene fungerer langt fra optimalt, og legekontorer sliter med gjentatte teknikkerbesøk og ekstrautgifter.
Legeforeningen bør presse på for kompensasjon av legesentre, som følger med IKT-utviklingen. Samtidig bør politikere - herunder Helseministeren - fokusere på optimering og fremtidsikring av den offentlige Helse IKT. Der er lite å vinne ved å legge hindringer i veien for Helse IKT-innovatører: For vil du ikke betale 5 kroner for å møte en vennlig og avslappet doktor, som har tid til nettopp deg i dag?
