Biggest surprise about technology in medicine?

[mikejones22]

We're among the first wave of med students, clerks, and residents who came of age with Facebook, Twitter, mobile apps, and the like.

 

I'm curious, what's the biggest surprise you've had in terms of how the medical community uses (or doesn't use) technology and the web?

[Hockeynut]

Not a med student but I'm from a rural town and the idea of video conferencing with a specialist 1000+kms away is amazing, both for the patients and physicians involved. This is one of the greatest technological innovations the north has seen in health care for some time.

[jmatt1122]

Not a med student but I'm from a rural town and the idea of video conferencing with a specialist 1000+kms away is amazing, both for the patients and physicians involved. This is one of the greatest technological innovations the north has seen in health care for some time.

 

Not even just for rural situations, but improving access to primary care and efficiency in general with things like Medeo. All really cool stuff.

[Jochi1543]

Biggest surprises in terms of how the medical field does NOT use technology:

 

1) the lack of funding and support for anything that allows to interact with a patient via the internet. I can get paid for calling a patient at home and leaving a voicemail, but not for e-mailing them. Same with specialists.

 

2) Difficulty accessing hospital information from home. I can easily access my clinic EMR from home or from my iPad anywhere, but if I want to see my own practice's patient's labs or reports from the hospital, it becomes an ordeal.

[rogerroger]

The fact that we do so much record keeping and order requests by hand on paper in the hospitals is a joke. I have not written my own study notes on paper in three years... Written notes can be easily digitized via tablet these days.

 

The fact that Ontario does not have all medical records shared between institutions (like Alberta) is pretty pathetic too.

 

Oh and we use pagers in the age of text messaging. A secure text based mobile messaging system should be the gold standard. This is like riding to work on a horse when the rest of the world drives a car... The 20th century is beeping us and it wants its pagers back...

[BK47]

The fact that we do so much record keeping and order requests by hand on paper in the hospitals is a joke. I have not written my own study notes on paper in three years... Written notes can be easily digitized via tablet these days.

 

The fact that Ontario does not have all medical records shared between institutions (like Alberta) is pretty pathetic too.

 

Oh and we use pagers in the age of text messaging. A secure text based mobile messaging system should be the gold standard. This is like riding to work on a horse when the rest of the world drives a car... The 20th century is beeping us and it wants its pagers back...

 

You know, I wonder about this. I kind of like the system of having a pager because if someone is going to consult you or ask you a question, they have to go to some effort and actually speak to you on the phone about it... that sets the bar a little bit higher than simply just sending off a text message.

 

And on the other hand, if you're the one getting the consult/question, you speak to them in real-time (once you've answered the page) rather than potentially playing text-message tag for a prolonged period. If you have questions or need to clarify something about their question you can ask them right then and there.

 

There's still something to be said for speaking to someone directly rather than typing out a message and sending it off.

 

I am a proponent of 'if it aint broke don't fix it' and in an age where everything else in healthcare is constantly getting more expensive, maybe we don't need to ditch the pagers just yet.

 

I agree completely though that it's ridiculous that institutions in Ontario don't share records like Alberta. I've worked in some places where even hospitals in the city won't have access to records from other hospitals. It's ridiculous and creates a lot more work.

[thebouque]

Glass slides in pathology. Hopefully they'll never be replaced.

[rmorelan]

I am constantly surprised with how primitive the tech is in places and how much poor software is approved and used.

[burrb]

Doing a video interview for a forensics psych consult on a prisoner.

 

Saves the effort of having to go to the prison

[GrouchoMarx]

Glass slides in pathology. Hopefully they'll never be replaced.

 

On the contrary, WSI can't come soon enough!

[fugacity]

As an M1, the EMR itself (and how integrated it is) amazes me. Prior to starting medical school, all my physicians (had an opthal consult one time) used pages of paper in folders for record keeping. The fact that my preceptor speaks into a microphone to record notes, and all the CXRs, lab results, and consult letters are a click away blew my mind.

[mavrik13]

As I go through clerkship, I'm always surprised not by the technology itself, but how much its implementation varies from person to person, floor to floor, or clinic to clinic. Some systems are set up beautifully. Others I've worked with continue to use paper charting (with the attitude - if it ain't broke...)

 

Personally, I find a lot of the technology frustrating because there is often little training in how to use it -for example, the QEII now uses electronic discharge summaries. Great in principle, but when (not if) you run into a snag, there is little IT backup. Often I wish I could just spend 15 minutes dictating the discharge summary.

[samy]

There is an interesting perspective in the current NEJM about the use and teaching of US in medical school. I really think in a few years stethoscopes will be obsolete and we will use mainly pocket-sized US machine to see the cardiac valves and chambers instead of listening...

 

http://www.nejm.org/doi/full/10.1056/NEJMp1311944

 

I personally followed a 2 days basic US course designed for family physicians and I really liked it. Basically, the course was covering a basic approach to abdominal, thoracic, cardiac, pelvic and limb US.

 

McGill has introduced US in its curriculum this year with the new medical students. I think it is a great tool to master and its place among our profession will anchor and will grow rapidly.

[Lactic Folly]

It will be interesting to see how handheld ultrasound develops. That being said, the NEJM article also correctly points out that ultrasound is extremely operator dependent (IMO one of the toughest imaging modalities to achieve proficiency in - taking years of hands-on experience and followup on cases to achieve anything approaching mastery, certainly not something that can be done in a short course), and the adverse consequences of inexperience in using ultrasound to diagnose:

 

"False positive findings may lead to additional and often unnecessary testing, and false negatives may provide unwarranted reassurance and result in underdiagnosis, especially since greater faith in “high tech” information may lead to the exclusion of other data."

[Jochi1543]

I find US helpful on occasion in the ER, even without any specific training. One time the medical student felt there was a pericardial effusion based on auscultation, whereas I didn't, so it was helpful to grab the ER US machine and just confirm at the bedside. I obviously don't have the skills to assess anything that's not extremely obvious like major valve prolapse/wall motion abnormality/huge effusion or tamponade, and the patient was still going to get an echo later on at another facility, but I had seen enough cardiac ultrasounds to be able to tell that the patient did not have a large effusion. U/S is also helpful for query pregnancy loss or early rupture of membranes. Bedside U/S by an untrained person does not replace proper US by an experienced technician, but it at least helps you figure out how worried you should really be.

[rogerroger]

It will be interesting to see how handheld ultrasound develops. That being said, the NEJM article also correctly points out that ultrasound is extremely operator dependent (IMO one of the toughest imaging modalities to achieve proficiency in - taking years of hands-on experience and followup on cases to achieve anything approaching mastery, certainly not something that can be done in a short course), and the adverse consequences of inexperience in using ultrasound to diagnose:

 

"False positive findings may lead to additional and often unnecessary testing, and false negatives may provide unwarranted reassurance and result in underdiagnosis, especially since greater faith in “high tech” information may lead to the exclusion of other data."

 

Bedside US is the future, but it is very operator dependent. Therefore it takes much more training to become proficient in it its use clinically. There are whole fellowships designed on this premise. I think its use will become standard, but not across all specialties. However, within Emergency Medicine the use of US is already highly Incorporated into the curriculum from day one. It is rare for a shift to pass without reaching for the bedside US at least once...

[deeman101]

^ you can consider stethoscopes to be operator dependent too. But its still useful. U/S in ER is amazing. I've seen the new pocket sized (literally pocket sized, fits in a white coat pocket) U/S in action...today. I don't think it can do doppler but to walk around and assess all your patients with it is amazing. Its uses:

 

chest pain - r/o CHF, pericardial effusion, gross infarct, right heart strain, pneumonia, pleural effusion, some malignancies, DVT

 

abdo pain - r/o abcess, appendicitis, ectopic, pneumoperitoneum, AAA, volvulus, pancreatitis, cholecystitis, colitis, ruptured viscus (if fat-stranding), peritoneal bleed

 

flank pain - r/o pyelo, urolith, RP bleed

 

limb pain - r/o gross fracture, DVT, nec fasc

 

...it just keeps going. Difficult IV access, guided abcess drainage, in ER nerve blocks (instead of doping the crap out of patients to reduce fractures), difficult LP's, definitive central line placements, this is just endless. There are even uses for ocular U/S. Only thing where it isn't capable of assessing (yet) is intracranially for bleeds. To know these things as soon as you pull out your U/S probe, as opposed to waiting for imaging/labs/cultures/etc., will save lives. And it will increase ER patient flow, decrease wait times, decrease overall cost to the system because of its efficiency, and improve quality of timely care. Yes the machines cost $5000 to $200,000, but thats muuuuuch cheaper than any EMR implementation, any other imaging modality, increasing personnel/beds, etc. Throw 5 U/S machines in an ER with well trained physicians to take advantage of it and you've got a win.

 

McGill does leverage the crap out of U/S, probably because its so damn cash strapped all the time. Either way glad to see them do it, even at the medical student level. 4th years have an optional 2 week U/S course which is quite useful. Even without it I got 1 day of teaching with U/S and that itself felt monumental. I'm sure the new cirriculum is even better with more U/S teaching.

 

 

EDIT: I went and googled the device I saw in my shift today. Its a GE VScan. $7900 with image quality of a full desktop machine, and I was wrong it does do dopplers too.

[deeman101]

Oh and we use pagers in the age of text messaging. A secure text based mobile messaging system should be the gold standard. This is like riding to work on a horse when the rest of the world drives a car... The 20th century is beeping us and it wants its pagers back...

 

I always wondered why they bother with pagers and spectralinks. The argument is you don't always have cell phone reception. But most hospitals have WiFi everywhere, and every non-asinine doctor has a smart phone. Make an app that only works on the hospital intranet for secure paging and SMSing. As well as conferencing (ex: cardio consult group, gen surg group), etc. And you can build in VoIP for secure calls to different staff/residents/med students/nurses/anybody of importance. Throw in secure MMS for sending to consulting services images or videos of transient EKG events or whatever and you're set. You can even disable copy/paste commands and screenshot like uworld style.

[GrouchoMarx]

I always wondered why they bother with pagers and spectralinks. The argument is you don't always have cell phone reception. But most hospitals have WiFi everywhere, and every non-asinine doctor has a smart phone. Make an app that only works on the hospital intranet for secure paging and SMSing. As well as conferencing (ex: cardio consult group, gen surg group), etc. And you can build in VoIP for secure calls to different staff/residents/med students/nurses/anybody of importance. Throw in secure MMS for sending to consulting services images or videos of transient EKG events or whatever and you're set. You can even disable copy/paste commands and screenshot like uworld style.

 

When we are staff physicians we should try to implement this kind of technology. Pagers are certainly outmoded.

[rogerroger]

I always wondered why they bother with pagers and spectralinks. The argument is you don't always have cell phone reception. But most hospitals have WiFi everywhere, and every non-asinine doctor has a smart phone. Make an app that only works on the hospital intranet for secure paging and SMSing. As well as conferencing (ex: cardio consult group, gen surg group), etc. And you can build in VoIP for secure calls to different staff/residents/med students/nurses/anybody of importance. Throw in secure MMS for sending to consulting services images or videos of transient EKG events or whatever and you're set. You can even disable copy/paste commands and screenshot like uworld style.

 

Amen. What you describe is being piloted at some sites. This should be standard. It probably will during our careers but will be 10-20 years delayed from when it should have been implimented.

[mikejones22]

I've been surprised with the state of technology and medical information. Yes UpToDate is awesome but it's not great in all use cases. I also find the flood of evidence hard to stay on top of - it feels like a firehouse and it feels like it takes a lot more work than it should.

[thebouque]

On the contrary, WSI can't come soon enough!

 

I dont think whole slide imaging is going to be standard in the near future. Surveys have been conducted among residents across Canada and we tend to prefer microscopes, it's just easier to navigate on the slide. Also, keep in mind that computerizing radiology actually saved some steps because you don't need a film anymore. In path, scanning slides adds a step, because you still have to produce the glass slide and then scan it, which is not time and cost effective. Also, in radz, the difference is a lot more noticeable because they can scroll through a CT scan instead of having all the images one next to the other. In path, wsi is 100% similar to what you see on a microscope but it's on a screen. Finally the images in path are huge because of the level of details needed. You need a 3 dimensional pictures, you need to zoom at 600x and more (or 60-70x if you're not counting the power of the binocular), and it can go up to several GB per slide. Considering that a single breast cancer case can go up to 100 slides, you can do the math.

 

Bottom line, I really think that wsi will be used for telepathology and teaching/conference purposes, but not for routine cases, otherwise it would already be used everywhere. WSI has been around for a while now.

[GrouchoMarx]

I dont think whole slide imaging is going to be standard in the near future. Surveys have been conducted among residents across Canada and we tend to prefer microscopes, it's just easier to navigate on the slide. Also, keep in mind that computerizing radiology actually saved some steps because you don't need a film anymore. In path, scanning slides adds a step, because you still have to produce the glass slide and then scan it, which is not time and cost effective. Also, in radz, the difference is a lot more noticeable because they can scroll through a CT scan instead of having all the images one next to the other. In path, wsi is 100% similar to what you see on a microscope but it's on a screen. Finally the images in path are huge because of the level of details needed. You need a 3 dimensional pictures, you need to zoom at 600x and more (or 60-70x if you're not counting the power of the binocular), and it can go up to several GB per slide. Considering that a single breast cancer case can go up to 100 slides, you can do the math.

 

Bottom line, I really think that wsi will be used for telepathology and teaching/conference purposes, but not for routine cases, otherwise it would already be used everywhere. WSI has been around for a while now.

 

I am hopeful that within the next decade WSI will be standard of practice.

 

At present it is not cost effective but will be later.

 

It has already been validated to be as good as, if not better than, traditional microscopy.

 

File sizes are high, but the infrastructure will eventually catch up to them. Not 15 years ago, sending an mp3 over Napster was a chore. Z-stacking technology is becoming more advanced now and will allow for fine focusing.

 

It adds a step but there are ways to integrate that step so that it replaces another downstream one. Storage, for instance, or slide retrieval and delivery. Overall it would probably be at par with the current steps in slide production.

 

WSI offers the possibilities for computer algorithmic ancillary studies, much like IHC is used now. There are a few studies published regarding patterns that the human eye cannot see but the CAD can pick up, and this can help stratify the diagnosis.

 

The advantages for consultative and remote work are obvious. Not to mention looking at a screen is 100x easier than looking down a scope all day. It might get more people into our field!

 

The major hurdle is that the vendors all have proprietary software and hardware that are incompatible with each other, so no organization wants to be the first to pay millions for a system only for it to be the one that is not widely adopted. Until they work together, WSI is not going to grow.

[TheBoss]

The fact that we do so much record keeping and order requests by hand on paper in the hospitals is a joke. I have not written my own study notes on paper in three years... Written notes can be easily digitized via tablet these days.

 

The fact that Ontario does not have all medical records shared between institutions (like Alberta) is pretty pathetic too.

 

Oh and we use pagers in the age of text messaging. A secure text based mobile messaging system should be the gold standard. This is like riding to work on a horse when the rest of the world drives a car... The 20th century is beeping us and it wants its pagers back...

Agree about the pagers, like seriously...

[holiday1001]

My biggest surprise was electronic ordering- both the fact that it's been implement, and secondly how cumbersome it is