Another MacGyver Moment in Pacemaker Implantation

Installing a permanent pacemaker or defibrillator has become commonplace event in cardiology these days.  These devices implanted in a patient are comprised of two main parts: the lead(s) and the pulse generator.  After installing the leads in the heart and connecting them to the pulse generator, the lead and pulse generator assembly are then placed beneath the skin in a small subcutaneous (or in rarer cases, submuscular) "pocket" that is created surgically.  Considerable care is taken to cauterize bleeding vessels when the pocket is created.  To facilitate visualization of these occasional bleeding vessels deep within the created pocket, I prefer to use a surgical headlamp to direct the light deep within the pocket cavity rather than relying on a conventional overhead surgical light.  I have found that headlamps have helped me limit my incidence of post-operative pocket hematoma development.

So as things have had it, I seem to have a knack for attracting every eighty- or ninety-plus year old who needs an emergency pacemaker on the weekend when I'm on call, and this past weekend was no exception.

So the team was assembled and the pacemaker implantation equipment readied.  They knew I liked a headlamp, so they dug deep into the recesses of their inventory to pull out their only headlamp that appeared to be from a bygone surgical era.  Being pressed for time, I couldn't argue and had to make due, but knew that this headlamp might not be very reliable, especially as I saw how the headlamp's fiberoptic cord was secured to the light source that generated about as much light as a few well-lit candles by a cumbersome spring-loaded Rube Goldberg contraption.  As I placed the headlamp on my head, and tightened the plastic strap that housed the headlamp to my head, I needed a backup plan in case the light failed.

Would I have to use the overhead light and make do, or might there be another way? 

I needed another MacGyver Moment.

That's when my on-call staff team came up with a brilliant, simplified idea:

iPhone to the rescue!

-Wes

(PS:  This device is experimental and has not been approved by the FDA.  Use this device at your own risk.    If you experience headaches, nausea, difficulty with concentration, or an erection lasting for longer than four hours, discontinue use of this device and contact your doctor immediately.  I have no commercial interest in this device.  Also, since the headlamp still worked this weekend, no workaround was needed for the patient, but something tells me we might be getting a new headlamp soon.)

When We Empower Patients to Pay for Expertise

"I know what you're thinking, punk. You're thinking "did he fire six shots or only five?" Now to tell you the truth I forgot myself in all this excitement. But being this is a .44 Magnum, the most powerful handgun in the world and will blow you head clean off, you've gotta ask yourself a question: "Do I feel lucky?" Well, do ya, punk?

Harry Callihan (played by Clint Eastwood) in "Dirty Harry"

Today, Alivecor accounced the launch of their AliveInsights(TM) EKG interpretation service where patients decide with their own dollars and sense, who interprets the single-lead EKG generated by Alivecor's EKG iPhone case. If the patient feels fine with a technician and wants a response in 30 minutes, they can get their answer if they elect to pay $2. If that same patient wants a "Board Certified" US cardiologist to interpret their tracing and are are willing to wait up to 24 hours, they can elect to cough up $12 instead.

Gee, which would you take?

My bet is that Alivecor's guessing people will accept the cheaper alternative. But will prescribing doctors?

It is an interesting model. I learned from Dr. Dave Alpert, the inventor of the Alivecor iPhone case, that "board certified" cardiologists get to keep $10 of the interpretation fee for providing the service - no insurance forms to fill out, no worry about a technical fee for the patient - just a plain ol' cash payment model.

Perhaps what is most interesting to me is how incredibly disruptive this model is to our current medical model.

But there are other concerns for doctors who might elect to "prescribe" an Alivecor case to their patients.

If the patient elects to pay $2 and a "technician" mis-reads the EKG, is the prescribing physician legally responsible for adverse outcomes that might occur? Who is responsible if a cardiologist mis-reads the transmitted EKG - the prescribing physician or the interpreting physician (presuming they are not always the same individual)?

These are interesting questions to ponder as this service launches. Certainly other issues are likely to arise where the lines of patient responsibility become blurred. Still, I like the fact that Alivecor is moving head-on into this space. It sets an exciting opportuntity for patients to have more control over their health concerns, and if this helps them, then all the better.

So as Harry Callihan said, "Feel lucky, punk?"

-Wes

Shadow Puppet: An App That Lets iPhone Pictures Tell a Story

They say a picture is worth that thousand words, but nowhere is this more true than with a new, free, iPhone app called Shadow Puppet that lets you turn selected photographs on your iPhone into a narrated video storyline.

I saw this app reviewed over at Techcrunch and immediately saw its potential as a teaching aid.  The app allows you to pick a series of iPhone photos from your camera roll, order them, and then record a narrative about your pictures.  What is unique is that you can zoom or move between photos as you tell your story, annotating them by touching areas on the photo that you are discussing as it records the video.  (Very cool).

Here's my very first video I made with the app describing the new Zio XT patch monitor that records 14-days of a patient's heart rhythm that we've been using in our clinic.  Simply made, these video clips are easily shared via email, Facebook or Twitter.  For this particular video, I still had to edit portions of the patient's report on Photoshop, then sent the images to my iPhone but, still, that was easily done.

Want to teach a fellow how to implant a pacemaker?  Take some photos and show them!  Have an EKG that has a finding that you're not sure about?  Snap a picture (without patient identifying information, of course) , annotate it with your question and send it to your EP!  Simple, elegant, and who knows, maybe even life-saving.

-Wes

How to Change The Battery in Your iPhone's Alivecor Heart Monitor Case

After recording about 120 electrocardiogram (ECG) tracings from your Alivecor iPhone case, the device will suddenly stop recording EKGs when the battery in the case cover runs low.  Fortunately, replacing the battery is a very simple process.

First, assemble all of the items needed: (1) a new 3-volt model 2016 battery (I got mine from Walgreens), (2) a tiny Phillips screw driver (used to repair eye-glasses and often found in hardware stores), and (3) your Alivecor iPhone case as seen below (Excuse the DEMO sticker - I was a beta-tester for the iPhone 4S case):

Click to enlarge

Next, unscrew the plate on the inner side of the iPhone case as shown:

This will reveal the old battery below the case cover.  Set the cover aside using care not to lose the tiny screw that attached the cover to the case:

In the upper left corner of the battery holder is a small recess where the battery can be carefully pryed from the holder as shown:

Carefully remove the battery to reveal the contacts below it:

Take the new replacement battery and remove the adhesive backing on the battery before installing it back in the holder:

Be sure to place the replacement battery in the holder with the writing side up, using care to first place it beneath the metallic retaining clips in the lower right side of the battery holder:

Once seated back in the case, screw back on the cover:

Then just place the cover on your iPhone and you'll be good for another 100-130 ECG tracings or so!

-Wes

Psychology's New Adjustment Disorder

You can see it in their eyes as they dart left and right, up and down.  Their hands make rapid, self-flagellating movements over their chest, hips, buttocks.  Their pulse quickens.  Cold beads of sweat rise across their upper lip and forehead.  Their breathing is shallow at first, then builds, gradually, to a large sigh.  Inaudible words are whispered and the individual appears agitated, often pacing in circles as they speak.

They stop.  They frantically look about, rechecking pockets, coats, desktops, and even peer under the keyboard.  Their thoughts circle, pupils constrict, palms moisten, and mouth goes dry.  

Then, as fast it came, nothing.  They try to stay calm but the damage is done. A blank stare descends as they look toward somewhere in space, as if every hope, every friend, every loved one, is lost.

"Doctor, are you okay?"

"Oh,  I'm sorry.  Acute Rectangle Deficiency...."

 "... I think I left my cellphone at home."

-Wes

Need an Expert? There's an App for That!

"Sally, we need an EP consult on Mr. Smith here. He has some trouble walking now due to pain from his multiple myeloma, but he also has a history of a heart attack, left bundle branch block, some non-sustained VT on his telemetry monitor, and is still a pretty young guy..."


"No problem!" said Sally, reaching for her iPhone. "I think there's a app for that!"

She scoured the apps on her iPhone 5. She clicked on her Heart Rhythm Society Sudden Cardiac Death Primary Prevention Protocol app walked through the algorithms there.

"Hmmm. Looks like I need to order an echo," she thought. * Click click * “Echo ordered! Damn I’m good,” thought Sally.

She continued with her Heart Rhythm Society app. "Says something here NYHA Class? I wonder how I figure that out....Wait! I have a MedCalc app for that, too!" A few taps later, "Looks like NYHA Class II!"

"Let's see, back to the Heart Rhythm Society app..."

A few more clicks and...

"Yipee! Looks like he qualifies for one! But wait, will the government pay for it? Let's check the CMS ICD app!"

A few more clicks and then...

"If we wait ninety days... he might get it paid for... but will I be investigated by the DOJ because I ordered it inappropriately? Hmmm. Oh, wait! There's an app for that, too! I can just use the American College of Cardiology Foundation's Appropriateness Use Criteria (AUC) app© ..." she thought to herself, “After all, it covers 369 clinical scenarios… Wait, looks like there’s an update to the app. This is only Version 1.1… I think I'm going to need Version 1.2…”

She left the "AUC app©" and went to the App Store icon on here phone. She waited a few seconds while the screen refreshed and then:

“There it is: the latest update!. Seems those guys update these scenarios every week. Wouldn’t want to be out of date on this.” She clicked the “Update” button. “I sure like how those clever app developers have all he right data I need right here at my fingertips,” she thought.

After it updated, she went back to the American College of Cardiology Foundation’s "AUC app©" on her iPhone and began entering the patient's scenario...

"Wow," she thought. "This is making it so easy for me! There's nothing to this! Hmm, can't seem to find anything in here about multiple myeloma ... Oh, heck, I'll just click on the 'no' button ... There we go, I got a green box! Looks like we'll still be okay to implant his ICD and stay out of jail." She turned to the resident, beaming.

"Well, did you get that EP consult I asked you to get on Mr. Smith?" the resident asked.

"I didn't need to, it looks like he's good to go!" Sally announced.

"Great!" said the resident, impressed with Sally's performance. "So when does the device go in?"

"I'm not sure.  As soon as the next iOS version becomes available I'll check the new software updates." said Sally.

"Awesome.  You think his low grade fever will be a problem?"

"Let me check," said Sally, reaching for her iPhone again...

-Wes

An Inside Look at AliveCor's iPhone ECG Case

The back of my demo
AliveCor ECG iPhone 4s Case

By now, the today's news is relatively old: AliveCor's innovative ECG Case for the iPhone created by Dr. Dave Alpert, MD received FDA approval.  But for something this innovative, it's never too late to give your take.  Like my good friend and fellow physician-blogger John Mandrola, MD, I was fortunate to have served as a beta tester of the device.  John gives his take here and mentions some great anecdotes of how he has used the device clinically.

AliveCor ECG
Setup Screen (beta)

While I haven't been using the device as long as John, I was impressed at the device's ease of use, intuitive software design, and handsome appearance.  While the case itself is not as sturdy as some more robust protective cases, it appeared to protect my phone sufficiently after it slipped from my pocket on more than one occasion as I changed into scrubs.  Set-up was a snap and required only the case to be shipped to my house and an app downloaded from Apple's App store.  After entering a few simple pre-requisite bits of information (like the web-based server name the device connected to for demo ECG-uploading purposes), the device was ready to go.

Inside of My Demo
AliveCor iPhone Case
Note: no wires.

The device uses a simple 3.0V CR2016 battery to operate.  It does NOT require the Bluetooth option on the iPhone to be enabled to function properly and therefore does not interfere with handsfree operation of the phone while driving a Bluetooth-enabled car.  The software did not appear to interfere with any other applications on my phone.



My unretouched ECG recorded with my hands
today (yep 1st degree AV block!)

 Signal quality was pretty good but is subjected to small amounts of baseline noise and drift if the device is not held still and person's hands were not warm and moist.  Adding a bit of alcohol to the finger tips greatly improved the clarity of the signal when needed.  The device can be used in several ways: with hands grasping the electrodes on the back of the device or by placing the device directly on the skin of the chest.  I found the device worked reliably when the hands were used to record the EKG but placement of the device on the chest occassionally failed to record the ECG signal because of less-reliable contact if the skin was not prepped first.  Skin skin prep with alcohol seemed to solve this short-coming.

Lead I of the standard EKG was recorded with the left and right hand holding the device with the left and right hand fingertips touching the electrodes on the back of the case.  It was important to hold the device with the iPhone's round button to the right to assure the device did not record an inverted lead I.

Options for sending tracings (beta)

While the images recorded by the device are not easily incorporated into an EMR (at least for now), the device can upload the tracings to AliveCor's server for web-browsing, create Adobe pdf images for viewing, or send those pdf images to any email address worldwide in seconds.  It also can detect local wireless Apple printers automatically to print the tracings (though I did not test this feature).  Finally, tracings were stored with date and time stamps for easy recall on an internal database that held plenty of tracings easily on my iPhone 4S.  I found its greatest weakness was requiring that patient name and demographic information be entered manually.  Trust me: dialing back to a 1929 birthdate using the canned iPhone date function was too time-consuming.  Hopefully direct data entry of dates will be allowed in future software upgrades.

Physician Reactions

Without exception, every physician I showed this device recognized this device as a compliment to the doctor's stethoscope.  It was a uniform hit as they gazed in amazement at the device's ability to record their real-time ECG.  I found this device was capable of instantly differentiating the irregular rhythm of atrial fibrillation from the irregular rhythm caused by premature atrial or premature ventricular beats or even atrial flutter with variable AV conduction.  Some care was required to get noise-free tracings or to obtain the appropriate EKG vector on the chest with which to identify lower-amplitude atrial arrhythmias.  But most limb leads can be replicated by the device (hold the R electrode with the hand and apply the left electrode to the knee to see lead II, for instance), or angle the leads in different directions on the patient's chest to obtain a new QRS vector.  (Obviously, the angle the electrodes were placed on the chest to acquire a particular limb lead requires some rudimentary knowledge of ECG basics.)

Patient Reactions

Perhaps the most interesting aspect of this device is what happened when it is placed in the hands of patients and friends unfamiliar with ECG tracings.  Their first reaction as they sit transfixed at their own ECG tracing dancing across the screen is "Cool! .... But what does it MEAN?"  Then comes "Am I okay?"  And then of course when tracings are compared between friends: "Why is my heart rate so much faster/slower than his/hers?" Or you might hear:  "Man,  I'm out of shape!"  And if the device occasionally had difficulty calculating the heart rate from a noisy tracing, three little dashes would appear instead, leading the person to ask, "Does this mean I'm dead?"  Any one of these reactions could came from generally healthy people who have never had a major medical problem.

What was more interesting to me was the nuanced reaction I noticed from patients who had had a complex medical history before but were seeing this device outside a medical facility for the first time.  When they encountered this device in a social setting, it was common that these patients refused to have their tracing performed "for fun" for fear they might be sent packing to the nearest medical establishment.  IT became immediately clear that discretion should be exercised if the device is to be passed about at cocktail parties.  (Yes, doctor, not everyone wants to see your cool gizmo.)  Hence, it appears that deploying this device on the general public has some challenges ahead, but I suspect it will come: gradually at first, then more generally.  It is clear that this really does take an understanding of ECGs to use effectively, so doctors (or techs) familiar with ECGs will have to be involved.  Liability and responsibility for reading remains a thorny issue one the device is released to the public.  I suspect these are relatively easy issues to resolve for AliveCor going forward.

Still, for doctors and medically-savvy patients, this device is a game-changer.  The number of ECG tracings obtained in clinics will probably diminish one day as this device enjoys a wider distribution amongst physicians since it doesn't require a special technician or equipment to obtain much of the information doctors need to manage their arrhythmia patients.  But caution with this single lead ECG device should be maintained, too.  Because multiple ECG leads are not collected simultaneously, the device could miss the subtle findings of a heart attack in locations remote from the there the single tracing is collected by the device.  Still, for routine rhythm analysis, this device has huge potential for time-savings, practical rhythm interpretation, and maybe even the potential to provide for considerable technical health care cost savings.

-Wes

PS: I have no commercial interest in AliveCor (darn it).

The AliveCor iPhone ECG Case website

How the iPhone Might Disrupt The Medical Device Industry

Doctors wanting to determine a patient's atrial fibrillation burden have a myriad of technologies at their disposal: 24-hour Holter monitors, 30-day event monitors that are triggered by an abnormal heart rhythm or by the patient themselves, a 7-14 day patch monitor that records every heart beat and is later processed offlineto quanitate the arrhythmia, or perhaps an surgically-implanted event recorder that automatically stores extremes of heart rate or the surface ECG when symptoms are felt by the patient. The cost of these devices ranges from the hundreds to thousands of dollars to use.

Today in my clinic, a patient brought me her atrial fibrillation burden history on her iPhone and it cost her less than a $10 co-pay.  For $1.99 US, she downloaded the iPhone app Cardiograph to her iPhone.

Every time she feels a symptom, she places her index finder over the camera on the phone, waits a bit, and records a make-believe rhythm strip representing each heart rhythm. With it, comes the date and time. When the rhythm is in sinus, she learned that her heart rhythm was typically in the 60's at rest:

When the rhythm was in afib, it was considerably higher and sometimes displayed an irregular rhythm:

or sometimes it displayed an error message:

I got a relative picture of how often she was having afib and she got the opportunity to help me with her care.

Was this a medical device?  No, it was an iPhone app.

Was it perfect?  No it wasn't.  I certainly couldn't differentiate frequent PAC's or PVC's from atrial fibrillation reliably.  It was NOT an EKG after all.   But we were past that point in her evaluation.  I just needed to know how often she was having her known paroxysmal atrial fibrillation and she wanted to keep a convenient record of her episodes.

Was it helpful in this case?  Absolutely.

More importantly, she just saved herself and the health care system a ton of money.

Welcome, my friends, to the era of patient-empowered, individualized medicine and a whole new era of patient care.  Now, if we can just keep the FDA from screwing things up.

-Wes

PS: I have no commercial interest in the Cardiograph app and do not endorse it as a standard of care, but merely use this case to demonstrate how innovation can facilitate cheaper, equally-effective health care in some cases.  I'd also like to thank my patient for allowing me to use her screen shots.

When Siri is Asked for Medical Advice

The implications of artificial intelligence to health care delivery and marketplace referrals have just changed with the introduction of Apple's new iPhone 4S and it's new voice recognition software, Siri. Here's what I got when I asked my phone if I need a pacemaker:

... and here's where "she" sent me to get the answer:

Nice. Except that's not OUR pacemaker clinic.

Uh, oh. Better call our marketing department and have them change our clinic's web-searchable name.

-Wes

How My iPhone Prevented an ER Visit (with screenshots)

It's one of those calls you never want to get as an electrophysiologist:

"Doc, I got four shocks from my device yesterday."

"What were you doing at the time?"

"Working outside."

"Wasn't it about a 100 degrees and humid then?"

"Yes."

"Were you lightheaded before the event?"

"Not too bad... I stopped what I was doing and got better. Should I come in to the ER?"

"This happened yesterday?"

"Yes."

"Why didn't you come in then?"

"Well I started to feel better..."

"Do you know how to upload the information from your device at home?"

"You mean using that thing next to my bed?"

"Yes."

"I think so."

"Okay, why don't you go do this and we'll call you right back after we have a chance to view the information you send us."

"Okay. Thanks, doctor."

So I waited about 15-20 minutes, then checked the Medtronic Carelink app on my iPhone. This application lets doctors and device management personnel view all of the information uploaded from pacemakers and defibrillators that we normally review in our device clinics on our iPhones instead. I hadn't had much need for this, or so I thought, until now. I thought it would be cool for patients to see what their authorized doctors can view on their iPhones when things like this occur, so I took some screenshots.

Booting the app:

Click on any image to enlarge

The login screen:

The initial alert that appeared after logging in:

The gory details of that event displayed after touching the above alert (Holy cow! He had a lot more than four shocks!):

The data were then loaded from the event in a 42-page unprintable pdf file (HIPAA prevents printing, I guess). Page one contained the various atrial and ventricular electrograms (signals from the wires in his heart) at the time the data were transmitted:

A few of the basic programmed parameters and remaining battery life (Whew, plenty left!):

The device's seven "observations" classifying the types and numbers of therapies:

More specifics regarding the time and number of shocks at each event:

The atrial and ventricular inter-electrogram interval plot for the most recent event with repetitive shocking:

Zooming in on the plot of atrial (squares) and ventricular (circles) intervals at the intitiation of the event (Who started things?):

The atrial and ventricular electrograms obtained during one of the events (Is that Wenckebach block?):

The effect of antitachycardia pacing during the event: the ventricle is paced but had no effect on the atrium driving the ongoing event:

The other events disclosed similar findings. It appeared each of these shock therapies were delivered as a result of a very fast atrial tachycardia that was able to conduct to the ventricle, rather than a ventricular rhythm problem.

Of course, there is a slight problem that presents itself to doctors and their business administrators when we use this very cool technology: it's all done for free. Still, the ability to review this important clinical information untied to a hard-wired computer terminal offers important advantages to our increasingly mobile physician workforce and, in this case, prevented an unnecessary emergency room visit.

-Wes

Epilogue: The patient was contacted by phone after reviewing this information. He as told he did not have to go to the Emergency Room. Instead, significant adjustments were made to his medication regimen over the phone. He was seen the next morning in our device clinic to reset the alarm that was triggered when his device exhausted all its therapies in one event. No further arrhythmias had transpired and discussions regarding alternate medical or ablative therapies are pending.

P.S.: Sorry patients, the while the app can be downloaded from the Apple iTunes App store for free, its use is restricted to authorized care providers only. Maybe when implantable devices carry memory bins for uploaded digital music...

A Fully-Functional Electronic Medical Record Comes to Apple's iPhone, iPad and iTouch

Today, Epic Systems Corporation launched their free MyChart application (app) for the iPhone, iPad and iTouch which at our medical center. The app provides the following functionalities:

• Test Results: View test result values and standard ranges for each result.
• Messaging: View and reply to messages in the Inbox, and create new medical advice request messages.
• Appointments: View and confirm or cancel upcoming appointments, and view some After Visit Summary information for past appointments.
• Health Advisories: View preventive care procedures and their due dates.
• Health Summary: View medications, allergies, immunizations, and current health issues.
• Proxy Access: View all features listed above for family members.

This functionality permits patients access to portions of the actual electronic medical record used by their doctors in a mobile format. A license agreement must be entered into by the patient that permits the use of their iPhone's UDID (unique serial number ID) to be collected, transmitted, and stored on their medical center's designated server for troubleshooting and "audits." As such, user data will be shared with others within the scope of the licensure agreement, including third parties. (Interestingly, "Apple will have the right to enforce the terms of the Licnse against you as a third party beneficiary thereof.") Still, I suspect most will consider this a very small price to pay for timely access to one's health information.

The following providers offer this functionality so far: Baylor Clinic (TX), Buffalo Medical Group, PC, (NY), Dean Clinic (IL/WI), Dreyer Medical Clinic (IL), GHCMyChart (WI), Hawaii Pacific Health (HI), Loyola Medicine (IL,WI, IN), Mercy Health System (IL, WI), Aspirus (MI, WI), The Institute of Family Health (NY), NorthShore University HealthSystem (IL), Oregon Health and Science University (OR, WA), SSM Medical Groups (MI, IL), Sutter Health (CA), Weill Cornell (NY), Wildwood Family Clinic, (IL, WI).

Yep. The wave of the future.

New iPhone Skin Doubles as Single-Lead EKG

Developed by Oklahoma physician and entrepreneur Dr. David Albert, a true single-lead ECG for the iPhone 4 has been created using a unique skin for the device (shown). The iPhone can store a pdf of the signal and also transmit a realtime wireless signal about a foot using the iPhone's battery.

Until now, most other free applications have used the camera feature of the device to display a person's heart rate, rather than their actual electrocardiogram. Here's Dr. Albert's demo video:



Nice.

-Wes

A Free iPhone 4 Heart Rate Monitor

Hey, it's fun AND free!

Use your iPhone 4's camera to measure your heart rate. The application detects how the color of your finger changes when blood flows into it, much like the way a pulse oximeter works.

-Wes

Addendum 29 Nov 2010 06:50 am CST: Seems there's an app for Android phones too.

Who Needs Calipers?

... when you have an iPhone:



-Wes

Bad Looks, Good Concept: A Bluetooth Heart Rate Monitor for the iPhone

Someone has to talk to this company about ergonomic engineering:

What looks like a bulky female hygiene product is actually a health monitor that hooks up to an iPhone via Bluetooth, sending bodily information such as heart rates to the compatible app.

It's not on sale yet, with Proteus' Raisin sensor only just being passed through the FDA, but it's another step for the iPhone into the operating room, after Apple showed off the Lifescan app by Johnson & Johnson at last year's WWDC, which works alongside a wireless glucose meter. Diabetes can analyze the glucose levels in their blood, with the information being sent to the iPhone app over Bluetooth.

To their engineers: Any color but white or light blue, okay?

-Wes

Will iPhone Apps Have to be FDA-Approved as Medical Devices?

... if you're a radiologist, it seems some do:

“We did a stroke trial ... and compared performance of radiologists reading on the iPhone to the standard clinical reading work station and the performance was identical,” said Mitchell. “They performed just as well in this tough diagnostic task.

“That’s a really good indicator that this could be quite useful for diagnosing all sorts of things that aren’t as tough,” he added.

Mitchell said it’s currently being tested on the new iPad, which has a larger screen to view the images.

The application for iPhone and other mobile devices has been licensed as a medical device in Canada, said Philippe Laroche, a spokesman for Health Canada.

It’s still awaiting approval from the US Food and Drug Administration and CE Mark in Europe.

Now, the next blockbuster: the FDA-approval iPhone app!

-Wes

Tracking Medical Procedures via the iPhone

If it's free, it's for me.

Especially if it's an iPhone app to track medical procedures:

That’s why Dr. Shanti Bansal developed a free iPhone application — “app” in Apple-talk — that lets doctors keep a record of each case and which procedure, from a cardiac MRI to a biopsy, they perform.

“The goal is to help physicians in training be the best physicians they can,” said Bansal, who practices at Yale-New Haven Hospital. “One of the reasons I came up with this is that I’m a cardiologist and in cardiology we do a lot of procedures. I lost track of hundreds of procedures during my first and second year” of residency.

Now, in about 30 seconds, each procedure can be entered into the iPhone.

Here's the link to ProcedureTracker.com

-Wes

A Stethoscope App for the iPhone

It's out there. It makes a cool picture, but I wonder how many medical students realize how unimportant apps like this have become to today's cardiovascular care. Don't get me wrong, it's good to hear the difference between a systolic and diastolic murmur, or for the really talented, a diastolic rumble on physical exam. Recognizing the difference between mild and severe aortic stenosis is also very helpful. After all, the physical exam remains the most cost-effective instrument in medicine.

But graphics to show the murmur that requires an electronic stethoscope and preamplifier to connect them to your iPhone? How much money do you want to waste on these toys?

The best way I know how to learn is get off the computer and get to the bedside. Look, listen, and feel the precordium a thousand times over. Only by doing will you learn. You really don't need an expensive stethoscope (but it does helps the auditorially challenged). I admit that I've stopped using super-expensive stethoscopes because I always lose them when I change into scrubs or round on too many different wards (or they're often stolen).

Honestly, by the time I'm asked to see a patient, the echocardiogram is already done, so for me, listening to the lung sounds and measuring blood pressures (especially orthostatics for patients with syncope) remains the most important reason I still carry (or borrow) an the old, cheesy, analog version of the stethoscope.

-Wes

h/t: Dr. Joseph Kim via Twitter.

Using the iPhone for Cardiology

It's being done:

An EKG is one tool used to diagnose various cardiovascular conditions, including a heart attack or heart failure.

Within two minutes the EKG technologist will have loaded the test results onto a secure Web site at the hospital, the Picture Archiving Communication System.

The cardiologist is able to log in to the system from anywhere there is Internet access, including mobile connections such as iPhone. In the past, if the cardiologist was not at the hospital the alternative was to await a fax showing the graph of the electrical waves.

Quintana said he predicts more physicians will begin using the iPhone to aid in diagnoses, but cautioned against abandoning traditional technologies; he recommended a combination of all available tools.

“The interpretation of an EKG is based on patterns,“ he said.

“The field of view on an iPhone is smaller, so there’s a limitation there. It’s good for a quick diagnosis, but it’s not the final answer.”

The use of mobile technology such as the iPhone in medicine is not limited to cardiology.

Hospital officials said obstetricians and gynecologists can purchase an application to view wave forms; radiologists may read X-ray images or magnetic-resonance images; and the iPhone can even be used at bedside to help patients identify which medications they take.

Despite it's obvious advantages, some centers have been slow to adapt this approach because of the iPhone's security concerns. Still, doctors can't get such practical uses for mobile devices fast enough. One only has to look at the advantages of being able to snap a picture of a rhythm strip or pathological lesion and paste it into a medical record or send the image to a specialist to see the power of applying this technology to improve patient care.

-Wes

The Ultimate iPhone App?

Steve Dahl, from the Chicago Tribune, gives us the run down:

I was warned in advance that "Avatar" is a very long and intense movie, and my second-biggest fear Monday afternoon was that my hummingbird-size bladder would dictate the pace of my movie watching. Luckily, I had the iPhone app RunPee (ed. note: video review here) to coordinate my visits to the men's room once the film had started. I was in full command of both the 3-D technology and my 3G technology as I transported myself between Pandora's laboratory and a Pompano Beach lavatory.

Run Pee suggests the best times during a movie to make a run to the bathroom or get a snack without missing too much of the plot. "Run Snack" isn't as catchy an app name. The first recommended break was at 56 minutes (I just made it). The app gives you the cue: When flying through the floating mountains, Trudy says, "You should see your faces." RP also provides a synopsis of what you are missing.

Urologists everywhere should take note.

-Wes