Online Electronic Medical Records (EMR) and Electronic Health Records (EHR)

The EMR issue is quite complex, because there is no standard yet, and thousands of competing applications try to conquer the big clients. Some are Open Source, some are free, many are sold. A few countries and states have decided to implement a single EMR application, to lower costs and focus all the development effort in a single product. However, not even Socialist countries have reached that goal. Continuar leyendo “Online Electronic Medical Records (EMR) and Electronic Health Records (EHR)”

Psychological Testing and Treatment

To this proposal, the 3 medical businesses described above apply: Online EMR, Telemedicine, Marketing and Marketplaces.

Psychology is a discipline that can greatly benefit from the Internet, because there is no strict need for physical contact between patient and doctor. Of course, something is lost when human proximity is replaced by a webcam. There are a number of clues from the environment, body language and details that help the psychologist to make a diagnosis. But psychological tests are objective and can be easily implemented and carried out online. The advantage of offering Web Psycho Testing is to centralize the tests, to assure uniformity, and to be able to chain the tests according to the results and following a predetermined algorithm, thus automating most of the diagnostic process.
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Opportunities for Pharmaceutical Companies

The 5 previous proposals have many advertising and sponsorship places for drug companies. Doctors who are active online are likely to be more influential and see more patients that those who are hiding in their offices, and pharm sales reps need to identify them and see them, virtually or physically.

When a product is being discussed in a forum, the “virtual reps” can intervene defending the drug from attacks. Although it is not correct, they can do so anonymously or without identifying themselves as company members.
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Traceable Medicine

This bizz takes elements of several others described here.

 

Medicine has always been defined as part art, part science. Art resists definition and can not be traced, while science is the opposite. As a part-time practicing doctor, I know that Medical care is far from being exact science and the doctor-patient interaction is hardly traceable. We doctors enjoy certain impunity from the fact that not everything we do and advice is recorded, and our errors most of the times, get covered with dirt… Even those facts that get written can be left in paper or in electronic format that is not integrated in larger databases.

 

For instance, let’s compare several parts of patient-doctor interaction, in the old and modern ways of doing medicine:

 

 

Standard-traditional-Old Way

Connected-traceable-telework-New Way

Patient selects Doctor

Word of mouth

Advertising

Managed care org. decides

Whoever is available

Verifiable CV

Knowledge Marketplace

Doctor selects patient

Clinicians accept everyone

Specialists accept patients broadly within their specialty

 

Doctors search for patients in knowledge (medical service) marketplaces, which assure they stay within their proven abilities.

Initial interview

Spoken

Spoken + Audio record + full data entry in EMR. Telemedicine.

Medical Records

Paper or single PC

Electronic Medical Record  (EMR) in a Database

Data collection

Analogical forms (paper, X Ray film, thermo sensitive paper)

Digital forms integrated into the EMR

Medical decisions

Doctor’ call. Hunch. Coin toss. Infrequently, second medical opinion sought. Many times, from a friend or the first doctor who walks around.

Software assisted. Expert systems. Knowledge Marketplace. Telemedicine. Online qualification system for medical acts.

Outcome

Hopefully, everything Ok. Doctor performance is approximately estimated by those few that happen to know the case.

Permanently monitored by the Online Qualification System for Medical Acts.

 

 

Special examples of Traceable Medicine are clinical trials. When companies need to test new products or treatments define tests with extreme control of every variable, write strict protocols and appoint experts that ensure compliance. Everything is traceable. The results are solid enough to allow researchers to extract valid conclusions of general value.

 

Traceable Medicine will push health care away from art and into science. The result will be a less human patient-doctor relationship, but without doubt, success rates will be better and costs lower.

 

The “Online Qualification System for Medical Acts” does not exist and is a business by itself. It requires the EMR, for every participant being able to check patient data. Let’s show some properties:

 

  • can be complemented by Verifiable CVs, because the ratings that doctors obtain in this system can be added (if good…) to their CVs.

 

  • would be a useful Medical Marketing tool for the service providers in the Medical Knowledge Marketplace, because those with a good record can be trusted and sell themselves better.

 

  • will add credibility for those who participate in the Medical Social Networks.

 

  • will be able to run Contests (with many marketing opportunities). Of course, the patient will stay anonymous.

 

  • will be able to provide Certifications (a new business)

 

  • instead of passing tests, obtaining certifications and solving quizzes for free or paying a fee, Doctors will do it and at the same time, get paid for their work

 

  • large amounts of valuable data will be available for Public Health and Epidemiology technicians and experts, which will greatly improve Health Care in general.

 

 

Personal View

I envision huge resistance from doctors to accept traceable medicine. They still fiercely resist using PCs to keep appointments and data. And the pen and paper generation still rules over the young and connected.

We doctors enjoy certain impunity from the fact that not everything we do and advice is recorded, and our errors most of the times, get covered with dirt

Medical Knowledge Marketplaces

Once the patients have an online medical record (EMR) most patients can examined by online doctors, and in many cases those remote professionals can solve the problem. Of course we are excluding many cases in which human contact is necessary for physical or psychological reasons.

 

I conceive the near future of medical care as a connected, distributed space where only a few persons have direct contact with the patient, and a number of consultants examine the relevant data and make recommendations. The eHealth paradigm will make medicine ultra-specialized, a bit de-personalized, faster and cheaper than today.

 

Imagine a situation where a complicated case is exposed to an inexperienced doctor, far from a high complexity centre. Let ‘s assume that this patient has his data online, but physically-present doctor does not have a marketplace where to seek advice. He can maybe bother a friend once or twice, or even pay him. But this friend is no assurance of quality, availability or price.

 

There is not a site where patients or doctors can publish their cases (with the necessary EMR) and seek advice from online doctors. It would be ideal for isolated places where no doctor would visit, for second medical opinion and for 3rd World doctors willing to sell their knowledge in the 1st World.

 

Such marketplace would implement many mechanisms to validate doctors, and to assure quality responses. This concept intersects the Verifiable CV business described elsewhere.

 

In order to sell services online as Telemedicine, doctors will need a little more than a diploma and a license. The competition will be intense, and they will need to demonstrate their knowledge, plus cost-efficiency, availability, response time, technology and marketing. They will need ability to receive payment in many forms, offer guarantee and credit, thinks that they very rarely do in the real world, in traditional Medicine or even in the many popular TV series that depict the medical world.

 

A few forms of knowledge marketplaces within the Health area:

 

– Business-to-Consumer markets, where the patient demands service offers from all the possible providers;

– Business-to-Business markets, where clinics will find complementary institutions across the Net

– Auctions and reverse auctions, where medical services/hours are sold to the best buyer.

– Professional Social Networks, which proved their value in other marketplaces

 

These “medical knowledge marketplaces” should have at least these features:

– access to a reliable online EMR (electronic medical record) for patients

– a doctor’s database, with a critical number of providers in any field. These providers do not need to travel to market their knowledge, because the transactions are essentially online.

– a companies database, ready to buy knowledge on given clinical cases, from doctors online. These companies will be validated in their contact data, and they will be required to pay any services bought thru the marketplace. Or face blacklisting.

– quality assurance service for doctors who want to validate their credentials by any necessary mean

– transaction platform, including bidding, alert mailing and auction.

 

 Other features present in current service eMarketplaces:

  • forum
  • contests
  • tests – quizzes
  • blacklist of those who broke the market rules
  • product offerings
  • group purchases
  • physical meetings

 

This market would be ideal for isolated places where no doctor would visit, for second medical opinion and for 3rd World doctors willing to sell their knowledge in the 1st World. In the near future, it would be nonsensical NOT to have a Medical Knowledge Marketplace

Medical Marketing

Doctors have ethical restrictions for doing marketing, and for that reason there are Patient Referral Services that with supposed objectivity advice patients as to which doctor to go. They have existed for a long time, but the web based ones are easier to run, more efficient and have wider reach.

 

Medical Marketing can sell the previous two medical businesses, EMR and Telemedicine. They can first convince the patients that they need an EMR, in order to recommend a specialist or sub-specialist. In order to produce the EMR a medical assistant and probably a doctor are necessary, so this is already Telemedicine. Once the patients have an online EMR, a remote doctor can provide some advice, maybe suppressing the original need for a physical encounter with a doctor.

 

Medical Marketing is currently applied to clinics or health organizations within a certain geographical area. However, some services are likely to be sold internationally, like Dentistry, laser eye optic correction, all kinds of cosmetic surgery and controversial surgeries like abortion, in vitro fertilization, cloning, sex change or virginity restoration.

 

Here in Argentina there are several opportunities for that, and the country already receives lots of Health Tourists. Let’s do a simple math to find the balance point: a round trip airfare from North to South America can cost U$D 1200, and 3 days hotel maybe 200 more. Procedures that are not covered by medical insurance, and cost over 2000 in the US, are likely to cost from 20 to 40% here.

 

Personal View

 

A step further would be to fit a boat with medical facilities and Argentine or other qualified and inexpensive doctors, and approach her to the coasts of Miami or London. The boat could carry the flag of some Medical Malpractice paradise, like Ruanda or Etiopia.

To round off the project we need a country that allows alcohol and casinos. Convalescence does not need to be boring. If patients do not come to you, you go to the patients…

Telemedicine

Telemedicine refers to any medical action done at a distance. For some tasks this is a very easy, and does not really need the physical doctor-patient contact. Or the contact can be replaced by video cameras and touch-sensitive data gloves.

 

For instance, interpreting EKG, EEG or X Ray images is often done with the hard data alone. Actually, starting a marketplace for those interpretations could be a still virgin starting point. With Medicine going more and more the way of biochemical, electrical or other physical tests, there are always more data to be analyzed. Some of those data can be very complex, like the EEG, and benefit for computer treatment for signal improvement and processing. I am currently advisor in a project for Computerized Polygraph testing for the Federal Police in my country.  Images provided by X Ray, Tomography, Photography, Microscopy or Sonography can also be computer-enhanced, compared and stored, before expert interpretation, all of which can be done remotely. This opens the field of

Telemedicine for almost every medical specialty.

 

The few exceptions are those practices where direct contact is required, like taking samples, feeling, smelling or operating. And still, some of them can be left to nurses, technicians or beginning physicians, with remote supervision by experienced professionals.

 

We are only scratching the surface of the immense, fast-growing medical information market

 

Developing software able to analyze instrumental data is another form of Telemedicine that already started to grow.

 

Health has always been a conservative area, doctors are known to be anti-computing technology, and lawyers are anxiously waiting to take action against every little mistake or data glitch. But still, there is a lot do in this area, with enormous potential for growth and wealth.

 

 

Personal View

 

I took part in a successful project where overweight patients were followed by phone, to ensure they took the medication, followed the diet and lost weight. The phone calls really helped them to comply.

I cannot wait for Telemedicine to mature and allow me to work from home and collect as if I was in a fancy American clinic.