Innovation and Technology


The iBeacon from Apple is intriguing — how might it be used in healthcare?


SOURCE:  Apple

According to Apple in December 2013, when it was announced:

iBeacon is a new technology that extends Location Services in iOS. Your iOS device can alert apps when you approach or leave a location with an iBeacon. In addition to monitoring location, an app can estimate your proximity to an iBeacon (for example, a display or checkout counter in a retail store). Instead of using latitude and longitude to define the location, iBeacon uses a Bluetooth low energy signal, which iOS devices detect. To learn more about Bluetooth technology, see the official Bluetooth website.

To use iBeacon, you need iOS 7 or later, Bluetooth turned on, and a compatible iOS device:

  • iPhone 4s or later
  • iPad (3rd generation) or later
  • iPad mini or later
  • iPod touch (5th generation) or later
  • You can control which apps and system services access Location Services data, including iBeacon: Tap Settings > Privacy > Location Services.

Healthcare has many vast bricks-and-mortar facilities where we might aim to keep track of providers & patients– not in an inappropriate way, we’d posit– just to ensure the right folks are connected at the right time in the right place.  Think of it this way:

“We need Dr. Jones in Room #14– where is he now?”

Or “We’re ready to see the patient with initials P.R. — where is she now in the building?”

While much of the buzz about iBeacon has related to retail, whereby one could (as an example) get an electronic coupon on the fly, I think there are myriad potential compelling uses in… the medical arena.



SOURCE:  Apple

Thus, inventors everywhere– have something we could consider?

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Pre Spike

Remember the movie Minority Report?  It explored the notion of “Pre-Crime.”


indexSource:  Warner Brothers

There’s an analogue in healthcare– getting to “Pre Spike.”

Think about it– traditional medicine is about a human encounter typically at the time your symptoms pop outside the norm, or AFTER this happens.  Often, you hear the platitude “if we had only caught this earlier….”

That’s why today is the very best time to be a doctor.  In the pre-mHealth era, doctors spent voluminous time COLLECTING the dots (data) … so they could then CONNECT the dots (figure out what’s wrong with you), so the right therapy can ensue.  I imagine this might have been 80/20– with the 80 being dot-collection.

Leaving far too little time in the average seven-minute appointment for the discovery.

Now, as the Tom Cruise character represented in Minority Report in the scene depicted above, there will be plenty of More

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What Takes 4000 Mouse Clicks?



Answer:  A ten hour clinical shift in the Emergency Department.

Recently I ran across 4000 Clicks: a Productivity Analysis of Electronic Medical Records in a Community Hospital ED.  There are some fascinating stats in this paper about EMR use in the Emergency Department:

1.  44% of clinical time in this Emergency Department was spent on data entry into an EHR, nearly double the amount of time spent on patient contact.

2.  It takes 6 mouse clicks to order a 325-mg aspirin.

3.  It take 227 mouse clicks to complete an ED encounter for right upper quadrant abdominal pain.

Makes me wonder, how many mouse clicks did it take you to read this blog post?  Or pay your bills online?

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Hacking Healthcare

What happens when you teach first year medical student to code and be entrepreneurs?

Answer: Great prototypes of original ideas on volunteering in hospitals, choosing a doctor for a virtual visit, and visualizing the business health of a medical practice.

At the advice of a long time friend, I decided to teach an eight class selective at Georgetown University School of Medicine called “Hacking Healthcare.”  I would teach medical student front end web coding.  Besides specializing in Emergency Medicine, I consider learning to code HTML/CSS/Javascript to be one of the turning points in my career.  Coding let me stop being strictly an “idea guy,” and rather become an agent of implementation.  I wanted to share this ability to make ideas happen with a new generation of medical students.  Most medical professionals are great at analysis and criticism, however, few are able to create.  I wanted to teach them to create.

I had four guiding principles More

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  1. Mike Bright: Another instance of microvolunteering in hospitals is this call-out for research on how microvolunteering actions might benefit a patient.

Next Big Thing, Predicted: Hydration Sensor



Given how ubiquitous fitness trackers have become (even before fitness watches appear in droves in 2015 and beyond), think hydration tracking next.

About 3.3 million fitness bands and activity trackers were sold between April 2013 and March 2014 in the U.S. through bricks-and-mortar retailers or large-scale e-commerce sites, according to the NPD Group.

But no one ends up in the Emergency Room for being too sedentary…

Consider the Annals of Epidemiology, Volume 17, Issue 9 , Page 736, September 2007, and this article by S. Kim More

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Revisualizing Strokes


Inspired by The Beauty of Health Data contest for the upcoming Health Datapalooza, some of us tried our hands at a few visualizations.

We ran across the NINDS data in an appendix to A Graphic Reanalysis of the NINDS Trial (Ann Emerg Med 2009; 54(3):329-36) and thought it was a gold mine of interesting data.

Hoping to better see the natural history of stroke, we came up with one nice visualization of the data. Since it is animated, we cannot submit it.  But if you would like the check it out, you can on YouTube.  It uses patients who had no neurological deficit before their stroke (approx 550) and follows their NIH Stroke Scale (NIHSS) at a few different data points.  You can see each patient get worse or better throughout the study (at one day after stroke, 7-10 days after stroke, and 90 days after stroke). The y axis is the baseline NIHSS severity of stroke, while the x axis is the NIHSS severity of stroke over time. At twenty four hours, the severity of stroke appears to be all over the board, however, at 90 days, patients tend to get better (move to the left) or succumb (move to the right with an NIHSS of 42). More

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How Medicine Can Learn From Javascript Callbacks

mobile-health-02-smallDid you just execute a callback?

Chances are … yes.  If you use browsers (which you obviously do if you are reading this), chances are you are using “javascript.”  Javascript goes hand in hand with the modern web.  You are using it right now.  And javascript is full of callbacks.

These are not HCAHPS callbacks for patient satisfaction.  Those are important, but for other reasons.

Rather, these callbacks in programming languages like javascript are things that happen when something else happens.  As a real world example of a callback, imagine a doctor in… More

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Thoughts on the mHealth Summit


The mHealthSummit gets bigger by the year (5,000 attendees from 60 countries this time around), and here are three takeaways from the event just ended, at the National Harbor in Washington, D.C. from December 9-11, 2013:

  1. ENORMOUS:  Increasingly the vendors are BIG.  In mHealthSummits past, the exhibitors typically had highly innovative products, but were not firms you’d recognize.  Now, the names are like this:  Sprint, AT&T, Verizon, Qualcomm, Intel.  Of course, many small companies also participated, and many of these are very well funded given the tsunami of venture capital funds that have hit the beach.
  2. EVIDENCE:  In the old days (you know, 18 months ago), your emblematic mHealth vendor would say “we think our ___ works.”  Now, vendors tend to have More
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8 Must-Haves To Innovate

Incentives for Innovation - Charles Lindbergh and Raymond Orteig
Medical futurist, software architect, and health IT strategist, Dr. Michael Gillam launches his first of many Dispatches from… Somewhere in the Future – Serving as faculty at Singularity University’s FutureMed Program, Dr. Gillam extracts the best of his notes from prior sessions. As a prelude to future posts, he kicks off with 8 Must-Haves for creating innovation in your organization. More

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Innovation and Facility Design Workshop

Innovation and Strategic Design for HealthcareThe patients are sicker. There’s fewer staff. Technology is outpacing your facility’s ability to adopt it. Data management systems are being revamped. The Emergency Department is over-capacity. And in the midst of all of this, you must be prepared for larger scale emergency. Such is the plight of ED Directors everywhere.

So, you want a re-design. You want an overhaul. Well, guess what? You’ve got one shot… a one-time opportunity to employ evidence-based physical design strategies. The Center For Health Design and MI2 hear you. More

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Creative Health Innovation Funding

Funding Health Innovation With Crowdfunding Or Through Progressive EmployersAction is a necessary ingredient for innovation. And health innovations are notoriously difficult to fund – often relying heavily on the time-consuming process of obtaining grants or yielding some ownership through venture capital. Well, new opportunities are presenting themselves. Health innovations may be funded through crowdsourcing sites like Kickstarter and through progressive employers like MedStar Health.

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Health Innovation Adoption Curves – From Scurvy To 2025

Health Innovation History - Vasco de Gama & Scurvy PreventionIt took consuming citrus fruits for the prevention of scurvy 264 years from discovery to widespread adoption. Today, the time from discovery to implementation is estimated at 17 or 18 years. How much can we close this gap? In this video from FutureMed, medical futurist Dr. Michael Gillam explores this answer and where he expects us to be in 2025.

Watch for Dr. Gillam’s Dispatches From…Somewhere In The Future coming exclusively to soon. More

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