Tuesday, December 26, 2006
It happened the other day. Anything 900g or less must breathe by itself or die. There are reasons of course, like not enough staff or intubators. Studies have also shown poor prognoses in lower grammages. Therefore those with a higher chance of surviving - will get the intubators.
This one is 3500 grams. Makes you think. Doesn't it?
Sunday, December 24, 2006
*Egos of management
*Concentrating on PATIENT MANAGEMENT, not financial management.
For instance, if the open source community can help with the situation I'm about to describe, and just this, you have no idea how much of a difference it will make to primary healthcare in this country. Build the "system" so it can be grown, sure. But little steps is the only way you'll get anywhere in a third world country.
Here's the situation. Primary healthcare patients (GP-based needs, meant to go to clinics, both rural and metro BEFORE they get referred up to secondary and tertiary centres - where they would get seen by specialists and clog up already clogged hospitals) HAVE to carry around a green piece of cardboard - their clinic card.
This card links to a manually filed medical history inside the clinic archives. To get to a hospital, you're meant to get referred - thus creating the link. If you don't, hospital doctors are practicing blind, because there is absolutely no way to retrieve paper-based files from clinics around the country.
And most patients believe they can just pitch up at hospitals with primary care problems (translation: trivial from a hospital's point of view). Small wonder we're understaffed? Especially Baragwanath.
Hospital doctor's don't need every little bit of previous scrawl - but there are some critical pieces of information that should be kept centrally on a patient database - and easily accessed at critical times. Such as: Patient diagnoses (incl the controversial HIV + - status, in code), current medication / dosages, allergies and relevant major tests (eg. CT SCAN, ECG, major blood work).
Solve that problem and you've taken a huge leap forward.
Saturday, December 23, 2006
- Linux Today
- Centromimir LiveSpace
- The Open Source Pimp
- Linux Medical News
- Africa By Art
We've also started doing a bit of digging... nothing like a good idea to inspire some late night surfing-with-purpose...
Mercy Hospital Opens Arms to Open Source... (Tina Gasperson)
"For almost 100 years a group of women called the Sisters of Mercy have been instilling a spirit of excellence into Baltimore's biggest hospital, appropriately named Mercy. Right from the start, the Sisters have made it their goal to push the medical institution beyond the ordinary by creating teaching affiliations, feeding the hungry, building state-of-the-art emergency services, and launching a neighborhood health center for the inner-city poor. In today's world, all that excellence requires a solid technology infrastructure--and one open source management package to manage a variety of systems.
"Mercy's data center houses more than 200 machines running Windows, Linux, Solaris, AIX, and other, more obscure operating systems. Mercy CIO Jim Stalder says about 160 of the servers are Windows-based, but because the health care services industry is 'fragmented,' with many essential applications available only on other OSes, he also has to maintain dozens of non-Windows machines..."
OpenVista is the open-source version of VistA, which is an enterprise grade healthcare information system developed by the U.S. Department of Veterans Affairs (VA) and deployed at nearly 1,500 facilities worldwide.
MedPix Medical Image Database Uses Healthy Dose of FOSS (Michael Stutz)
"MedPix is a sprawling online medical images database and diagnostic tool that's used around the world by radiologists, nurses, physicians, and medical students--and the whole system is powered by Linux and open source software.
"MedPix is hosted by the US federal government's health sciences university, the Uniformed Services University in Bethesda, Maryland. It's the brainchild of James G. Smirniotopoulos, M.D., a USU professor of Radiology, Neurology, and Biomedical Informatics and Clinical Sciences Chair of its Department of Radiology and Radiological Sciences..."
Interview with Fred Trotter: The Medsphere (Tony Mobily)
"Recently Medsphere, supposedly an 'Open Source' Medical Software Company, has sued its founders Scott and Steve Shreeve. Why? Medsphere claims that the Shreeves illegally released Medsphere software to Sourceforge. An 'Open Source' Software company is suing its founders for releasing code under a free license... that's a bit like Ford suing its employees for making cars.
Recently Fred Trotter has come forward with evidence that he claims makes the Medsphere lawsuit baseless. Read on for an email interview with Fred Trotter regarding who did what in the Medsphere lawsuit, and why every free software developer should care about what is happening to the Shreeves..."
Raw Matter: Free Software and Quality
"Ben Chaff argues that Free Software is better than average in terms of security when compared to the proprietary software market, but falls short of the standards that apply for software used in crash-and-people-will-die type of mission critical applications.
"I fear I have to cry foul here: developing software for the kind of systems he describes (nuclear power plant controlling, medical equipment, ...) means developing software with a large budget and a limited, relatively well specified functionality..."
A special thanks to the first couple of people to prick up their ears: Mike Stopforth, Aaron and Farrel. We'll keep gathering interested parties together and see what happens. That's usually how these things start.
Things we're particularly interested in, and will research for a couple of new year posts...
- 3rd World PC Projects. Who exports old PC's and to where?
- Sustainability. Nothing is for free anymore. If the idea on the table allows national collaboration in the medical field, and empowers the medical profession to be more efficient - who pays the bills?
- Software. I'll bring SA Doc into the fold here - we need to figure out firstly, what do hospitals / doctors / nurses ACTUALLY need in terms of software? What's available on the Linux platform.
As Farrel says in his comment on the initial post - this could be done by pretty much any Linux distribution - but why not use the perfectly good South African one then eh? (Note to self: Proudly South African involvement?).
Would be nice to get a response out of Ubuntu themselves. These ideas sometimes have a tendency to run away with themselves - the developers and distributors themselves may be able to push this thing along the right path...
We've already started digging for interesting stuff. That post coming up next...
Oh, and a shout out to the Ubuntu Blog (unofficial) - who was looking for interesting stuff being blogged - about Ubuntu!
Thursday, December 21, 2006
So what might be applicable? SA Doctors need lab results, need to do research, need to store and retrieve patient records (on demand)... How do you get a connected, low cost, easy to use, low maintenance technology infrastructure into South Africa's hospital system? And then keep it there?
We've been using Ubuntu Linux (a proudly South African distribution of the Linux operating system - with our very own billionaire Mark Shuttleworth as the brains) around the office a bit - mainly to do tricky techy stuff, but I've been absolutely blown away with the new version (6.06 I think). It's funky, it's African, it's VERY easy to use (provided you don't mess with settings / use installed packages - which are more than ample for everyday use) and it runs on fumes.
I've personally run Ubuntu on a P3 256mb RAM - like lightning on the highveld.
So here's the challenge:
TO MARK SHUTTLEWORTH, OUR BILLIONAIRE BRUVVA...
Well done, chaps, excellent job. How about a project? We could secure funding (Government?) for an independent, empowered, Section 21 company to create an Ubuntu network of computers linking all SA's primary, secondary and tertiary care hospitals together.
- It's low cost because the operating system is free.
- It's low cost because it runs on the kind of computers America is throwing away.
- It's low maintenance, because once the networking protocols, any required software and web browser have been installed - the OS can be locked down and user logins/passwords managed fairly easily.
- It doesn't get viruses. Including the ones spread by the nasty germs on the kettle in the tea room (whole new post, different time).
- It could network and interlink over a low cost dialup, sponsored by Telkom.
- It could encourage the open source community (multiverse, universe... I get confused) to get together and develop some simple software for storing patient records, lab results, X-Rays and making them available to the right channels at the right time.
- It doesn't crash!
I think I'm onto something - if I dare say so myself. South Africans are too ready to throw away local solutions when faced with more expensive, inappropriate overseas ones. A project like this, while creating jobs and uplifting infrastructure would equip and empower our medical industry to fight a battle they're not getting a lot of help with. And we'll be doing it, the South African way.
Baragwanath is 2km wide. How would you like to run a kilometre (the phones just don't get answered) and wait in a queue (only 5 terminals work currently) for those lab results as your patient lies gasping on the slab?
This is a call. Who's in? Are the folks at Ubuntu interested in pursuing a project like this? Is there anything going on at the moment?
If I'm not mistaken - movements like this ARE the spirit of Ubuntu. Leave a comment, we're really interested in your views...
Wednesday, December 20, 2006
But in the public sector (where management in this country is needed most) it would never happen. The Public Sector can't seem to even afford to keep the Pentium 1's running (and thus provide us with lab results)... How on earth would they manage to network entire systems and then control/manage them?
Great idea in the 1st world.... but alas, Africa will just sit and look from the side line again.
Monday, December 18, 2006
Just what is it? Will have to find out. Here is, apparently, an example (got this off The Health Care Blog - worth a read).
Click4Care is a relatively new software company (although a lot older than most of those Health 2.0 companies I've been featuring) that’s spent a lot of time building a very, very complex system for what can broadly be described as care management, sold primarily to plans and payers—with United HealthGroup being the marquee customer so far.
Hmmm. Will wait for SA Doc to wash off the snot - and take a look at what this means in a South African context.
(SIDEBAR: SA Doc is on call at Coronation Hospital tonight. Thinking I should encourage a blow by blow pictorial of 8pm to 7am in the scary kiddy ward?)
Wednesday, December 13, 2006
Artery - The study of paintings.
Benign - What you be after you be eight.
Bacteria - Back door to cafeteria.
Barium - What doctors do when patients die.
Cesarean Section - A neighborhood in Rome.
Cat Scan - Searching for Kitty.
Cauterize - Made eye contact with her.
Coma - A punctuation mark.
Dilate - To live long.
Enema - Not a friend.
Fester - Quicker than someone else.
Fibula - A small lie.
Hangnail - What you hang your coat on.
Impotent - Distinguished, well known.
Labor Pain - Getting hurt at work.
Medical Staff - A Doctor's cane.
Morbid - A higher offer than I bid.
Nitrates - Cheaper than day rates.
Node - I knew it.
Pelvis - Second cousin to Elvis.
Post Operative - A letter carrier.
Rectum - Darn near killed him.
Seizure - Roman emperor.
Tablet - A small table.
Tumor - More than one.
Urine - Opposite of you're out
Varicose - Near by
Monday, December 11, 2006
Friday, December 8, 2006
I wasn't as much of a zealot as I thought I was. The DSTV Streetpole ad series that featured pouty-lips Rihanna with a subheading 'Be Unfaithful' - of couse referring to decoders at a special special low price... has been changed.
It now says Visit Paris. That's clever, while not encouraging promiscuity. Win win.
PS. Buhle Dlamini wrote a piece for Business Day on the same subject. Published 5 December. Self-congratulatory pat on the Scrubbed Up back for scooping the story by 15 days!
Wednesday, December 6, 2006
I understand and support the notion that a patient HAS to be educated. They take their pills regularly, they look after themselves, they’re more compliant patients if they understand what’s happening to them.
But... What’s wrong with the Internet is that patients have no guidance on what they’re educating themselves with – what to hold onto vs. what to discard. They end up wrongly informed – which is far worse than not informed at all.
I worry about Google's content rating system. You’re asking non-medical, ignorant people to judge the relevance of medical content. There’s a reason doctors study for 6 years and then practice for 2! It’s like me trying to make a judgement on the performance of the latest BMW – I just don’t have a clue!
Prime Example. Had a patient the other day who’s 6 year-old daughter has rectal prolapse. She’s been seen by a GP and paediatricians and no sinister cause has been identified. Mommy went to the internet and looked up rectal prolapse – and of course - out pops the textbook list of causes. She then arrived at the Practice with her mind made up. Her daughter now had cystic fibrosis – and I should investigate accordingly. Cystic fibrosis is barely even a contender in this diagnosis btw.
Now. I had to explain to Mommy and her superior Internet knowledge that cystic fibrosis occurs in BOYS - almost exclusively! And that if there were any signs of cystic fibrosis – the signs would have manifested as increased mucus at the age of 2!
Two consultation sessions later, and a bunch of time wasted trying to explain to Mommy that just because it's on the internet – doesn’t mean its true... a mild example of what can go wrong with layman internet research.
Don’t believe me? Try it out for yourself. Go to Google.com. Type in “rectal prolapse”. Conveniantly, Google picks this up as a medical term and offers you Treatment, Causes, Diagnosis, For Patients, Alternative Medicine etc. etc. examples. Click Tests / Diagnosis. Result number 3 is E-Medecine. And there, for all to see and interpret, is a pretty damn scary list of causes.
- Advanced age
- Long-term constipation
- Long-term diarrhea
- Long-term straining during defecation
- Pregnancy and the stresses of childbirth
- Previous surgery
- Cystic fibrosis
- Chronic obstructive pulmonary disease
- Whooping cough
- Multiple sclerosis
- Paralysis (Paraplegia)
This isn’t differentiating between age, gender or pre-existing illnesses – three of the most fundamental differentiators. That’s WHY doctors have consultations. To narrow down, or eliminate lists of causes before a proper diagnosis.
Little Susie is now a potential victim of Whooping Cough and Multiple Sclerosis – and if Mommy is paranoid enough… Chronic Obstructuve Pulmonary Disease (Translation: Emphysema. Do you really think the 6 year old has been smoking 20 cigarettes a day for 20 years?)
Empower the patient - definitely! But who's going to help us undo the influence of bad research?
Tuesday, December 5, 2006
So, Google is getting in on the action. Their blog post says:
In the end, one key part of the solution to these problems is a better educated patient. If patients understand their diseases better -- the symptoms, the treatments, the drugs, and the side effects, they are likely to get better and quicker care -- before, during, and after treatment. We have already launched some improvements to web search that help patients more easily find the health information they are looking for. Using the Google Co-op platform, Google and the health community have labeled sites and pages across the web making it easier for users to refine their health queries and locate the medical information they need. Do a search on Google about a medical issue or treatment like diabetes or Lipitor and you'll see some choices for refining your query, such as "symptoms," "treatments," and so on. If you click on "treatment," your search results are refined and reordered so that sites that have been labeled as being about treatment by trusted health community contributors are boosted in the rankings. Note that how trusted a contributor is -– and thus how much they affect your search results -– is dependent both on Google's algorithms and on who the user decides they trust. For example, if my doctor is a Google Co-op contributor and I indicate to Google that I trust her, then when I search, the sites she has labeled as relevant will show up higher in my search results.
This presents an interesting quandry. Do you empower patients with the information, to help them through weak "support" sections of a national health system at the risk of placebo sickness? As a non-medical patient essentially - I think the risk is terrifying. Google my symptoms - and come up with the wrong set of suggestions? I would get hives on the spot.
How much can we trust the Google Search Algorithm, or its users' quality rating of the information it returns? When it comes to correctly equipping me with the right information about my health? I don't know...
The post goes on:
Patients also need to be able to better coordinate and manage their own health information. We believe that patients should control and own their own health information, and should be able to do so easily. Today it is much too difficult to get access to one's health records, for example, because of the substantial administrative obstacles people have to go through and the many places they have to go to collect it all. Compare this to financial information, which is much more available from the various institutions that help manage your financial "health." We believe our industry should help solve this problem.
I'm all for empowering the individual - it's something Google does really well. But a Doctor's handwriting is illegible for a reason! I'm kidding. But the pressing issue here is having health records available via the Internet. Just by definition - private medical records opened up to a world of hackers / crackers and identity thieves has me quivering in my paranoid Internet boots!
How does that suddenly translate to a South African context - where we hold things like HIV status absolutely SACRED. In SA, a medical representative is not even allowed to consult/reveal HIV status to a spouse.
Am I being naive in terms of how such information could be protected on the Web? Or will this open a whole new bag of stigma worms in a country like ours?
Kudos to Google for continually trying to improve and empower. Perhaps we need to take a quick step backwards and consider the consequences?
Monday, December 4, 2006
Just realised I don't know any more TV doctors. Well enough to write about them at least.
Thinking of adding Dr. John Dorian (Scrubs) to the contestant list - but I used up my "Appletini, STAT!" picture... and that just ruins the comedic value of the post. I've got the one above, but those shifty eyes...
Then there's George Clooney (so hot!) and a couple of others. Further research and some DVD box sets needed. The Showdown will continue at a later stage.
In case you missed out, here are the current contestants, in order of merit:
Friday, December 1, 2006
So, turned to AskYahoo (nice service by the way) for an answer.
We've all heard the harried medical team on ER call for something "stat." From the context, we knew it meant "quickly," but had no idea what the normal definition of the term was. We turned to the Net to cure our ignorance.
After various searches on phrases like "stat terminology" and "stat meaning" failed to provide an answer, we sat down and rethought our strategy. Several of our searches had turned up acronyms for the term, and while they weren't what we were looking for, they did point us in a new direction.
Remembering a helpful site we'd used in the past, we pointed our browser to Acronym Finder, a web site devoted to decoding mysterious combinations of letters. Typing in "stat," we hit the "Find" button and awaited a diagnosis.
As it turns out "stat" stands for a number of things, ranging from the obvious (statistics) to the not so obvious (Society of Teachers of the Alexander Technique). However, the very first entry provided the answer to your question. "Stat" in medical parlance is actually not an acronym; it's short for statim, the Latin word for immediately.
That made sense, considering many medical terms have Latin origins. Next time we get a similar question, we'll know to head to our Latin dictionary. Stat.
Hope that helps eh? In the immortal words of Dr John Dorian.
Read more here... NHS Blog Doctor: The BritMeds
Or take a turn by some of SA's finest...
- All Scrubbed Up (you're on it, wombat)
- Just up the Dose (angsty, studenty, funny)
- Try not to Kill yourself this Year (pity it's closing)
I actually thought there were a couple more when starting this post. Hmm. Any others out there? I'm sure I'm missing a bunch...