Jul 30, 2009

HIPAA compliant mobile consultations for Doctors

Finally, a commercially available intelligent system to allow all physicians to provide consultations from anywhere, simply through a Blackberry ( or any other smartphone, but not an iphone !?! See Comment 1).

The mVisum Medical Communication System is a communication tool that allows medical professionals to securely receive, review and respond to patient data recorded at the point of care.

mVisum uses multiple levels of security and authentication to ensure HIPAA compliance. The handheld requires unique username and password for each physician, which is then authenticated by the server against the IMEI number and phone number. Data transmission between the server and the handheld is carried out through a patented double encryption system, where the data is first scrambled, which is further delivered through a 128 bit encrypted pipeline, each step individually meeting or surpassing HIPPA requirements. The sending console to server communication is also similarly architected, thus providing strong security end-to-end.

Types of Data Transferred include-
  • DICOM Images - loss-less representation of the original file, with Zoom capabilities.
  • CT Scan
  • MRI
  • EKG
  • Cine Loops
  • X-Rays
  • Free text

The system has advanced technology that allows the system to be availability aware,so that another physician can immediately be contacted if the original intended physician is unavailable.Once received, the physician can review data and securely respond with medical opinion, prescription or other critical orders. Real Neat, eh?

View more news videos at: http://www.nbcwashington.com/video.

mVisum System - http://www.mvisum.com/index.php

Jul 22, 2009

Your cell phone is your ( doctor's) best friend.

Microscopy provides a simple, cost-effective, and vital method for the diagnosis and screening of hematologic and infectious diseases.It is an essential tool in disease diagnosis and widely used all over the world. Unfortunately, the EXPERTISE required to use the tool, and to evaluate the findings is not very common. One requires a pathologist with many years of experience to make sense of those seemingly random and confused pixels. (I know, i am a pathologist :-)

It takes a lot of effort, and money to train a pathologist, equip him/her with all the instruments required, and then use the skills in a backward area without proper facilities. But the advent of digital imaging has solved many of our troubles. Telepathology made sure that we do not need a pathologist physically present at the site, to render a diagnosis.

But microscopy and digital imaging of the biopsy/tissue fragment was still a hassle. Now we have done better. You don't even need a microscope to send a microscopic image over the network!! Researchers from the Univ. of California worked with high-powered LED – which retails for just a few dollars – coupled with a typical camera phone to produce a clinical quality image sufficient for detecting in a field setting some of the most common diseases in the developing world.

The newly developed technology, CellScope, allows for average cell cameras to be retrofitted with powerful microscopes, able to detect malaria parasites, and even fluorescent marker-stained tuberculosis bacteria.
Thus you have your humble cell-phone transformed into the sherlockian "cell-scope".

“The images can either be analyzed on site or wirelessly transmitted to clinical centers for remote diagnosis. The system could be used to help provide early warning of outbreaks by shortening the time needed to screen, diagnose and treat infectious diseases,” University of California in San Francisco (UCSF)/UCB Bioengineering Graduate Group graduate student David Breslauer adds. CellScope could also provide remote access to digitized health records, and would be amenable to epidemiological studies, using triangulation or global positioning system location data, such that outbreaks could be monitored as they happen.

So maybe i could click a photomicrograph of that mole on my friend"s forearm, twitter it to my onco-pathologist friends, who view it on their smartphones and twitter / message their diagnosis back to me. Simple and fast, especially with my own group of pathologists on the network.

Jul 1, 2009

Physiology of Propofol drug abuse

Is Propofol, or Diprivan what Michael Jackson Used for ( Drug) Abuse ?

According to Cherilyn Lee, a registered nurse who operates a Los Angeles-based nutritional counseling business, in California, “Jackson was complaining of insomnia and pleaded for her to get him some (Diprivan)". Other reports claim Propofol was recovered from his residence. This conversation reportedly occurred in April of this year. Preliminary reports say that M.J died of cardiac arrest, which is within the possible effects of unmonitored Diprivan use. (A rapid bolus injection can result in undesirable cardiorespiratory depression including hypotension, apnea, airway obstruction, and oxygen desaturation.)

Diprivan is a general anesthetic, used to start or maintain anesthesia during certain surgeries, tests, or procedures. It is available in a white vial of 20, 50 and 100 ml (containing 10mg/ml.).Most adults require 2 to 2.5 mg/kg of the drug ( approx. 10 ml). DIPRIVAN Injectable Emulsion is an IV sedative-hypnotic agent and can cause potentiation of other narcotic drugs and benzodiazepines when used together. The most common side-effects include Change in mood or emotions; dizziness; drowsiness; lack of coordination. It is given intravenously, usually within the operation theater or in a clinic. It has a rapid onset of action ( less than 1 min) and short duration of action (approximately 10 min but is dose dependent).It has direct cardiodepressant effects, leading to decreased blood pressure and heart rate in higher doses. Its actions causing decreased heart rate and respiratory rate mean that use of propofol is done only under continuous monitoring of vital signs.Diprivan is not meant for use in pediatrics and elderly population since its safety has not been established in these populations. Prolonged use of propofol results in accumulation of the drug in body tissue and increases the duration of action as well as chances of overdose.

Rarely, Cases of death due to propofol have been discussed in medical literature. All these cases have occured in hospital settings only.It is definitely not meant for home use and this is the first time I have heard of Diprivan being used as a drug of abuse outside hospital settings.

Euphoria, sexual hallucinations and disinhibition have been described on recovery of propofol anaesthesia. These effects could explain the recreational use of the drug. Moreover, several experimental studies strongly suggest the potential for abuse and dependence on propofol,and few cases of abuse and dependency have been described, mostly in medical professionals. As propofol is generally not recognized as a substance of abuse, and because of its safe profile, it is important to remember that rare adverse reactions of propofol could produce death in a context of abuse, even at therapeutic dose range, in the absence of ventilatory and medical assistance.

British Journal of Anaesthesia 2006 97(2):268; doi:10.1093/bja/ael168


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