Digital Medicine: 2008

Dec 30, 2008

Three Points about Medical Informatics in India.

As knowledge expands and requires better management, role of I.T in health care can only become more important. India has a large number of trained I.T professionals and is in a position to leverage its Brain power to take Health informatics to new heights. As i have argued before, smart use of health informatics can also help us attain Health rights for all in many ways (lower costs, better quality, better informed patients, e.t.c). Here, i have tried to showcase a few points about Use of Health Informatics in India as well as the various educational courses available within India.

The Three major uses of Health informatics in India
1) For better training of Health care professionals ( includes Doctors, Paramedicals and Non-medicals)- e.learning
2) For improved delivery of high quality health care services to the remote areas.- Telemedicine,EMRs, CDSS.
3) To bring about a transparency in public health care delivery system.(e-governance)- Public participation

The three major obstacles to Health Informatics in India.
1) Inadequate Skills of health care personnel/others
2) Inadequate Physical infrastructure
3) Inadequate access to I.T ( Digital divide).

The Three major Post Graduate Health care Informatics courses in India
1) Medvarsity online P.G Diploma in Medical Informatics. , associated with Apollo group of Hospitals
2) Amrita Institute of Medical sciences MSc/ P.G.Diploma in Medical Informatics , at Kochi,India.
3) Post Graduate Programs at BII (Bioinformatics Institute of India), Noida, with good industry integration.

The Three short Online courses for Medical Informatics in India-
1) eHCF School of Medical Informatics, Delhi provides Certificate course in medical informatics
2) IAHI online course on Health Informatics
3) BII provides various online/distance educations courses in Health care Informatics.

In view of the fast changing world of medical informatics, it is essential to formulate a flexible syllabus rather than a rigid one for incorporating into the regular curriculum of medical and paramedical education. Only after that one may expect all members of the health care delivery systems to adopt and apply medical informatics optimally as a routine tool for their services.
Suptendra Nath Sarbadhikari

Three Points about Medical Informatics in India.

Dec 29, 2008

Better E.M.Rs to attain "Health Rights for All".

Image via WikipediaHeres a study on how Use of e-prescribing can lower health care costs, and bring health care services closer to all, without discrimination. This study quantifies the enormous savings that can be generated by a simple introduction of one more option within Electronic Medical records to choose the lowest cost generic amongst a preselected list of generic drugs (to ensure quality).

"Electronic prescribing(e-prescribing) systems that allow doctors to select lower cost or generic medications could save $845,000 per 100,000 patients per year and possibly more system-wide, according to findings from a new study.

Doctors using e-prescribing with formulary decision support, which accounted for more than 200,000 filled prescriptions in the study, increased their use of generic prescriptions by 3.3 percent.These changes were above and beyond the increased use of generics that occurred among all doctors and the already high rate of generic drug use in Massachusetts. Based on average costs for private insurers, study authors estimate that the use of e-prescribing could save $845,000 per 100,000 patients per year and generate even higher savings with greater use.

Researchers found that the doctors who wrote electronic prescriptions were slightly younger and more likely to be female than those who did not. In addition, internists, pediatricians, and family physicians made up nearly three-fourths of those who used e-prescribing. Of the 17.4 million prescriptions filled over the course of the study, about 212,000 were prescribed electronically. This study was funded in part by the Agency for Healthcare Research and Quality"

More use of I.T in health care will have a cascading effect on Health Rights for all as it increases affordability, efficiency, quality and information accessibility of health services. And these are few of the basic requirements of Health Rights for All.

Dec 25, 2008

-A Fantastic Medical Informatics conference in India

Just back from the Meditel 2008, the fifth International conference on Medical informatics and Telemedicine. The theme of the conference this year was "ICT for Medical Education and Research" and there were some pretty sharp presentations in Medical e.learning. Hopefully, as promised, most of the presentations would be available on the MCSI website soon.

The few presentations i thoroughly enjoyed included,

E-Learning- Current trends in India- by Dr.Balasubramanyam, Prof. and head, Dept. of Anatomy, SJMC, Bangalore.

Cochrane Collaboration- Informed healthcare in South Asia- Dr.Pratap Tharyan

Improving Healthcare via Transparent monitoring- Mr.Bill Thies, MIT and Microsoft ( use of microchip within pill boxes to monitor compliance in National health programs like DOTS India.)

World"s first prepaid service for Doctors consultation from any Phone- by Mr.Sunil Kulkarni, Group President, Oxigen Services (India) Pvt. Ltd.( a beautiful concept to allow pre-paying for telephonic medical consultations)

There were a number of other interesting ones, like this Virtual conference using Webex services, via a lowly Tata Indicom plug2surf device !!

To keep in touch with other happenings regarding Medical Informatics in India, subscribe to my Friendfeed or connect to my Del.icio.us account.

Dec 5, 2008

-Futile medications in cancer patients.

With early diagnosis and better therapy, life expectancy/survival in cases of cancer has improved dramatically. In many cases of cancer, all that is required is good palliative care.

Such patients take many medications, and many of them may be unnecessary. Now there is a study regarding Futile medication use in terminally ill cancer patients.

Futile medications were defined as unnecessary ( no anticipated short term benefit to patients for survival, quality of life or symptom control) or duplicate ie 2 or more drugs from the same pharmacological class.

The results were better than i expected. About 20% (only?, i think more) terminally ill cancer patients are on futile medications, most commonly Statins (56%). The most common duplication of medication was for the benzodiazepines class.(no surprises there!).

As a doctor, many-a-times i am "forced" to write medications i know is not required by the patient. I usually use this tactic as a placebo.What do you think of use of such "Futile" medications in cancer patients?

-Cannot treat without I.T support?

We know that wider adoption of healthcare information technology (HIT) results in better patient care. Here, in India, most medical students learn to use HIT after they start working as Doctors. Many medical students use the net to study, at a personal level, but institutional use of IT in Indian Medical colleges and associated hospitals is very low.

But here is a study with a very different perspective regarding HIT.

"About 80 percent of the 328 Vanderbilt graduates who participated in the study were working in an environment with less IT. According to the study, they reported "feeling less able to practice safe patient care, to utilize evidence at the point of care, to work efficiently, to share and communicate information and to work effectively within the local system."

Used to IT support in decision making, Medical students were left flabbergasted when they had to provide healthcare from Knowledge. Definitely not a very good sign.

Read the study on Healthcareitnews here.

Dec 2, 2008

-India"s Responsibility it can not shirk- Clear Pakistan of Terrorists"

India faced some tuff 59 hours recently. Its now time to clean up the mess, in all respects.I have also been closely following the Mumbai attacks since Naveen stays at Mumbai.

I want you to watch these videos. They would easily demonstrate India"s responsibility as a World citizen and American ally in going into Pakistan to clean up all the already known+documented+proven terrorist training grounds.

1) President-elect Obama explains that Pakistan is a big problem in War against terror. But it is misusing all its funds in non related Military expenditure and corruption. He also believes he would be stretched if he had to initiate a direct military offensive against Pakistan

2) The following news items ( one of many,with proofs) demonstrating Pakistan
territorial involvement in Mumbai terror attacks.

Ergo, India is expected to Join this war on terror and eliminate the Risks in Pakistan, for Everybodys sake!!Before ending, let me mention that i am a very old member of the India Pakistan friendship club on Orkut.

Nov 29, 2008

-Black Holes Bared !!

I might have spent my past 18 years studying Medicine, but my fascination for Physics persists. If i ever see something interesting in these fields, I just have to read it.

With all this comes an innate childish curiosity in matters related to Astronomy. The mere thought of all that endless space ( and Time!!) thrills me. So when i was stumbling my way through Recently popular blogs tagged with Health, I could not resist clicking on this Link. ( I wonder why this is tagged "Health"?)

Think technologies, Florida, U.S have this incredible page which explains Black Holes.

This is a simplified explanation of a Black hole, the physics behind it and examines probable theories connected to it. Of course, My favorite theory is when I get to travel to a different time-space on passing through a black hole. :)

I used my Alchemy Grid widgetizer to make this.

Nov 26, 2008

Meditel 2008 @ Chennai, India

Chennai-Image via Wikipedia
The use of ICT ( Information and communication technologies) for Health care in India is still very limited. Most of the efforts in this direction are sporadic and rudderless.There is no dearth of skilled manpower in this field, but a unified plan of action is still awaited.

Medical computer society of India has taken the lead to organize a national conference on Medical informatics and Telemedicine. Under the leadership of Dr.Sunil Shroff, eminent Nephrologist and President of MCSI, the fifth national conference on Medical informatics and telemedicine is scheduled to take place at Sri Ramchandra Medical College & Research Institute, Chennai on 19th-20th December, 2008.

"The conference (as in the past) will bring together decision makers, policy makers, practicing clinicians, healthcare educators and researchers, health administrators, health technologists and IT vendors.Meditel 2008 offers a platform to meet, interact and network with qualified specialists, users, buyers, healthcare providers, industry representatives, researchers and policy makers from India and abroad.

The event will showcase successful products in the Indian healthcare environment and discuss the challenges in their implementation. The use of ICT for 'Health Education & Research'’ is the theme of this conference.

Meditel 2008 will feature an exhaustive conference program with more than 100 presentations along with workshops on a wide variety of topics to learn about what is latest in e-health and the likely future trends."

I was a part of Meditel 2006 and can vouch for the quality of discussions held at Centre for Digital Health, Amrita institute of Medical Sciences, Kochi, Kerala.It proved extremely useful to me then and I expect a similar experience this year.

Nov 15, 2008

- Importance of Digital Pathology ( with Business model)

Dr. Ajit Singh, CEO, Bioimagene talks of digital pathology.
He is talking to non-medicos and therefore keeps ALL medical terms out of his speech.Without getting into the nitty-gritty,Dr. Ajit simplifies the meaning and importance of digital pathology.Anything i mention on this topic here would only take away from his Talk. So i leave it to you to experience first hand.

The previous part of this talk can be accessed on Youtube.

He is surfing on the edge and i believe he has picked a swell wave.

- Importance of Digital Pathology ( with Business model)

Image via Wikipedia

Dr. Ajit Singh, CEO, Bioimagene talks of digital pathology.

He is talking to non-medicos and therefore keeps ALL medical terms out of his speech.Without getting into the nitty-gritty,Dr. Ajit simplifies the meaning and importance of digital pathology.Anything i mention on this topic here would only take away from his Talk. So i leave it to you to experience first hand.

The previous part of this talk can be accessed on Youtube.

He is surfing on the edge and i believe he has picked a swell wave.

Nov 14, 2008

- No green beards in path labs @ John Hopkins University

The pathology department at my medical college was very strict with us Resident doctors. All our activities were constantly noted by our seniors, and being reprimanded frequently for "unprofessional conduct" was the norm. Our seniors made sure we were always properly dressed and behaved.

Mason Hall (2007), the Visitor's Center & Admi...

But what i read on John Hopkins university, Dept. of Pathology website takes the cake. They have a detailed list of "acceptable" and "unacceptable" conduct. Sample a few,

1) Acceptable- Knee length culottes and dress shorts; Unacceptable- Mini skirts, blue jeans, baseball caps.

2) Acceptable- Fingernails that are of "professional length", whatever that means; Unacceptable- Applying cosmetics in the laboratory.

3) Acceptable- Short/ Tied back hair of natural color ; Unacceptable- Purple and Green beards and mustaches!!

4) Acceptable- Socks/ Hose/ Tights ; Unacceptable- Printed underwear showing through outer garments.

5) Acceptable- Jewelery in moderation ; Unacceptable- Badges promoting causes/products/slogans NOT endorsed by the Institution/department.

Its definitely a good read. Click here to access the pdf file of acceptable appearance standards at John Hopkins University.

Nov 13, 2008

-Why American healthcare is so expensive?

That the American healthcare delivery system is out of control and wasteful is a no-brainer.

Needless battery of investigations and over diagnosis, branded drugs, impractical insurance laws, free-markets approach to health care and sedentary lifestyle are all major factors in creating the current scenario.Its like a bad spiraling black hole which only sucks you into unnecessary and wasteful consumption of health services.

Keeping the whole machinery ticking seems to be the raison d'etre of patient existence.

This video below touches on a few reasons on why health care is so expensive in America. Features like this convince that India must be doing something right in its public health policy. I have been a member of Public health delivery system for about 10 years, in a wide range of positions and institutions. I fully appreciate Indian obstacles (population) and limitations (poverty) in public health delivery. A good step has been taken with the Swasthya bima (govt. sponsored health insurance with private partners). This Indian central govt scheme for BPL (Below poverty line) families is built on sound understanding of indian conditions and mindset. Eighteen states, including Rajasthan, have already launched this scheme. What is needed now is to make sure ALL BPL families OBTAIN an insurance smartcard. NGOs need to come forward to ensure all BPL families get their smartcards. The cost of the insurance is Ruppees 750/- annualy, 75% paid by central govt. and 25% state govt. The consumer would have to pay an annual Ruppees (Thirty) 30/- as registration/renewal fees. Then they would be able to use services at all public hospitals, many private hospitals and most specialist health care institutions all over the country with the help of a single smartcard!! The claims section of the scheme still has to show efficiency. But all in all, its a very well thought out scheme and should work wonders in more ways than one.This would also have a trigerring effect for adoption of EMR(Electronic medical records).

http://www.youtube.com/watch?v=JYC2DJWU41s

Nov 8, 2008

- Al Gore knows it.

Image by World Economic Forum via Flickr

Internet revolution that elected Obama could save Earth: Gore- Internet -Infotech-The Economic Times

In this article, Al Gore comes across as a very sharp observer of the power of internet. As expected, internet ( and web 2.0) has evolved along commercial lines. Its time social sector is similarly boosted by intelligent use of the real-time 2-way connectivity provided by the internet.

The scope of using these services in public health is a very fertile field.
Education, training, Information, Interpersonal communication, Data gathering, Remote/ Telemedicine, Real time decision support in interventional medicine, Telepathology, Teleradiology, i could go on and on.

Hope i can make a difference with my RAKSHA ( Registered society for knowledge and health).

Nov 7, 2008

-Where are the Doctors?, says "Assocham", Indian industries.

India lags in primary health, lacks specialists : iGovernment

New Delhi: About 50 per cent of sanctioned posts of specialists
at various community health centres (CHCs) throughout India are vacant,which shows that the primary health still remains the lowest priority of state governments including union territories, reveals an industry lobby report.

According to the Associated Chamber of Commerce and Industries (Assocham) Paper 'Role of Health Insurance in Medical Care in India', 59.2 per cent of posts of surgeons, 46.4 per cent of obstetricians and gynaecologists, 56.6 per cent of physicians and 51.9 per cent of pediatricians are vacant in the 4,500 CHCs in the country.

Releasing the paper, Assocham President Sajjan Jindal said that 2,525 CHCs should have been added to current operational community health centres that number around 5,000 by end of 2007-08 which did not happen at all, speaks of utter apathy that state governments observed towards them.

The CHCs are supposed to provide specialised medical care in the form of facilities of surgeons, obstetricians and gynaecologists, physicians and paediatricians throughout the country to promote rural health.

Even out of the sanctioned posts, a significant percentage of posts are vacant at other levels. For instance, about 8.8 per cent of the
sanctioned posts of female health worker are vacant as compared to about 32 per cent of the male health worker.

At primary health centres (PHCs), about 13.8 per cent of the sanctioned posts of female health assistant and 22.1 per cent of male health assistant are vacant.

At the sub centre level, the extent of existing manpower can be assessed from the fact that about five per cent of the sub centres were without a female health worker, about 37.2 per cent sub centres werewithout male health worker and about 4.7 per cent sub centres were without both female health worker as well as male health worker.

This indicates a large shortfall in male health workers, resulting in poor male participation in family welfare and other health programmes, the Assocham paper said.

About 5.6 per cent of the PHCs were without a doctor, about 40 per cent were without a lab technician and about 17 per cent were without a pharmacist.

The chamber has, therefore, recommended that states who manage these centres should attach equal priority to their well being just as they take up issues of creating infrastructure such as roads, ports and aviation.

Nov 6, 2008

-Palliative care in Cancer-

Most People do not realize the importance of palliative care. in Cancer.

Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than striving to halt, delay or reverse progression of the disease itself or provide a cure. Palliative care is an interdisciplinary team approach, with a focus on comfort and quality of life rather than prolongation of life
or "cure" for a patient.

With better drugs and technology, we are dramatically improving the survival in cancer patients. New studies are carried out everyday to find new cures.Unfortunately, the research frequently focuses exclusively on survival as an endpoint, leaving surgeons with little information on an
intervention's impact on QOL (Quality of Life).

There are multiple examples of problems that can affect the QOL for a patient facing the end of life. These can be categorized based on symptoms or systems in the body that are affected. Major symptoms include pain, dyspnea, anorexia, and depression. Related to body
systems, one can imagine a potential symptom related to each body system. Neurologic problems include fatigue, headache and other pain syndromes, and delirium. Pulmonary complications include dyspnea, fatigue, and immobility. Cardiac symptoms include shortness of breath, fatigue, and pain. Gastrointestinal problems include obstructions, diarrhea, nausea, vomiting, and anorexia. Musculoskeletal complications include fractures, functional loss, and pain. Epidermal problems mainly focus on wound problems, but also can include poor cosmesis and pain. Complications related to the hematologic system include infection and fatigue. Urologic problems include ureteral obstructions, bleeding, and pain. It is this compendium of problems that palliative care research focuses on, rather than increase in survival time or cure. We need more research to focus on these problems of the people who survive cancer.

There are many potential reasons for the lack of palliative care research. Many of them are related to ethical aspects of this research.There are also innate barriers, such as a lack of trained researchers and the challenges of subject recruitment.

For the original article, click here.

Nov 1, 2008

- Better radiotherapy at Tata memorial cancer Hospital-

I am referring here to something which appears under the heading (?)
Official Google Blog.

"One of India's leading cancer hospitals will expand its program of
advanced whole-body radiosurgery with the acquisition of a
Varian/BrainLAB Novalis Tx™ radiosurgery platform"

"Varian and BrainLAB joined forces late last year to introduce the
Novalis Tx and Tata Memorial is the first hospital in India to order
this advanced solution"

"Novalis Tx offers radiosurgery for malignant and benign lesions
throughout the body, arteriovascular malformations, and functional
lesions. It features very high dose delivery rates, which means that
treatments can be delivered very rapidly. Novalis Tx also offers
dynamic ultra-fine beam shaping and frameless patient positioning for
more rapid and comfortable treatments. The platform also includes an
On-Board Imager® device for pinpointing the tumor and positioning the
patient with sub-millimeter precision"

Tata memorial has always been one of India"s finest cancer hospitals and it is not surprising that the hospital has teamed up with Varian medical systems( Paolo Alto, California) and BrainLAB ( Munich, Germany) to offer better and more precise radiotherapy to its patients. Good use of technology and software for better health care. I love it!!

I have been a longtime fan of Dr.Anita Borges, Pathologist @ Tata memorial cancer hospital and i know that Tata memorial cancer hospital will make good use of its superb diagnostic and treatment resources.

Catch cancer early and "fry" it precisely.

Oct 30, 2008

- Podcasting from Yale medical library-

Yale medical library published an interesting study-cum-project-cum-guide for use of screencasts and podcasts by medical learners.

The study finds many more off-campus users of the medical podcasts and videos than on-campus users. Not surprisingly, the cost benefits were very obvious. What i found particularly arresting was the suggestion of using only 1 to 3 minute long videos for teaching purposes. I would have thought that Ten minute videos would prove very effective. But apparently, yale students have difficulty viewing high quality content for more than a couple of minutes!!

See this slideshow for the complete report.

Screencasting and Podcasting: Experience of the Yale Medical Library

View SlideShare presentation or Upload your own. (tags: cla yale)

Oct 27, 2008

- Imaging technologies, Connectivity and the markets.-

Let the commoditization of medicine begin! | Trusted.MD Network

I was tempted to read this article, though the headlines(COMMODITIZATION of medicine) don't appeal to the Human rights aspect of my personality. I find the choice of word very cynical and it brings to question the motives of the author. But the services he describes are definitely noteworthy.

I believe the author talks about providing the best radiology service in the most cost-effective manner. Looked at it this way, the services provided by Nighthawk teleradiology services is a boon for patients.It has the potential for bringing down the costs of healthcare. Any measure taken to reduce health costs will benefit the patient, even if the healthcare is being provided via third party ( Insurance) paying for the service.

Telerays.com is a new service allowing bidding for radiology services. You can understand more about the process here.

Since radiology involves interpretation of digital images, it makes real sense to get the best doctors at the best prices (wherever they may be) by making good use of technology.. Simple economics here. And, i dont think quality will really suffer. After a few possible initial hiccups and pruning out of "sub-standard" opiners, I am sure only quality work will prevail.Quality radiologists will always get work, wherever they are. Teleradiology services now being woven into this kind of business model shall definitely be a positive step towards health rights.After all, "TIMELY, best possible quality healthcare for all without discrimination" is what health rights is all about, in essence.

Wonder when will a chunk of pathology services go this way. Very soon, i believe.

Imaging technologies, Connectivity and the markets.

Oct 25, 2008

- Web 2.0, Copyrights and Plagiarism-

the Web2.0 Rights project.

Web 2.0 has changed many things. But the most profound change, IMO, is in the field of Intellectual Property Rights.

New content is being created collaboratively, from distant locations. We now have the concepts of Joint authorship and joint ownership. Joint authorship means a work produced in collaboration by two or more people, where the contribution of one is NOT DISTINCT from other collaborators.The term joint ownership refers, in general, to a situation in which two or more persons share interests in property rights.Performers rights are another important field because of easy distribution of videos online (Youtube) . Many IPR theories have not yet been tried in court, especially in use of deep linking, embedding of content and use of crowd sourced content.

When one talks of IPR, how can talk of plagiarism stay far behind?

According to Wikipedia, Plagiarism is the unauthorized use or close imitation of the
language and thoughts of another author and the representation of them
as one's own original work. Plagiarism is a huge problem in schools with thousands of students passing off content from the web as their own content. But it is now quite simple to detect frank plagiarism. One way is to use "" quotation marks and search within google. Advanced search features of google allow for better search of copycats.You can learn using gogle to detect internet plagiarism on this link of Marywood university Library.

You can check whether your own content is being copied elsewhere by using copyrightspot.com. You can also download free software for detection of plagiarism here.(University of Virginia).

You can access useful links to sites on Plagiarism here.

This link talks of everything related to IPR in the Web 2.0 environment. Check it out.

Oct 22, 2008

- Imaging techniques in Pathology-

Israel's ASI gives pathologists a vital second opinion - ISRAEL21c

-I have written previously about the subjectivity involved in the practise of Pathology. Its difficult to get two pathologists to agree on any one diagnosis if both pathologists insist on looking at the case through the prism of their own experiences.Besides, it is always tough disputing any one"s diagnosis as it is merely an opinion and reflects the Pathologists own "view" of the case.

Now, ASI (Applied Spectral Imaging), a privately held company in Israel has come up with a colorful solution for the problem. Instead of depending totally on the "morphology", ie shape and size, it provides a way to visualize the antigenic proteins present in the tissue. Using their Spectracube family of products, It allows researchers to distinguish between
different materials on a chromosome by highlighting its features with
unique colors, instead of the black dye that had been used previously. This leads to better identification in suspicious cases and the test also lends itself to reproducibility.

The company has already launched " TB Finder" in the market.In addition to TB Finder, ASI is already selling
or planning to market additional tools for pathologists, including
PathEx, as well as for morphologists, who examine protein structures
and alterations in cell structures.

The company presently promotes its products only as a backup / second opinion. But this seems to be more out of its desire not to rub the so-called "Specialists" the wrong way. Being able to corroborate one"s opinion by a scientific and a reproducible test is a tool sorely needed in the practise of Pathology. I shall not be surprised if such corroboration of opinion of a pathologist soon becomes a norm rather than an option.

All in all, a very very useful service to improve accuracy of diagnosis.

- Imaging techniques in Pathology-

Oct 19, 2008

- Telepathology made simple-

MEDTING - MedicalTube, medical meeting; exchange video and image

"MEDTING is a clinical web portal that provides a platform for exchanging clinical cases, images, and videos. Physicians can post clinical cases with associated images or videos for discussion among colleagues. In addition, independent images or videos can be sent to the Atlas space for other to review. Other members of the community can then vote and write comments on the cases and images posted."

Medting allows doctors from around the globe to offer their opinions on any histopathology slide (or any other clinical image). Any doctor can upload the facts and images related to any case for second opinions from experts all over the globe.Patient privacy is not compromised as names are not revealed and the site claims to be 100% HIPAA compliant.

The images uploaded presently on the site were of very good resolution. One could easily scan the whole slide, Zoom in on interesting areas of the slide, leave comments, tag images, share them, etc. It provides an excellent collaboration platform and can serve as an excellent educational tool. At present, it boasts of 1840 cases and 15760 images and videos. Cases and images are tagged with keywords using the SNOMED CT terminology.

Medting also offers premium membership and individual institutional support.

I like their service, though it is still very BASIC and has tremendous scope for improvement.

Medical consultation on the Move (medical-communication.blogspot.com)
Web 2.0 in health (neeleshbhandari.blogspot.com)
Using Cellphones to diagnose Malaria and Blood disorders (meducationtechnology.blogspot.com)

- Telepathology made simple-

MEDTING - MedicalTube, medical meeting; exchange video and image

As a pathologist, I know the importance of collaboration and second opinions. The practice of pathology is sometimes very subjective and its not unusual to get three different diagnosis for the same tissue sample/ histopatholgy slide from three different pathologists.Besides, all pathologists at one institute tend to think along similar lines, further increasing chances of bias. But getting distant doctors to review any one case and histopathology slide has been difficult till date. The best we could do was "store-and-forward" telepathology, where the images of a histopathology slide were forwarded to known experts via email for second opinion. A very primitive means of practicing telepathology, if i may say so!

Enter Medting.

"MEDTING is a clinical web portal that provides a platform for
exchanging clinical cases, images, and videos. Physicians can post
clinical cases with associated images or videos for discussion among
colleagues. In addition, independent images or videos can be sent to
the Atlas space for other to review. Other members of the community can
then vote and write comments on the cases and images posted."

Medting allows doctors from around the globe to offer their opinions on any histopathology slide (or any other clinical image). Any doctor can upload the facts and images related to any case for second opinions from experts all over the globe.Patient privacy is not compromised as names are not revealed and the site claims to be 100% HIPAA compliant.

The images uploaded presently on the site were of very good resolution. One could easily scan the whole slide, Zoom in on interesting areas of the slide, leave comments, tag images, share them, etc. It provides an excellent collaboration platform and can serve as an excellent educational tool. At present, it boasts of 1840 cases and 15760 images and videos. Cases and images are tagged with keywords using the SNOMED CT terminology.

Medting also offers premium membership and individual institutional support.

I like their service, though it is still very BASIC and has tremendous scope for improvement.

Oct 17, 2008

- Health support services in Hindi-

Many Seek Second Opinions From Health Sites and Online Communities - NYTimes.com

Web 2.0 has certainly changed the way Medicine is practiced.
Now, if you are a lazy Doctor, your patient might come to you with more knowledge about his own disease than you do!! I cant help feeling amused when i think of some of my classmates and how they would be coping with today's super-informed patients.

And its not just about the information available to the patient.
Its also about the support.

Its easy to join any forum/group of people having the same illness as you. Have a Migraine? Log onto the headache blog and find out how other people are coping with theirs. Want to talk to someone about your migraine? Join a chatroom. Want some advice from a doctor? Log onto the Live chat service of Organized wisdom. Want to know more about the drugs the doctor prescribed you? Check it here. The options available are endless. Gone are the days when the doctor simply prescribed you acetaaminophen and sent you home.

My only crib is the lack of such resources and support in the Hindi language.Hindi is spoken by almost 500 million people and is the third most spoken language in the world. Native speakers of Hindi dialects account for 41% of the Indian population.And yet, we have no such services available for this huge under served population.

I am hoping to soon start similar services in Hindi, encompassing the whole patient education and support services. I hope to do this through RAKSHA, a non profit organization working for democratization of knowledge and health. This is a huge task and will take time. But then, SOMEONE has to do it. Why not me? :)

Read the original article here.

-Obvious uses of data and technology-

Scientists to use satellite imagery to predict disease outbreaks

At last, scientists are correlating what they know and what they see to come up with new ways to fight diseases.

Seen from a distance, both figuratively and literally, it is ridiculously easy to predict an epidemic or infectious disease outbreak.All you need is good dependable information about the current environment at the location. Tie this up with what we already know about the infectious agent life-cycle and the disease process and Voila!- We have our own Crystal Ball.

Scientists now plan to use satellite imagery to predict some seasonal and climate dependent infectious diseases like Cholera. Similar models can later be developed for other diseases like Hepatitis A, Malaria and Leptospirosis.

Hoping more money is spent on such life-saving use of Technology in preventive medicine.
Read the original news item here

Oct 16, 2008

-Web 2.0 strategy for Business-

Ten Aspects of Web 2.0 Strategy That Every CTO and CIO Should Know [Dion Hinchcliffe's Web 2.0 Blog]

Web 2.0 has changed the way things are or can be done. Organizations need to adapt to these new trends ASAP. A few key points of note for business to survive in the new world-

# It's not about technology, it's about the changes it enables.
# The implications of 2.0 stands many traditional views on their head and so change takes more time than usual.
# Get the ideas, concepts, and vocabulary out into the organization and circulating.
# Existing management methods and conventional wisdom are a hard barrier to 2.0 strategy and transformation.
# Avoiding external disruption is hard but managing self-imposed risk caused by 2.0 is easier.
# Incubators and pilots projects can help create initial environments for success with 2.0 efforts.
# Irreversible decisions around 2.0 around topics such as brand, reputation, and corporate strategy can be delayed quite a while, and sometimes forever.
# The technology competence organizations have today are inadequate for moving to 2.0.
# The business side requires 2.0 competence as well.
# Start small, think big.

-Web 2.0 strategy for Business-

Oct 15, 2008

-Characterstics of a medical blogger-

Examining the Medical Blogosphere: An Online Survey of Medical Bloggers | Kovic | Journal of Medical Internet Research
Blogs are the major contributors to the
large increase of new websites created each year. Most blogs allow
readers to leave comments and, in this way, generate both conversation
and encourage collaboration. Despite their popularity, however, little
is known about blogs or their creators.This was a study on 197 medical bloggers, their backgrounds, blogging habits, reasons for blogging, etc.
Majority of medical bloggers were highly educated, white, American males, between the ages of 30 and 49 years.Almost half of them had a personal website before they started blogging. Most had been blogging for more than two years. More males offered news via RSS than female bloggers.

Major motivations for blogging were sharing practical knowledge or skills with others, influencing the way other people think, and expressing oneself creatively. Making money and staying in touch with friends and family were not reasons to blog for a majority of the participants.
All in all, a very informative study. Read it here.

Health wisdom , not just information

I am always on the look out for web services delivering knowledge services in the field of health. I run a non-profit organization, RAKSHA, for exactly this purpose and seek new ways of achieving democratization of knowledge in health.

Organized wisdom is a well thought out web service. This interview with the team at Organized wisdom clearly spells out their views and visions for this knowledge service. The talk with their Chief Medical Officer, Dr. Howard Krein and Esther Dyson , one of the investors was very interesting.

The service claims to be " a free service that provides patients with easy access to the best information available in easy to navigate Wisdomcards, helps patients to prepare for their appointments and helps streamline some to the conversations that must take place."
So, I decided to explore this service logged in as a patient searching for information about my imaginary headache. The first thing i noticed was the cleanliness of the welcome page. Simple, no unnecessary multimedia ( as is VERY often the case with medical information sites) and therefore, fast navigation between pages.

The fonts were friendly, the letters bold and easily legible. It didn't intimidate me, as a patient, with its vastness of information. There was a large search box in a major location with built in prompts via a drop down menu. So far so good.

What really won me over was the neatly laid out information. Not too deep on the first page, just plain English medical speak for an average person.There were links to more scholarly items, but everything i could possibly want to know as a patient was easily available within 2 degrees of separation. There were links to support forums, foundations and drug information ( again in plain English).There were chat rooms, message boards, personal blogs, every useful service i can think of today. They were also initiating a" LIVE chat with a doctor" service, which is now in a beta phase.

All in all, I really liked this service and i am sure something like this will soon be up and running in India, preferably in the Hindi language.
Amen.

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