You are currently viewing What is wrong with you?

By Nahum Kovalski

If you are in the medical technology field,  I have one simple question: what is wrong with you? Do you have something against patients? Do you enjoy seeing people being sick? Are you in the hospital business so that you make can money, the more people are ill? Or perhaps you are in Pharma and you make money the more pills that people take? I am asking this question very seriously because I find it hard to believe that simple lack of vision and plain stupidity are the reasons why so many obvious medical applications are not being developed. If you do have access to money and engineers and you are looking for ideas, I would be more than happy to share what I know. But if you have an ulterior motive for keeping doctors and patients dumb, then shame on you.

I was just reading a review article talking about the  importance of having competition amongst the major players in technology. The article I refer to  appears on the online magazine “The Verge”, which is an excellent commentary on the state of technology. The title of the article is “Apple and Google are playing catch-up and that’s a good thing”. When Apple introduced the iPhone, the world gasped. It shouldn’t have. What Apple demonstrated on that day, in the hands of the near divine Steve Jobs, was not a piece of hardware that was generations ahead of its time. Steve did not first create time travel to reach forward and snag a piece of silicon that would make the iPhone unique. I also think it’s fair to say that the iPhone was not reverse engineered from Megatron. But Steve Jobs captured the imagination and the sense of potential of every one around the world. Every prediction about the spread of technology before the iPhone presentation went straight into the garbage, and we were all witness to a new world.

Less than 10 years later, Apple is worth half a $trillion but is actually facing a battle, potentially for its very existence. Regardless of how well Apple tries to play business as usual, the death of its prophet has seriously hurt it. When Apple introduced its latest tablets with the addition of a stylus, something that Steve Jobs literally called “uchhhh” and “yuck”, there was a collective gasp from the audience. How could it be that in so short a time, he who saw all was being overthrown within his own kingdom. Could it be that Jobs himself would have eventually agreed to include a stylus with iPads? It’s possible. But at least there would have been an explanation. Human beings are much more comfortable with gods that explain their actions.

There was no other way to interpret this back step as anything other than fear. Apple feared its competition and felt that it could not achieve its maximal potential without adding the hated stylus. Could this mean that Jobs was fundamentally wrong about how iPads should be used? This has even more of a serious negative message than ignoring the 10 Commandments of your prime prophet. If your prophet was wrong, even once, could he have been wrong about everything?

These days, there are other phone makers who are a serious challenge to the iPhone. And despite the throngs of people who would stone me for saying so, I still personally believe that the Android ecosystem is superior to iOS. I enjoy my android phone, and interacting with multiple android apps via my chrome browser, all the while running a Windows 7 machine. Although my home laptops and 2in1’s are Windows-based, I’m seriously considering buying a chrome machine for my next laptop. The one application that I still find superior on Windows than on chrome is Dragon naturally speaking, which I’m using to dictate this blog post [and every one of my previous blog posts]. I haven’t made much of an effort to look for an alternative since I always dictate my blogs while sitting at my main computer station. But I have no doubt that I could find something sufficiently similar [including the built-in voice to text feature in chrome] if I needed to.

What that means is that even though I am Windows-based, I can transport my entire work environment to any machine, including an Apple, as long as it supports a chrome browser. This degree of mobility was a dream, not that many years ago. Considering that I keep all of my essential files on Google Drive, I really can just move to a new machine. Admittedly, the one thing missing is my list of desktop icons. I should back this up at some point, but I’m too lazy. My entertainment these days comes a great deal via Netflix and Marvel comics subscriptions. And I hear that there are some people who make use of illegal websites to watch every TV show and movie that they follow. We live in the clouds, just like the gods of ancient times. And I personally have no desire to ever touch the ground again

In relation to health care, I’ve seen advertised at various points of development, devices and even independent robots that can freely interact with an individual. I have spoken about the obvious benefit of such devices. Rigidly attach such a device/robot next to the hospital bed, or on the hospital bed, of every patient, and you have a digital ombudsman who can answer any professional or private question that arises during the treatment of the patient. “Hello Google”, “please tell me what medications this patient is presently taking and at what doses”. Given the technology demonstrated by Google at last week’s I/O conference, there is absolutely no reason why Google home  could not become a permanent 24/7 watchdog over each and every patient, totally  specific to the patient in question. As Google itself described this technology:

One of the top announcements in the keynote was Google Home. Like the Amazon Echo, Google Home is a multi-functional smart device that lives in your home. It’s designed to integrate with everything and exists as a voice-activated device that sits in your home as a hub. It can use Google Assistant to interact with a whole load of different services, from changing your calendar appointments, acting as a Chromecast for your music, turning your lights on and more.

Imagine the nurse approaching a patient with the intent of giving that patient a medication. The patient or possibly the nurse announces the fact that “I am now giving/receiving” regular medications. Google home checks the patient’s charts to verify those medications and asks what specific pill is being handed to the patient right now. When the patient or nurse announce that the pill is one that is not on the patient’s list, and worse, can counteract with a medication already on the patient’s list, a siren will literally sound and a note will be made in the chart that the medication being given is highly problematic, and an email, SMS, hangout message, Allo message  and any other communication tool you wish, will inform the treating doctor of this fact. Now if the medication has been okayed, it is simple enough to add the medication to the approved list of medications that the patient is receiving and from that point on, Google home will stay quiet.

Let me be clear – the medical literature has already demonstrated that patients who have family representatives by their side 24/7 receive better care than patients who are alone. It is a surety that patients. who have a medical watchdog who validates everything done to the patient, will receive better and safer care than they receive now. As I have recently stated in previous blogs, 400,000 deaths occur every year in the United States due to malpractice. Having such a technology integrated into standard medical practice will make a huge difference. Ideally, the EHR that guides the patient’s care should be watching out for such things. But the profit oriented EHR companies that interact with ignorant, stupid, uncaring, and money driven staff in varied medical services do not protect patients sufficiently. I believe that there is a hope that the Google home version of the medical ombudsman will be generalizable enough so that  the warnings built into it will override the failings in the EHR, that the particular medical service is using.

Google also announced a competitor to Apple FaceTime which is intended to provide a one to one encrypted visual conversation between two individuals. I don’t know about you, but this sounds like a HIPAA wet dream. When faced with a patient whose care is suspect, or a patient who presents with a syndrome which is not yet diagnosed, Google’s DUO would allow for two professionals to safely communicate visually. Any information could be shared across this connection. Assuming that the medical chart is protected by the appropriate encryption, the physician at the bedside need only specify the patient number and then both doctors on each side of the conversation can be looking at the same material at the same time. The x-rays included in the EHR that I designed are also HIPAA compliant. It wouldn’t take too much money or expertise to have a 12 inch dedicated tablet on each hospital bed. This could be used for looking at x-rays, lab results, and anything else pertinent to the patient’s care.

I am a man of ideas. My EHR, which has been recognized even internationally as being of the high quality, was derived from my personal experience and vision of what an EHR should be. With the right engineers, integrating existing technology into my EHR would be straightforward and take little time. Of course, my personal wish would be for such EHR additions to be modularized in such a way that they could be plugged into any other competing EHR.

Why would I want to make it easy for other EHR’s to make use of technology that I have designed? Because I’m a doctor. And because every single doctor should always be thinking about how to maximize the care that every patient gets. And if you are lucky enough to have an idea that is marketable, then you should do everything in your power to get that idea out to the market. How will you make money off of this? Good question. I am sure you know plenty of marketing people who can help you with this issue. In the meantime, share your ideas and your technologies with your colleagues for the benefits of the patients. I know it’s a radical idea to put patient care before income. In a previous place of work, the foundation of the company I worked for was destroyed by people who were financially well off but were still greedy to the point of needing more. They destroyed potential, they destroyed hope. And I bet these money-grubbing animals don’t even feel the extra money they’ve made.

My email is open at all times and I am happy to consult with any company that would like to explore these ideas. I wholly admit that I would hope to make a salary for my work. But there is a huge chasm between making a salary that leaves room for investment in technology, versus making “a score” that interferes with proper technological development.

Thanks for listening.

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