Many central office / autodialer systems are advertised on TV, and in print media and as such are the most well known approach to medical alarms/monitoring. Some are connected with medical centers and/or pharmacies.

The benefits of such systems are:

1. 24/7 central office availability, this is perhaps their biggest and best feature if done well.

2. The ability to talk with the central office after pressing an alert button provides for optimal response. Ie not every emergency requires EMS response, and such a method also reduces the potential for un-necessary EMS dispatch and/or false alarms.

3. The alert pendants are water proof, and can be worn anywhere and at any time.

4. The alert pendants have integral batteries with long life spans and as such do not require periodic charging. In order to maintain the pendants water proof status, batteries in generally are not user-serviceable. Fortunately, many systems do a periodic battery and diagnostic check and transparently send the data to the central office. Such an approach if handled well mititgates much of the the danger of system failure, in that replacements can be made well before any type of device failure occurs.

5. Most systems will operate even in the event of a power failure, as long as the local telephone system does not go down… subject of course to the limits of the systems internal battery.

6. The physical hardware is based upon exceedingly stable autodialer technology, robust analog telephone systems, simple rf remote control systems, and as a system in general is decently robust. In addition, such equipment is also under the FDA’s pervue as a medical device which serves to keep most sub par manufacturers and counterfeitors out of the business.

6. The central office is in possession of a lockbox keycode and physicial location of said lockbox just outside the customers dwelling. The idea of such, is that a neighbor, or EMS responder can be given said keycode when called out. The ultimate advantage, is that a neighbor or EMS provider can use a customer’s door key for entering the dwelling without the need to physically break a door or window. Likewise, after an activation, it is very easy to update the lockbox keycode on site and at the monitoring center and thus maintain the security of the customers home.

7. The setup and configuration / activation and test of said systems has the potential to be near 100% automated, after the customer connects it to the phone line, and plugs the power supply into a wall outlet.

However, such systems are subject to a number of shortcomings.

1. The sales techniques and business practices of some of the various vendors are worst than those of the worst used car salesman and/or loan shark firm.

2. The ability to talk with the central office after pressing the alert button is exceedingly limited. Yes, in an outdoor super quiet environment, such systems may allow for communication up to a 50 meter range. However, if one is using a shower or running water, wears a hearing aid, and/or has a tv at high volume, or is on another floor other than where the main unit is located, the probability of a successful verbal communication is exceedingly low.

3. 24/7 central monitoring centers vary a great deal in service and response. Most are UL listed, but even then, service can vary widely. A few vendors outsource their monitoring services to a third party, some of which are better than other internal operations. A good central office is worth its weight in gold. A bad one is worse than no system at all… the problem is, the consumer often doesnt know a good one from a bad one until its too late.

4. Such systems depend upon a users cognitive and physicial ability to press the pendant call button. In the event of a serious fall, and or partial dementia, the probability of the user pressing the call button is substantially reduced.

5. The costs of 24/7 monitoring can be substantial, to say nothing of other fees. Many systems would cost over $1000 for 3 years of service.

6. The alert pendants are typically worn around ones neck, and the FDA has reported cases of strangulation and/or injury when the pendant breakaway function did not work as designed.

7. As more and more people leave the world of analog telephone service behind, there exists a serious gap in this approach. VOIP is no where near as robust as analog telephone service, especially in the event of severe weather or electrical disruption. Likewise, cellular service is even worse in such regards, to say nothing of the massive issues involved with trying to couple an alert system to a cell phone.

8. While many hardware manufactures provide automated diagnostics to prevent failures and gaps in coverage, it is up to the vendor to step up to the plate when a device notifies them that it is in danger of failing. A good vendor manages this well, bad ones will drop the ball, and gaps in coverage are exceedingly possible.

9. Some pendant test procedures are excessively convoluted, which seems goofy in that weekly and/or monthly testing is highly recommended. Most assuredly if one of my customers had to jump said steps, they would quickly tell me to go jump… and they would be right.

The bottom line

Ultimately, this is a buyer beware industry to the max… Contracts need to be read through with a fine tooth comb, and likewise every t and every i dotted and double checked. Such decisions should never be made on the spur of the moment no matter how much pressure is exerted by the sales guy.

Some have suggested such integration could enable remote patient monitoring… which I think could be pretty cool. Of course the problem of patient education would need to be addressed, as well as healthcare system reimbursement, after all someone does have to pay. Adwords driven analysis of PHR captured auscultation data is probably not the answer.

Its also interesting to note the comment on the bluetooth stethoscope software.

Zargis(R) Cardioscan(TM) software easily pairs with the Littmann Electronic Stethoscope Model 3200 to guide the clinician through four main cardiac sites, then after approximately one minute, indicates whether or not the patient possesses a suspected diastolic or systolic murmur–and whether or not the murmur is suspected to be a Class I indication for echocardiography referral.

On the one hand, this could be a majorly cool thing. On the other… its sort of like an early stage autopilot. Bean counters will always push to cut costs, and the ability to shift intrinsic knowledge to automation is a major temptation. The intrinsic knowledge of a highly experienced cardiologist, is not the sort of thing that lends itself to automation, much less scaling.

Now, if the software can just take some of the routine burden away, ie running down checklists, and capturing the obvious, and thus open up more time for the cardiologist, its a good thing… the problem will be the bean counters temptation to replace experience and intrinsic knowledge base with technology.

I can understand the rationale….

The experiment comes amid rising concern among governments and health insurers that they are not seeing the health improvements claimed by drugs companies because patients do not take the medicines as prescribed unless they are closely supervised in clinical trials.

Yet, my thinking is, egads, there has to be a better way, and perhaps more importantly, a way in which to do so to avoid locking into a single vendor. Obviously while Novartis is not against a more elegant or transparent solution, they most certainly want some type of proprietary solution.

Certainly simple solutions which have been tried in the past, such as pill cap timers, or even timed pill boxes haven’t worked, probably because they require the user to transfer meds. In other words, the tech is not seamless. On the other hand, wearing a reader on ones shoulder isn’t exactly seamless either, but it is a lot more fool proof. Ie, the RFID reader only logs an event when the pill is within a few cm, thus ensuring a valid time/date stamp when the pill is actually swallowed.

Years ago, I was thinking of this as well. One of the ideas was a pill bottle holder with a strain gauge, such that every time the pill bottle was removed, an event was logged. In addition, the pill bottles quantity could be checked via weighing the bottle every time it was returned. The problems were two fold. First, its yet another gadget for the user to mess with, and secondly, just because the pill bottle was removed and a pill was removed, doesn’t mean said pill was actually taken.

Another idea was a pill bottle ring containing an RFID tag that could be transferred from bottle to bottle. A reader was implemented in a wristband, such that time and date stamps were made every time the bottle was opened. In addition to audio and visual reminders, it also had the provision to upload data to the internet for ease of analysis, and/or potential physician monitoring. Such a system also suffered the issue of transparency and extra gadgets. Alas, such was during the dot bomb days, and it also died on the vine.

The use of an internet enabled camera phone, ie Iphone or Android could drastically simplify record keeping, provide for some level of medical review, and thus increase compliance multifold, and potentially reduce the cost of medical services.

In a nutshell, custom code would provide the following:

• Reminder to take peak flow measurement
• Instructions as to take photo of peak flow device
• Image processing, likely offline, such that the numerical peak flow measurement can be extracted from the image data.
• Thresholds pre-determined via medical professionals based upon said numeric data as to course of action. Ranging from no-action to med changes, to head to the ER.
• Long term trend analysis, perhaps via an offshore version of Amazon’s mechanical turk (albeit comprised of medically trained personal)
• Periodic updates back to the phone screen as concerns asthma management.
• Provisions to do a datadump to healthvault, any number of medical databases, or even printouts, in order to share data with a medical care provider.
• Provisions to graph the data in any number of user customizations.

The above would hopefully provide the following benefits:

• improved patient compliance via simplified data taking
• improved patient care through better management
• reduced medical costs via offshoring lower level functions, reduction in the the need for onsite physician time, and reductions in un-necessary ER visits / hospitaliztion.
• much easier self reviews via graphical charts of the data, as contrasted with a worn tablet of numbers entered via a pencil.

Said code would not require new peak flow meters, nor a specialized cell phone other than a Iphone, or Anroid variant. The code for the most part only deals with the higher level phone functionality, thus providing for a range of potential phones, to say nothing of a reduction in obsolecence. The use of offshore medical reviewers offers significant cost savings, albeit there would be value in such a device, even if the iphone’s owner was just doing self reviews.

It should also be noted that any camera phone with the ability to email photos, and recieve SMS messages could be used is such a fashion, elbeit the computing power available is much lower, thus necessitating more offsite processing.

Wow, this is sad….

I did a bit of googling, and it appears the contemporary solution is video. Yet, to depend on video for safety assumes the entire field of view is covered, the optics are not dirty, and there is no oppurtunity for a child to run in from the side, being the camera’s field of view covers that as well. In order to do so, the only reasonable solution is a matrix of cameras, and ideally one from overhead, such that everything is covered.

Now, on the one hand, such accidents are pretty rare, 2500 injuries, and 100 fatalities per year. Thus an overhead wide angle solution would seem to be overkill. Yet, imagine the parent, who ran over their kid, and yet had gone to the lengths to have a video system installed.

Thus, I thought about this a tad more. An extremely simple solution has been around for over 50 years. The curb feeler, although back then, they just made noise, todays provide an alarm and indicator on the dash. Simple, inexpensive, and they don’t depend that you are looking at the video at just the right time to see a child run in front of, in back of, or to slide in front of a wheel of your car.<%image(20070623-feeler.jpg|575|431|Curb Feeler on 77 Cadilac)%>

Granted, curb feelers won’t prevent a sideways crush injury, or being hit by the undersides or other appendeges of your car. But they will alert you to stop before running over a child or even a pet with your wheel.

I guess the ultimate solution is a overhead, an undercarriage, and a rear fish eye camera, plus feelers as well as image analysis. On the other hand, a single simple camera, or feelers is better than no protection.

No matter what, if this happens, it is a very sad, and a very preventable accident, even with the technology we have today.

Health: FAQs About Melamine Contamination – US News and World Report

Hmmm, for adults and children the above statement is certainly true, but for babies, its a little different. There is variety, but some of the base ingredients are often times the same witin a given manufacturers product line. Then add in the low body mass of an infant, and this imho could be something to be concerned about, especially concering the somewhat ambiguous statements from the FDA.

Now, I would like to think that baby food regs are pretty tight, as far as process control, and monitoring the transit from field to home. Yet, I would have liked to have thought that the pet food manufacturers would not be so foolish as to be so dependent on one contract manufacturer.

Considering the problems with counterfeit infant formula some years back, I sure hope I am way wrong on this.

An interesting concept for sure, but I think they might well be missing a key issue of human body thermoregulation. Ie, when skin is in contact with a cold surface, vasoconstriction occurs, and as such, heat transfer is reduced. Thus, while the cooled handle bars might serve on the surface as a good idea, in practice may not be so effective.

However…. one can trick the human body a little bit, by applying a vacuum, and in doing so counter vasoconstriction. I am not aware of anyone doing this in the handle bar domain, although it is somewhat common in the arena of football and medicine, when palm based heat transfer efficiency is used for both heating and cooling. This is perhaps best demonstrated in US Patent 6966922 and as well as in commercial products such as CoreControl.

This is cool, especially since we prototyped something simliar back in 98, but thought it would never fly due to FDA hassles and product liability issues. It is great to see an outfit not let such headaches stand in the way, and make the call to plunge through them.

Whats cool, is based upon the about us section, is its a spin off technology from a govt grant for Medevac monitoring. The result, is that the upfront barriers we faced were less of a concern for them, as they already had government connections, and quite possibly, some initial test data right from the start.

To some extent, our industry experience led us to believe our ideas were impossible. In most cases, market experience is a help, and not a hindrance like it was for us. Yet, we had blinders on…. had we been not just looking at the standard way we did things, and had been open to SBIR programs and the like, perhaps we might have had something.

In the past, I was always a little negative on the SBIR, as its a upfront money loosing deal in many cases. The restrictions, and the low levels of funding often times make pursuit of an SBIR grant, a major pain. Yet, as shown in this case, its not the funding, but the connections, and ways to reach a market that do allow some really cool ideas and technology to make it to market, rather than to be shelved as bluesky stuff that will never fly.

This is a pretty impressive unit. Ultrasonic energy is used to create and direct a mist into a wound for debradement and cleaning. It should have significant impact for those with wounds that do not heal. In addition, the non-contact approach would also seem to improve patient comfort compared to a contact method.

I did a little bit of digging through the USPTO, and found the following patent. Its quite impressive, as is the list of prior art.

I wonder if the flickr guys ever thought their service would be used for xrays? An interesting concept, and a whole lot better than seeing someone kids who you don’t know.