Pat Stricker, RN, MEd

Senior Vice President

In 1950, the medical knowledge doubled every 50 years. By 2020 it will double every 73 days. Based on this, and the fact that other technological advances may increase this even more than currently predicted, how can we expect physicians to keep up-to-date on medical knowledge and evidence-based guidelines for all possible conditions, with variable dependent on their individual patient’s unique situations? Is that reasonable or even possible?

I recently read an article about a study at a large medical center that used Best Practice Alerts to help physicians determine the appropriate next steps in a patient’s care, based on evidence-based guidelines. Physicians do their best to follow the best practices, but it is almost impossible. However, now with the help of artificial intelligence and information technology, specific information based on the patient’s condition can be provided to the physician in real-time at the point of care, as he/she is writing the order.

The study embedded electronic alerts in the EHR system.  At the time the physician submitted the order, the computer system gathered vital statistics about the patient from the EHR and determined if the order met evidence-based guidelines. If it did not, the physician received an alert explaining why it did not meet the guidelines and seeking a reason for overriding it. The physician then had a choice to change the order to meet the guideline or override the guideline and keep the original order, due to specific situations related to the patient’s condition. The study only used 18 alerts out of hundreds of possibilities to reduce the number of pop-ups, so physicians would not become fatigued and begin to ignore them.

The study involved nearly 26,500 patients admitted over 3 years. Results of the study showed that encounters that did not meet the guidelines but were overridden by the physician: increased costs by 7.3%, increased length of stay by 6.2%, increased readmissions rates within 30 days by 14%, and increased complications by 29%. While there may have been good reasons for overriding some of the guidelines, the study did show that using the guidelines would have made an impact on outcomes, as well as costs.

As for the information being provided to the physicians, I’m sure some probably liked it while others may have thought of it as an intrusion into their normal routine. But with the enormous increase in the number of treatment modalities today, it seems like it would be a definite help for medical professionals to have a decision support system, such as this, to help them make decisions.

This made me look into other new innovations being used today or being studied for future use.  While some of these are very recent, others may have occurred in the past few years and I was not aware of them. I hope they are all new to you also. I have included links so you can obtain more detailed information, if desired.

 

Screening Test

  • Eye Exam for Alzheimer’s: A new retinal scan using polarized light shows promise in being able to identify the risk of developing Alzheimer’s disease by detecting beta amyloid plaques. This could lead to earlier detection and treatment, thereby improving quality of life and overall outcomes. This is also less expensive and less invasive than the current methods of using PET scans and lumbar punctures.

 

Wearable Devices

  • Skin-like Wearable Monitors: An “electronic skin”, developed of silicone that adheres to the skin like a Band-Aid and can be used on any area of the body, sends data to Smartphones. It is being studied in rehabilitation settings to monitor vital signs, gait, range of motion, and speed or duration of motion. Other studies will be looking at other areas of use for this technology.
  • Parkinson’s Postural Instability: Postural instability and muscle weakness cause about 60% of people with Parkinson’s Disease to fall each year, leading to loss of independence and other more serious complications. The American Parkinson Disease Association (ADPA) funded a grant that developed a small, lightweight, biofeedback belt lined with sensors that transmit real-time mapping of movements to a smartphone application. In turn, the belt makes the patient feel as if the physical therapist is touching them and guiding their  Initial studies showed “noticeable improvement” in performing daily activities and physical therapy exercises at home because patients felt safer and more confident in their movements.
  • Scalp-Cooling Cap to Reduce Chemo-Related Hair Loss: Scalp-cooling caps were approved in 2015 by the FDA for “reducing the frequency and severity of hair loss” in adult patients with solid tumors receiving chemotherapy. (These have been available in Europe for several decades). While the loss of hair may seem like a minor issue to some, given the gravity of the overall cancer diagnosis, however, one in 12 women with breast cancer avoid chemotherapy for fear of hair loss. In initial trials about 50% of the women who used the cap kept some or a large amount of their hair and didn’t have to use a wig. These results mean nearly 800,000 Americans could avoid significant hair loss and it could make women more comfortable in deciding to take chemotherapy, if needed.
  • Oxygen Glasses for COPD: Oxygen glasses offer an alternative to having to wear a nasal cannula. The frame of the glasses conceals small tubes that can be inserted into 1 or both nostrils. The tubes continue down each stem to the back of the head where the tubing is connected to a small oxygen canister that can be hidden under loose clothing or carried in a small pouch. While the tubing can still be seen if viewed closely, it is not very apparent. This gives those who are self-conscious about going out in public, because of their nasal cannula, a “fashionable” alternative that most people won’t even notice. This has the potential of increasing socialization and one’s compliance with oxygen usage.
  • Exoskeletons for Stroke and Spinal Cord Injuries: The FDA has approved several exoskeletons (a rigid external covering for the body providing support and protection) that allow patients who have had a stroke or a spinal cord injury to walk. This is not only a life-changing event for these patients, but eliminates wheelchair complications for them, e.g. digestive problems, heart disease and brittle bones.
  • Vibrating Insoles: Age, diabetes, and nerve damage in the feet dull the sensors that help maintain balance, thereby causing a potential for falls. Foam insoles, with embedded actuators that provide stimulation that feel like pressure or movement, have been developed to mimic the nerves in the feet. Studies showed these insoles significantly  improved their balance.

New Treatment Innovations

  • New drug for Multiple Sclerosis – Most treatments for MS target T cells, a type of white blood cell. A new drug has been developed that targets B cells, another type of white blood cell. The drug is undergoing multiple studies but is showing promise in initial studies in being able to reduce symptoms, slow the progression of MS, and reduce relapses when drugs targeting the T cells are not effective.
  • Immunotherapy Drugs for Cancer: These types of drugs work with the immune system to help fight cancer. They are used with or instead of traditional chemotherapy and have shown great promise. One of them, Keytruda, was used in 5 trials with 149 people who had 15 different types of cancer. Almost 40% saw the tumor shrink or disappear and it lasted for at least 6 months for 78% of the patients.

New Technological Advances

  • Artificial Retinal Implant: A artificial retinal implant that provides limited vision to patients with retinitis pigmentosa, will now soon be available to patients with all types of blindness. This “bionic eye” consists of an implant on the retina and glasses containing a tiny video camera. Truly amazing!
  • Virtual Reality (VR) for Chronic Pain Relief: Studies have shown that VR headsets immerse people in a virtual world, thereby distracting them from their chronic pain. Patients have reported a 24-60% reduction in pain while being engaged in a VR experience. Some even reported pain relief for at least a day after the experience.
  • “Smart Gloves” for Gaming: “Smart gloves” are designed to reduce the monotony of stroke rehabilitation exercises. They allow patients to play more than 45 games designed to target specific goals to improve wrist motion or finger dexterity. The rehab still gets accomplished, but it’s a lot more fun.
  • Artificial Pancreas”:  The artificial pancreas was approved by the FDA in 2016. This device, worn externally, communicates with a sensor in the abdomen to monitor glucose levels and administer appropriate insulin doses via a pump. It has drastically changed the lives of many insulin-dependent diabetics and has been shown to maintain steady glucose levels and has even dropped A1C levels by a half percent. Further work is being done to make it a stand-alone closed-loop artificial pancreas.
  • Earlens Hearing Device: An innovative hearing aid approved by the FDA in 2015 uses a laser light signal and direct stimulation in the eardrum to amplify sound. This has been found to help those who haven’t had success with traditional hearing aids. This innovation is particularly important in light of research that shows that hearing loss may be associated with impaired memory and an increased risk of dementia and Alzheimer’s disease.

(Note: With artificial intelligence, the retinal implant, artificial pancreas, “electronic skin”,  and exoskeleton we are on our way to creating the “Bionic Man” (or woman)!  This is just a little reminder for those of us who remember this TV show from the mid-70s. We thought it was science fiction then, but it is becoming a reality).

It is totally amazing to me how medicine has changed since I started my nursing career. I’m going to show my age here, but at that time we primarily worked in a hospital, home health, or a doctor’s office. Urgent cares, outpatient centers, and call centers had not been developed yet. All documentation was done manually and access to the patient’s record was only available if you were physically in the same room with the record.  It took 2 minutes to take a temperature because the lead thermometer needed to under the tongue (or elsewhere) for at least that long to register. FAX machines were the big technology innovation – making it much faster to get information than using “snail mail” through the Post Office. There were no cell phones, but pagers were being introduced so there was some connection without being physically connected to a land line. Informational content was only available in written material or books. Drug information was contained in a thick PDR (Physician Desk Reference) which was updated once a year. Medical information on lab values, procedures, surgeries, and other guidelines were available in small pocket-size books that were carried in the bulging pockets of lab  coats. I could go on and on, but…………

I know some of you cannot even conceive of what it was like to live in a non-internet, non-computerized world!  I can’t even imagine how we got things accomplished, but it seemed to go well at the time. We had no idea what was coming our way in the next 50 years, just as we have no idea what lies in store for us in the next 50 years. I can’t even imagine. Can you? I am sure it will be totally amazing!!