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Health care: Information tech must catch up to medical marvels
Michael Dowling, Northwell Health's CEO, believes we're entering the age of smart medicine.
- The United States health care system has much room for improvement, and big tech may be laying the foundation for those improvements.
- Technological progress in medicine is coming from two fronts: medical technology and information technology.
- As information technology develops, patients will become active participants in their health care, and value-based care may become a reality.
In his book Health Care Reboot, Michael Dowling, Northwell Health's CEO, argues that "[the United States] is constructing a solid foundation upon which the new American health care is being erected." To those steeped in news of health care's administrative bloat, under-performing primary care, and low levels of insurance coverage, such a thesis may seem bold, wishful, or downright delusional.
But Dowling does not ignore the health care system's need for improvement. Rather, he believes that contemporary trends can foster such improvement if we recognize their value. He cites advances and disruptions in areas such as consolidation, education, payment reform, and mental health to support his progressive view that "better, safer, and more accessible care" is coming.
Among those trends is big tech's move into health care, or as Dowling puts it, technology may soon move us into the age of smart medicine.
Medical tech marvels
Dowling sees big tech's stride into health care as coming from two fronts: medical technology and information technology. On the medical technology front, the technology available to doctors has accelerated at an unprecedented pace, resulting in tools and techniques that are "the stuff of Star Wars."
"Some of the most advanced technology tools ever developed in any field are in use to care for patients. Look at any modern operating room or intensive care unit, and the technology to treat patients and keep them alive is remarkable," writes Dowling.
To pick one of many examples, Northwell Health's Cohen Children's Medical Center was the first pediatric program on Long Island to institute ROSA, a "robotic operating surgical assistant." Before ROSA, children suffering epilepsy would have to undergo a full craniotomy to target and monitor areas of seizure activity. With ROSA's assistance, surgeons can get the same results through a minimally invasive procedure, reducing the risk of infection and strain on the patient.
Even technology not designed for therapy has been co-opted to play small, yet supportive, roles in quotidian treatment. A study out of the Children's Hospital Los Angeles found that virtual reality can help reduce a child's anxiety and stress during basic procedures such as a blood draw.
Information tech plays catch up
Photo: Sisacorn / Shutterstock
Dowling characterizes the information technology front as "less impressive," pointing to the well-known difficulties of onboarding electronic health records. Beyond concerns of cybersecurity and interoperability, such systems have caused widespread burnout and dissatisfaction among practitioners thanks to their time consumption and complicated workflows.
But progress is being made. Apple recently added a Health Records app to its iPhone, giving patients from 39 health systems access to their medical records.
"This existing new reality is that a fat file, that until recently was stored away unavailable to the patient, now sits in its entirety on the patient's phone," writes Dowling. "For patients with chronic conditions who make frequent use of medical services, this leap forward enables them, whether a mile from their doctor's office or a thousand miles, to track and share with their doctor essential data on blood pressure, heart rate, glucose levels, and scores of other important clinical markers."
But to succeed, this information must be gatherable, accessible, and understandable to any patient. Big tech will need to streamline such systems for maximum user-friendliness, all while keeping operations on a device with which patients and practitioners are intimately familiar.
That device will be the smartphone and tablet. 77 percent of Americans own smartphones. Among Americans over 65 years of age — the demographic most in need of such advancements — 46 percent own a smartphone, a number that is likely to climb.
Big tech's vision of integrating information technology with health care is some ways off. Much experimenting must be done, and big tech needs to better collaborate with traditional health care stakeholders. Even so, these incipient steps may lead to a framework where practitioners can gather more data more quickly and with greater ease, while patients become partners, not passive recipients, of their health care team.
Accelerating value-based care
In the United States, value-based health care exists today as a should-we, could-we debate topic. Big tech's entry into the field could push value-based care closer to practice. As noted on the health care blog Tech Prescribed, integrating improved data acquisition with AI-powered platforms could turn value-based care into a manageable venture.
"As a result, we will see the move to VBC accelerate even further as more firms turn a profit through this business model. Good news for docs — this will make you the primary customer for provider technology and really improve your user experience as a side effect," writes Colton Ortolf of Tech Prescribed.
The Northwell Health entity Pharma Ventures was created both in response to collaborating with big pharma and as a means to promote value-based care. Pharma Ventures was designed "to link drug prices to drug performance" and "to serve as a super-site for clinical trials." The goal is to drive down costs while simultaneously improving patient experience. Such an initiative is only possible due to Northwell's integrated systems and system-wide electronic health records.
Entering the smart age of medicine
For Dowling, health care in the United States is laying an important foundation for the medicine of tomorrow. We're moving away from the view that health care is something the patient receives at a medical facility. Soon, health care will see the patient take an active role alongside a team of health care providers.
"The new American medicine is proactive and has physicians working in teams with nurses and other caregivers to reach out to patients and guide them along a pathway to health and wellbeing," writes Dowling.
By creating new machines, proliferating information, and making that information easier to obtain, big tech's dive into health care will be a fundamental element in this upcoming paradigm shift.
Pandemic rumors and information overload make separating fact from fancy difficult, putting people's health and lives at risk.
The dark side of the information age<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzU1NzYwMi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNjE3MzY3Nn0.0HveQP16MbMkj9HXE8miohSHXETOak7oFDtBdXtE7lM/img.jpg?width=1245&coordinates=0%2C400%2C0%2C256&height=700" id="60d48" class="rm-shortcode" data-rm-shortcode-id="9085c1a7d5b3f81344c3002acdf1df68" data-rm-shortcode-name="rebelmouse-image" />
A South Korean church became a viral hotspot after church officials sprayed a salt water "cure" in congregants mouths, without disinfecting the nozzle between uses.
The cure for bad information is good<div class="rm-shortcode" data-media_id="e0tfZ3YB" data-player_id="FvQKszTI" data-rm-shortcode-id="601aa46855087a4dfcf02a67a160e0c4"> <div id="botr_e0tfZ3YB_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/e0tfZ3YB-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/e0tfZ3YB-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/e0tfZ3YB-FvQKszTI.js"></script> </div> <p><strong></strong><strong></strong>That doesn't mean we are defenseless. The best cure for rumors, stigma, and conspiracy theories is good, evidence-based information. We just have to know how to recognize it when we find it. Unfortunately, that's difficult in the center of the infodemic vortex.</p><p>"Information overload is incredibly anxiety-provoking—which is true even when the information is accurate," Jaimie Meyer, a Yale Medicine infectious diseases specialist, <a href="https://www.yalemedicine.org/stories/covid-19-infodemic/" target="_blank">told <em>Yale Medicine</em></a>. "But here, if people get the wrong information from unreliable sources, we may have more trouble slowing the spread of the virus. And we can't afford to get this wrong."</p><p>In their study, the researchers concluded that governments and health agencies should study the patterns of pandemic rumors, track the misinformation, and develop communication strategies to circumvent these messages. </p><p>In the <em>Yale Medicine </em>article, Meyer provides advice for helping individuals deal with information overload. She recommends looking at data and graphs carefully, considering how individual studies connect with established facts, and considering the whole story (not just the eye-catching headline). </p><p>When it comes to garnering information from social media, proceed with caution.</p><p>"Everything looks the same on Twitter," Meyer said. "When you have a tweet from Anthony Fauci, MD, director of the National Association of Allergy and Infectious Diseases, next to a tweet that says the opposite thing from a celebrity or some random person—and they all appear similar, you have to weigh the credibility of your sources." </p><p>She recommends following health agencies like <a href="https://twitter.com/who?lang=en" target="_blank" rel="noopener noreferrer dofollow">the WHO</a>, <a href="https://twitter.com/CDCgov?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor" target="_blank" rel="noopener noreferrer dofollow">the Centers for Disease Control and Prevention</a>, and your local and state health agencies. When you come across a pandemic rumor or something that seems suspect, you can double-check it against these authoritative sources, such as the WHO's <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters" target="_blank" rel="noopener noreferrer dofollow">COVID-19 mythbusters page</a>. And if you find yourself stressing out over the news and your social media feed, <a href="https://bigthink.com/mind-brain/mental-health-activities-coronavirus-lockdown" target="_self" rel="dofollow">take a mental break</a>.</p><p>We all would like a return to some form of normalcy, but that return will not emanate from a miracle cure. It will be a slow, steady course of handwashing, social distancing, and learning to navigate the infodemic.</p>
Carbon locked in soils can be emitted by bacteria.Turning up the heat on them releases more carbon.
- A new study shows that an increase in temperature can increase the amount of carbon released by the soil.
- This is in line with previous studies, though this one demonstrates a larger increase than the older experiments.
- The risk is that increasing temperatures cause a positive feedback loop.
The dirty details of an aggravated carbon cycle<div class="rm-shortcode" data-media_id="CabkeAzx" data-player_id="FvQKszTI" data-rm-shortcode-id="169377c88f392a86f6c42180b74820a5"> <div id="botr_CabkeAzx_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/CabkeAzx-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/CabkeAzx-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/CabkeAzx-FvQKszTI.js"></script> </div> <p>There is a lot of carbon in the dirt. The world's soil contains more carbon than the atmosphere, all the plants, or all the animals<a href="https://blogs.ei.columbia.edu/2018/02/21/can-soil-help-combat-climate-change/" target="_blank"></a>. A third of this trove of carbon resides in the soils of the <a href="https://www.sciencetimes.com/articles/26866/20200813/tropical-soils-highly-sensitive-climate-change.htm" target="_blank">tropics</a>. Under normal circumstances, this works as a carbon <a href="https://earthobservatory.nasa.gov/features/CarbonCycle" target="_blank">sink</a>, keeping carbon in storage and out of the atmosphere. Some of this carbon is used by bacteria in the soil to provide the building blocks of new microbes. They expel surplus carbon into the atmosphere in the form of carbon dioxide. </p><p>Many of these microbes are known to be more active when exposed to higher temperatures. To determine what this could mean for carbon emissions, a team from The University of Edenborough and the Smithsonian Tropical Research Institute turned up the heat in tropical soils to see what would happen. </p><p>The researchers went to an undisturbed plot of forest on Barro Colorado Panama, the home of the Smithsonian's Tropical Research Institute. They placed heating rods just over a meter into the soil and turned up the heat, warming the earth by four degrees centigrade. They then measured the carbon emissions from the heated ground and another nearby patch left at ambient temperature. These measurements covered two years.</p><p>Their findings, published in <a href="https://www.nature.com/articles/s41586-020-2566-4" target="_blank">Nature</a>, show that the heated soil emitted 55% more carbon than the control plot<a href="https://www.sciencedaily.com/releases/2020/08/200812144102.htm" target="_blank" rel="noopener noreferrer dofollow"></a>. <br> <br> Study lead author Andrew Nottingham commented on these findings to the <a href="https://phys.org/news/2020-08-global-tropical-soils-leak-carbon.html" target="_blank" rel="noopener noreferrer dofollow">AFP</a>. "Carbon held in tropical soils is more sensitive to warming than previously recognized. Even a small increase in respiration from tropical forest soils could have a large effect on atmospheric CO<sub>2</sub> concentrations, with consequences for global climate."</p><p>You can probably also spot the potential feedback loop here: If the global temperature increases too much, more carbon will be released from tropical soils, which then increase the greenhouse effect, which causes global temperatures to rise. </p>
Once is happenstance, twice is a coincidence, thrice is evidence of a pattern.<div class="rm-shortcode" data-media_id="8PLWDgcM" data-player_id="FvQKszTI" data-rm-shortcode-id="378380d273bf4a1c9606370acea15e58"> <div id="botr_8PLWDgcM_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/8PLWDgcM-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/8PLWDgcM-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/8PLWDgcM-FvQKszTI.js"></script> </div> <p>Previous studies on this topic point in the same direction. Those studies and the models they inspired suggested that increased temperatures could increase soil-based carbon emissions, but they all underestimated how much carbon would be involved.</p><p>A 2016 study focusing on temperate soils also concluded that increasing soil temperatures would increase their carbon <a href="https://www.nature.com/articles/nature20150" target="_blank">emissions</a>. They predicted that, if left unchecked, these emissions would equal the amount produced by a country similar to the United States over the next few <a href="https://www.ucsusa.org/resources/each-countrys-share-co2-emissions" target="_blank" rel="noopener noreferrer dofollow">decades</a>. Another experiment in Colorado found similar <a href="https://science.sciencemag.org/content/355/6332/1420" target="_blank" rel="noopener noreferrer dofollow">results</a>. Both of these studies found lower increases in carbon emissions by percentage than the study on Barro Colorado. </p><p>However, these studies did not take place in the tropics, and the differences in the soils between temperate and tropical zones could explain the differences between the studies. Moreover, the dirt on Barro Colorado Island differs from the dirt in the Amazon and may be more inclined to produce more emissions when the heat is turned up. The same can be said of tropical soils <a href="https://www.nytimes.com/2020/08/12/climate/tropical-soils-climate-change.html?searchResultPosition=3&utm_campaign=Hot%20News&utm_medium=email&_hsmi=93170710&_hsenc=p2ANqtz-8McWKRhE8U9ChcWW2qkqNyp2Qndzr1aJmGlrMUwK_h1bM8RDQukWcM8r2OcBKW2Y0bWlRr9o4WUixKDzIo4HzKkVv19g&utm_content=93170710&utm_source=hs_email" target="_blank" rel="noopener noreferrer dofollow">elsewhere</a>. </p><p>Another <a href="https://www.forestwarming.org/" target="_blank" rel="noopener noreferrer dofollow">experiment</a>, very similar to the one in Panama, is currently underway in Puerto Rico. However, this experiment is taking the extra step of also heating the plants near the heated soil to see what the effect of warmer temperatures is on their ability to absorb carbon.</p><p>The current study also did not heat the soil past the one-meter mark and cannot provide us with predictions of what more comprehensive heating of the soil would do to emissions. It was also comparatively short, and the effect may be reduced in the long run as the nutrients in the soil are depleted by the increased activity of the microbes, which are using the carbon and other resources to <a href="https://www.nature.com/articles/d41586-020-02266-9" target="_blank" rel="noopener noreferrer dofollow">reproduce</a>. </p><p>The team behind the most recent study will continue their experiment to try and understand how tropical ecosystems respond to increased <a href="https://www.earth.com/news/billions-of-tons-of-co2-could-be-released-from-tropical-soils/" target="_blank" rel="noopener noreferrer dofollow">temperatures</a> over more extended periods of time. </p><p>As we increase our understanding of the planet and its various environmental systems, the potential consequences of climate change become clearer and more horrifying. This new study supports previous findings that suggest disrupting soils can increase carbon emissions. While it may be too soon to tell if the eye-popping increases found by this study are typical or an outlier, they do re-enforce the notion that a breakdown in the systems that keep the climate stable is possible if nothing changes. </p>
A study published Friday tested how well 14 commonly available face masks blocked the emission of respiratory droplets as people were speaking.
- The study tested the efficacy of popular types of face masks, including N95 respirators, bandanas, cotton-polypropylene masks, gaiters and others.
- The results showed that N95 respirators were most effective, while wearing a neck fleece (aka gaiter) actually produced more respiratory droplets than wearing no mask at all.
- Certain types of homemade masks seem to be effective at blocking the spread of COVID-19.
Fischer et al.<p>A smartphone camera recorded video of the participants, and a computer algorithm counted the number of droplets they emitted. To establish a control trial, the participants spoke into the box both with and without a mask. And to make sure that the droplets weren't in fact dust from the masks, the team conducted more tests by "repeatedly puffing air from a bulb through the masks."</p>
Fischer et al.<p>The results, published Friday in <a href="https://advances.sciencemag.org/content/early/2020/08/07/sciadv.abd3083" target="_blank">Science Advances</a>, showed that some masks are pretty much useless. In particular, neck fleeces (also called gaiters) actually produced more respiratory droplets compared to the control trial — likely because the fabric breaks down big droplets into smaller ones.</p><p>The top three most effective masks were N95 respirators, surgical masks and polypropylene-cotton masks. Bandanas performed the worst, but were slightly better than wearing no mask at all.</p>
Fischer et al.<p>Research on mask efficacy is still emerging. But the new results seem to generally align with <a href="https://newsroom.wakehealth.edu/News-Releases/2020/04/Testing-Shows-Type-of-Cloth-Used-in-Homemade-Masks-Makes-a-Difference" target="_blank" rel="noopener noreferrer dofollow">prior tests</a>. For example, a study from June published in <a href="https://aip.scitation.org/doi/10.1063/5.0016018" target="_blank" rel="noopener noreferrer dofollow">Physics of Fluid</a> found that bandanas (followed by folded handkerchiefs) were least effective at blocking respiratory droplets. That same study also found, as <a href="https://newsroom.wakehealth.edu/News-Releases/2020/04/Testing-Shows-Type-of-Cloth-Used-in-Homemade-Masks-Makes-a-Difference" target="_blank" rel="noopener noreferrer dofollow">others have</a>, that masks made from multiple layers of quilter's fabric were especially effective at blocking droplets.</p><p>The researchers hope other institutions will conduct similar experiments so the public can see how well different masks can block the spread of COVID-19.</p><p style="margin-left: 20px;">"This is a very powerful visual tool to raise awareness that a very simple masks, like these homemade cotton masks, do really well to stop the majority of these respiratory droplets," Fischer told CNN. "Companies and manufacturers can set this up and test their mask designs before producing them, which would also be very useful."</p>
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