All posts by Bobby Caina Calvan

Colin Autry, who is undergoing months of chemo for leukemia in isolation, uses the wireless Internet at Kaiser Permanente’s Roseville hospital as his mother, Pushpa Autry, waits nearby.

Colin Autry, a 17-year-old cancer patient from Elk Grove, likened it to a life of solitary confinement, cocooned in a hospital room and cut off from the usual life of a high school senior – his cell phone and television screen the only connections to friends and the outside world.

“When they told me I was going to be in an isolation room for six to eight months, that scared me pretty good,” said Autry, who began his long hospital stay in October at Kaiser Permanente Roseville Medical Center.

But earlier this month, Kaiser ushered in the digital age for patients at its Roseville campus, allowing Autry to regain one important part of a typical teenager’s life: wireless Internet.

While his disease has wrought havoc with his life, Autry can again experience the joys of scrolling through Facebook updates. His fingers clack away for online chats, his time is occupied by the latest gossip at school streamed into his hospital room.

Wireless Internet has become a part of everyday life – it’s in our homes, workplaces, airports and coffee shops. But hospitals are relative newcomers in providing the now-ubiquitous technology.

“What we’re seeing now is an explosion of this,” said Bache Perry, a consultant assigned to Kaiser’s network services.

“Being able to provide this to the patient eases the stress of staying in a hospital for a long period of time,” he said.

Kaiser isn’t the first in the area to beam Wi-Fi signals into patients’ rooms. Sutter hospitals and the UC Davis Medical Center said their wireless services went online a few years ago.

Last fall, Mercy began providing Wi-Fi at its Folsom hospital.

“It has become an expectation to be connected,” said Randy Castillo, the hospital’s vice president of ancillary and support services. “You have Wi–Fi when you go to Starbucks, McDonald’s, airports – but not too many hospitals.”

For years, doctors and nurses had access to wireless signals to access electronic medical records. But because of security issues, hospitals were cautious about opening up their airwaves in patient areas.

Indeed, most hospitals have two wireless networks – one for protected data and the other for public use – as a firewall against any potential security breaches.

Quality issues have also been a concern, said Perry, the Kaiser consultant, because two signals occupying the same airspace could interfere with each other.

Other area hospitals still without Wi-Fi access are hoping to roll out the service soon.

For Autry, who was diagnosed with leukemia in October, it couldn’t come soon enough.

“I went from a normal life to being locked up in a hospital room,” he said. “It isn’t something you acclimate to immediately. I’m missing my senior year of high school.

“I really count on my friends to keep me updated,” he said.

With his laptop, he’s been able to get virtual visits from his grandmother who lives in Raleigh, N.C., through a video camera and Skype. Soon, he hopes to spend time – via the Internet – with his sheepdog Klondike, who is being cared for by his sister in Washington state.

“I feel trapped sometimes,” he said.

“It was so hard coming in,” said his mother, Pushpa, a Kaiser therapist. “Oh my God, solitary confinement – how are we going to do this?”

She got her son a Kindle electronic reader for Christmas – on which he’s reading the latest book from Stephen Colbert.

“I wish he spent more time on that” – less time on the Internet, she said – “but he’s the one who’s going through chemo.”

Young doctors have taken to iPhones – could iPad be next?

Apple’s new creation, the iPad, may be a novelty to many consumers, but hospitals are already starting to abandon paper-and-pen clipboards for hand-held digital tablets.

In Sacramento, Kaiser Permanente is in the midst of experimenting with one brand of computerized tablets – with the hope of freeing nurses and doctors from old-school tools and allowing them more time at a patient’s bedside.

“We want our nurses to have time to actually nurse and support the patient. We want to remove the barriers … to provide seamless technology integration,” said Ann O’Brien, a registered nurse and Kaiser’s national director of clinical informatics.

The trial being conducted in Sacramento is part of a broader program, dubbed “Destination Bedside.” Kaiser expects to choose an electronic tablet by the end of the year for use at its hospitals nationwide.

The idea is to improve care and safety by providing up-to-the minute medical information on the patient that can help prevent mistakes. X-rays, medical charts, prescriptions and notes would be readily available at a tap of a finger.

One tablet, the Motion C5, promoted by its manufacturer as a “mobile clinical assistant,” is about the size of a small bathroom scale. It has handles and is equipped with a pen-like stylus.

“I love it,” said Thomas Whiteford, a registered nurse at Kaiser’s Sacramento Medical Center, who took part in testing the device. “I can sit next to the patient and do my charting.”

The popularity of Apple’s iPhone among doctors could be a natural springboard for the iPad. But O’Brien, the health care giant’s informatics director, said the device isn’t even out yet to assess its potential.

Already, the iPhone has become a favorite tool among young doctors, who use many of the scores of health care-related apps, including encyclopedic information on pharmaceuticals.

Kaiser officials are considering whether the iPhone, now a ubiquitous accessory for hipsters and the tech-savvy, will become standard issue at its hospitals to more intimately bring technology to a patient’s bedside.

Jason Wilk, who authors the technology blog tinycomb.com” target=”_blank”>>tinycomb.com, reported last week that Apple officials had visited a Los Angeles hospital, ostensibly to market their products. He presumed it was the iPad.

“Considering what happened with the iPhone, it seems like it makes a lot of sense that they would be talking with hospitals,” Wilk said, noting the mobile device’s popularity among doctors. “You can do so much more with a larger screen, for medical charts. This is probably the future of computing.”

Perhaps it’s the future of medicine, said Dr. Javeed Siddiqui, associate medical director for the Center for Health and Technology at UC Davis Medical Center.

Nurses, doctors and pharmacists have already been using hand-held tablets, but wide-scale deployment would be expensive. The model that Kaiser is considering and that UC Davis is already using on a limited basis costs more than $2,000 per unit.

Many hospitals now use full-sized computers and monitors mounted on wheeled carts, but these don’t offer the same ease of use and mobility as hand-held tablets.

Laptops would seem an alternative, but aren’t as easy to use as they would seem, particularly in a clinical setting where doctors and nurses are always on the go. And they aren’t durable and can’t easily be swabbed down for disinfection.

The hope among hospital officials is that electronic tablets will further power the technological revolution already under way at hospitals. And it’s an obvious extension of the industrywide push toward paperless electronic medical records.

“Information at your fingertips is what medicine should be all about. It allows you to access information as you walk around or as you talk to the patient,” Siddiqui said.

“The paper chart is an antiquated way of providing health care,” Siddiqui said. “The paper chart is inefficient. It doesn’t allow for rapid dissemination of information and really is no longer, I believe, the standard of care in health care delivery.”

Siddiqui, if not caught up in all the buzz generated by Wednesday’s product announcement of the iPad, is excited about the technological strides the device could spur in the medical industry. “It’s portable and it’s lightweight. It has touch screen, a Web browser – and all those features can be utilized as a way to integrate technology in patient care,” he said.

Patient Joel Thomas, left, of Lincoln discusses his shoulder injury with Dr. Stephen Weber, an orthopedic surgeon. Weber conducted a study using platelet-rich plasma in a group of patients recovering from torn rotator cuffs; he concluded that the treatment didn’t make a difference.

With Tiger Woods and Pittsburgh Steeler Hines Ward providing star-powered proof, demand boomed in recent years for injections of “concentrated” blood rich in platelets to relieve hard-to-heal joint and tendon injuries.

But Dr. Stephen Weber, a Sacramento orthopedic surgeon, was not convinced that the new therapies involving so-called platelet-rich plasma would speed recovery. So he conducted a study.

When he compared the outcomes among patients who used the blood product to help mend torn rotator cuffs and those who didn’t, Weber concluded that it didn’t make a difference and wasn’t worth the extra hundreds of dollars in expense.

“My advice to patients: Be skeptical,” he said.

The country as a whole could use a dose of such skepticism when it comes to expensive new therapies, critics say.

More than $700 billion is spent annually on unproven medicine and procedures, a significant factor in the escalating cost of health care. Patients and doctors rush to adopt the latest and newest medical treatments – often without regard to whether they actually make sense from a cost-benefit standpoint.

Some members of Congress are taking aim at the problem by proposing research centers that could promote less expensive approaches in health care.

Such research centers could serve as libraries of best practices and proven medicine, gathering data that would better inform health care decisions made by physicians and their patients.

The health insurance industry, which blames escalating premiums on the high cost of dispensing medical care, supports the effort – in theory.

“Health plans certainly want this kind of information. Which treatment works best is really crucial information,” said Robert Zirkelbach, spokesman for the group America’s Health Insurance Plans.

In the absence of such scrutiny, he added, “Patients aren’t always getting the best medical treatment.”

Because the proposal for comparative research centers is included in the massive health care bills now before Congress, its fate is uncertain.

If passed, it would build on the $1.1 billion allocated to so-called comparative effectiveness research approved in last year’s economic stimulus package, which will fund programs at existing federal agencies and create a council to provide guidance.

Critics say establishing Comparative Effectiveness Research Centers, as they would be called, could lead to treatment being dictated by nonmedical oversight panels.

They’ve also raised the specter of rationing. Former vice presidential candidate Sarah Palin deepened the controversy last summer by referring to “death panels” that could make life-and-death decisions.

Pharmaceutical companies and medical device companies have been wary of comparative effectiveness panels that, they say, could be automatically dismissive of products deemed too expensive.

Advocates dismiss those concerns, saying the intent is much more benign: Reduce pain and suffering – and wasted expense – by educating doctors and consumers about medical care that is safe and effective.

In some cases, the research centers would weigh in, analyzing data or launching studies of their own.

Supporters say the proposals would in no way undermine the doctor-patient relationship. The House health bill states that it would not “authorize any federal officer or employee to exercise any supervision or control over the practice of medicine.”

The idea, rather, is to provide information that health plans, hospitals and doctors could use to decide which treatments make sense. Health care costs have been steadily escalating and are now estimated at $2.3 trillion annually nationwide.

About a third of this money now goes to pay for health care products and services whose value is unproved, according to estimates by the Congressional Budget Office.

More expensive doesn’t always translate to more effective, according to researchers at the Dartmouth Atlas Project, which for the past two decades has been monitoring what it says are “glaring variations in how medical resources are distributed and used in the United States.”

Regions that spend lots of money on health care don’t necessarily get better results than other areas with lower expenditures, according to the researchers.

While some experts blame the high cost of medicine on expensive new technology, that’s only part of the problem. In general, there are few incentives for doctors and patients to keep costs down – particularly when health insurers are picking up most of the tab.

The U.S. Food and Drug Administration approves pharmaceuticals and medical devices for use, but it does little to inform the public about how truly effective a drug or device is – compared with other drugs or other treatments, said Maribeth Shannon, director of the market and policy monitor program for the California HealthCare Foundation.

“It’s a common American phenomenon to jump on the new thing,” she said. “But it may or may not be better than existing therapies.”

That may be the case when it came to treating joint injuries, said Weber, the orthopedic surgeon.

Weber launched his study last year after noticing the increasing use of platelet-rich plasma therapies in repairing joints and torn tendons.

Some doctors believe that platelet-rich blood, when injected or surgically implanted into wounds, helps the body more quickly repair bone and tissue, particularly in hard-to-treat tendon injuries, such as tennis elbow.

Weber’s small study compared two groups that had undergone rotator cuff surgery, 30 patients in each, who volunteered for the research. They showed no noticeable difference in healing and effectiveness whether or not they were treated with platelet-rich plasma material.

Another study on the use of platelet-rich blood in Achilles’ tendon injuries, published in the Jan. 13 issue of the Journal of the American Medical Association, appears to corroborate Weber’s conclusion that the blood therapy may have little value.

But Dr. Alan Hirahara, another Sacramento orthopedic surgeon, stands by the therapy. He offered a study he conducted himself last year showing improvements in recovery for his patients, 139 of whom received surgery with the platelet-rich blood and 39 who did not.

“There was a big difference in my patient outcomes. We’re saving money; we’re saving the system money,” said Hirahara, who opposes comparative effectiveness panels.

“You should always justify why you’re doing things. If it’s not working, you shouldn’t do it because it’s wasting money,” Hirahara said.

Weber doesn’t quibble with that.

“We want to be the guys in the white hats – the good guys. If physicians aren’t responsible, then the government is going to step in,” said Weber.

He said he supports comparative effectiveness research but is wary of the proposed panels because they could take away decision-making authority from patients and their doctors.

“I prefer to do things that are supported by medical literature,” he said. “You want to be in front of the pack, but at the same time you have to be careful.”

The skeptic, he said, would seek out a second opinion.

In Dr. Stephen Weber’s office, a magnetic resonance image shows a patient’s shoulder. Knowing whether the newest therapy is the best one is a health care challenge.

A Kaiser Permanente employee was fired last month after a computer storage drive, containing information on 4,000 Sacramento-area patients, was stolen from a car parked at her home, hospital officials reported Tuesday.

The external drive contained data on as many as 15,500 Northern California patients, according to a statement from the hospital’s vice president for compliance and privacy, Kristin Chambers. She said the patients were notified. She considered the breach “low risk.”

Information on the drive included the patient’s name, Kaiser medical record number and, depending on the patient, may have included birth, sex, phone number and medical information. The data did not include Social Security numbers.

Kaiser has established a toll-free line for patients who have questions: (877) 608-0050. Patients covered by Medicare can call (800) 443-0815. Those needing TTY, call (800) 777-1370.

Clinical coordinator David Buettner, left, trains paramedic student Bobby Blanco on a birthing simulator at UC Davis Medical Center last week. UCD also has a lifelike dummy that can blink, breathe and on cue mimic a full-blown heart attack – one of many innovations being tried to cut costs and save time.

In a warehouse tucked among rows of nondescript office buildings, medical wizardry is taking place.

A wand remotely controls beams of light, a robotic cart dashes through the hallways, and camera-equipped metal arms hang from ceilings, poised for surgical duty.

At Kaiser Permanente’s laboratory for innovations in San Leandro, emerging tools in medicine – as well as some low-tech problem-solving – are being put to the test.

The talking robotic cart, known as TUG, might not have the bedside manner of an affable doctor, but soon could be wheeling through the corridors of Kaiser hospitals in the Sacramento region.

So could hand-held electronic tablets that might serve as conduits for better medicine, bringing new tools to a patient’s bedside, said Sean Chai, senior technology manager at the Kaiser lab.

In the long run, saving time saves money, Chai said. “Everything we do here is geared toward saving money.”

There’s a national focus on taming health care costs and improving the quality of care. For institutions such as Kaiser and Sacramento’s UC Davis Medical Center, scouting innovations is critical for improving hospital efficiency and patient safety.

“We have to be better at delivering care more effectively and more efficiently. Technology will play a critical role,” said Dr. Javeed Siddiqui, associate medical director at the Center for Health and Technology at the UC Davis Medical Center.

As a teaching institution, UC Davis Medical Center is also at the forefront of technological advances, sometimes testing medical tools in real-life hospital settings.

At the Center for Virtual Care at the UC Davis Medical Center, lifelike dummies blink, breathe and on cue mimic a full-blown heart attack. They act as simulators to train the next generation of doctors. There are also robotic surgical arms that perform less-invasive surgeries, saving time for doctors in the operating room and patients in recovery wards.

“We’re focused on helping to develop the next generation of technologies,” said Betsy Bencken, a clinical instructor at the virtual care center.

The health system’s Innovation Center, housed within the Center for Health and Technology, serves as a think tank for expanding telemedicine to far-flung reaches, not just in the rural areas of California but around the globe.

At the Garfield Health Care Innovation Center in San Leandro, Kaiser assembles teams of doctors, nurses – sometimes volunteer Kaiser members – to test the latest in medical research.

Nothing is too minor, such as testing the healing properties of paint colors. To enhance patient convenience, one room is equipped with a wand that directs beams of overhead light.

And there’s TUG, the robotic courier that ferries supplies and equipment from one spot to the next. The robot already has been darting through the hallways of some Kaiser facilities in Southern California on a trial basis.

This summer, hand-held LCD monitors – which could extend the portability of electronic health records – will be tested at the Kaiser Sacramento Medical Center to help evaluate products that could become standard issue across the health system’s facilities.

The San Leandro center, which sprawls over 37,000 square feet, opened in June 2006 and is the only one of its kind in the Kaiser health system. It is equipped with patient rooms, mock-ups of workstations, operating rooms – and a living room equipped with gadgets that turn the home into a control center for personal health.

“By 2015, the home will become the hub of care,” Chai predicted.

Home-based equipment will connect a patient at home to the doctor, who can monitor vital signs and other health care metrics.

But it’s not always about high-tech gadgetry. Useful changes often come after simple brainstorming, said Sherry Fry, operations specialist for the Kaiser facility.

A case in point: How to keep nurses charged with administering medication from being interrupted during their rounds.

There were no bells and whistles. At first it was just a neon-green vest, to be worn while on duty. But the vest wasn’t exactly a fashion statement. In the end, the team settled on a simple white sash to be worn during rounds, meant to deliver the message: “Don’t bother me.”