Major General Robert Lee Howze

In some ways healthcare resembles American military thinking before World War II.  Naval strategists believed the battleship would remain the platform for winning wars at sea.  When  Brig. General Billy Mitchell proved that aircraft made battleships sitting ducks, “leaders” saw this disruptive argument as unreasonable.  In frustration, Mitchell accused them of  “almost treasonable” neglect, for which he was court-martialed in 1926.  Major General Robert Lee Howze presided over Mitchell’s trial, convicting him of insubordination.  Demoted, Mitchell resigned. General Howze was a significant soldier-a Medal of Honor winner from the Indian wars-and like many senior military officers adhered to the conventional thinking of prior experience.  The Japanese attack on Pearl Harbor was the price for that line of conventional thinking.

Brig. General William "Billy" Mitchell

Molecular medicine, medical automation, and telemedicine are disruptive innovations in today’s healthcare.  It’s also quite apparent a Howze effect permeates from the physician’s office to the halls of Congress.  Let’s hope that aging demographics, a widening gap between medical costs and insurance coverage, and an underclass in need don’t sink our ship of state.

Image Credits:  Wikipedia

Christian Klit Johansen

Question:  Will robotics and automation of service task help meet the challenge of the demographic change world wide affecting the operation the hospitals -  more patients and less staff?

The University of Texas MD Anderson Cancer Center has the challenge of staffing and managing thousands of nurses busy delivering top-notch patient care. To manage this complexity, MD Anderson relies on three critical applications - a Human Resource system by PeopleSoft, a Time and Attendance system by Kronos, and a Staffing system by Per-Se’s ANSOS One-Staff. These three applications (with their various inputs, outputs, and interfaces) must be kept up-to-date and in-synch at all times in order for the Cancer Center to staff at appropriate levels, operate efficiently, and provide quality patient care.

Over 2,700 nurses and administrative staff rely on an IT process automation solution called AutoMate from Network Automation to ensure optimal staffing levels and patient care. At any one time, the Cancer Center has 150 concurrent users interacting with the solution. The applications involved are a crucial component of our world-class and renowned patient care system.

The Challenge

Previously, the Cancer Center attempted to use two technologies, AutoIT and LaunchPad, to orchestrate the PeopleSoft, Kronos, and ANSOS One-Staff applications. However, these technologies failed miserably because they did not support secure logon capability or job failure/success notifications. In short, IT personnel were unable to guarantee the appropriate level of security with these tools, and they could not effectively monitor their performance or the performance of the overall solution.

Once Juan Garcia, a Systems Analyst at the Cancer Center, and his team members realized what they needed, they turned to IT process automation for the solution.   Juan says,   “For us, the automation technology combines two very important functionalities: job scheduling/triggering and automation. In our initial effort when we attempted to use Launchpad and AutoIT, we were trying to combine Launchpad’s job scheduling functionality with AutoIT’s automation capabilities. This was a mistake. What we really needed was one powerful tool that had both the triggering and automation capabilities.”

The Solution

Juan says,  “In our solution, AutoMate is central to application integration - it orchestrates three critical applications used extensively at MD Anderson Cancer Center, and coordinates thousands of file and data transfers.”

In essence, the solution acts as a “traffic cop” between PeopleSoft, Kronos, and ANSOS One-Staff. The traffic cop’s main duty is to automate the thousands of file and data transfers that occur among these applications. The solution operates on a Windows server with secure access to servers running the other applications, as well as access to backend databases and files.

This technology gave the Cancer Center the application security it needed; not only did it allow secure logon and access, but it also provided enhanced security features such as password and task encryption. Moreover, the IT automation technology enabled the Cancer Center to send emails and text messages to IT personnel regarding the failure or success of automated tasks.

For task failures, the messages would be very granular, identifying exactly when and where the error occurred. This provided IT personnel with the timely and relevant information they needed to rectify the error in near real time. It also enabled the IT staff to spend less time babysitting the application, often at nights and on weekends, as they had with the previous tools.

Another benefit the Cancer Center discovered from this solution was its flexibility and versatility. It has allowed the Cancer Center to set up a more dynamic system architecture. Now, when a group of automated tasks has to be modified, for example, IT personnel can change a single variable instead of pouring through and editing thousand of lines of code. Making additions and changes to existing automation tasks is a snap.

Juan also adds,  ”Another extremely powerful aspect of our automation solution is its development interface. Users can easily drag-and-drop their way to creating extremely complex automation tasks, even when they don’t know a lick of code. It offers the ability to ’script’ any kind of solution, even when you don’t know anything about scripting. But AutoMate is powerful, too. If you do pride your scripting prowess, you can really take your talents to the next level with IT process automation. There’s really nothing you can do with scripting that you can’t do better with this technology.”

Pharmocogenics and DNA

Imagine a time-about a century ago-when physicians generally accepted the idea that germs caused disease, but didn’t know what to do about it.  That’s approximately where genomic medicine is today. More and more screening tests are becoming available, but doctors are reserved about interpreting the results.  Actually, physicians in the age of genomic medicine face an extraordinarily different field of practice.  Meanwhile, pharmacy-benefit managers Medco and CVS Caremark are proceeding with new businesses (DNA Direct from Medco; and Generation Health from CVS) that will do in-pharmacy genetic testing to determine dosing for drugs like warfarin, tamoxifen, antidepressants and statins. As such, commercial pharmacogenomics in the neighborhood drug store is about to begin.       MORE

Image Credit:   Technology Review

Operating room throughput is a crucial financial interest for any hospital group  Consider the math:  if a hospital group has, say, 50 OR’s, and can add one more procedure from workflow optimization per day, for, say 200 days a year, and it earns $3k per procedure, the increased annual revenue is $30m.  Thus, for planning greater throughput, Presbyterian Hospital (Charlotte, NC, part of the Novant group ) is building full scale OR mock ups to optimize design.         MORE

Nano Diamond

The rare earth metal gadolinium is the most common contrasting agent used in MRI imaging, but like any drug, proper dosing depends upon patients’ metabolic rates, and gadolinium can be toxic to the kidneys.  Recently, chemistry professor Thomas Meade and colleagues, at Northwestern University, reported that attaching gadolinium to carbon “nano diamonds” increased the contrast effect some 15 fold.  This means good images can come from smaller amounts of the agent.          MORE

Image Credit:   American Chemical Society and Technology Review

Vitality Group, a wellness branch of South Africa’s largest private insurer Discovery Health (Capetown), has seen positive results from enrolling subscribers in fitness activities that are linked to incentive-based health savings accounts.  The healthier subscribers remain, from positive life-style adjustments, the more they earn, year to year, in the medical insurance coverage.             MORE

Currently, there are about 250 hospitals in the US that do surgery quality assessments based on the American College of Surgeon’s National Surgical Quality Improvement Program. This assessment tool evaluates some 140 different factors from pre-op risks to 30 day post op outcomes, and applies forty different quality measures.  There are nearly 5,000 hospitals in the US; so it might be worth asking if the one where you’ll face the knife is among the 250 that apply analytics to results. Key words: information analytics, American College of Surgeons, surgery, quality improvement. MORE

While this 240 page report on telemedicine largely reflects European thinking (where, arguably, personal health management is more advanced than in the US), it is an extraordinary overview of the technologies (e.g. wearable and portable monitoring, biomedical sensors, micro and nano systems, intelligent algorithms, et al) and concepts of person-centered health management and preventive care.   DOWNLOAD THE REPORT