Healthcare technology saves lives, boosts care

Medical Tribune April 2009 SFI

David Brill

Adopting the latest healthcare information technologies can save lives, reduce complications and cut costs, a new report from 41 US hospitals shows.

It is one of the first studies to provide generalizable, empirical evidence that technology actually improves outcomes, the researchers say.

Inpatient mortality dropped by 15 percent in hospitals with the most highly automated notes and record systems. Complication rates were reduced by 16 percent in those with the highest levels of electronic decision support. [Arch Intern Med 2009;169:108-14]

Lead author Dr. Ruben Amarasingham, assistant professor of medicine at the University of Texas Southwestern Medical Center, said that the study “provides good news and caution” as governments worldwide debate healthcare stimulus packages.

The findings were welcomed in Singapore, where the upgrading of electronic systems across the healthcare clusters continues apace (inset).

Dr. Chong Yoke Sin, group chief information officer at SingHealth, said: “This study is reassuring for the people who invest in information technology for hospitals. There is now evidence to prove that it is indeed useful.”

Although happy with progress so far Chong stressed the importance of performing “meticulous” checks to ensure the integrity of new systems.

“When you use any kind of technology you have got to do it right, otherwise you are propagating the wrong faster and more pervasively. If a human being writes a wrong prescription you have only got that one wrong prescription, whereas if technology is not performing correctly it’s systemic,” she said. “At SingHealth we are always improving with constant feedback from clinical staff on the ground, which enables us to review workflow for better efficiency.”

Amarasingham agrees. “Our results suggest that investment in information technology is a necessary part to improving healthcare. But it’s clearly not sufficient – there needs to be a lot of other action taken.

“It has to be done carefully and thoughtfully over a prolonged period of time with careful outcome measures. If [investment] is not accompanied by a deliberative, strategic approach within hospitals and clinics then you may end up with worse systems, or at least a waste of money,” he said.

Over at the National Healthcare Group Mr. Ho Khai Leng, information technology director, said that new technology “improves care” by giving clinicians quicker and more accurate access to medical information. New systems also “facilitate the seamless transfer of patient information between care providers,” he said.

The digitization of x-rays has been particularly successful – cutting turnaround time from 2 or 3 days down to an hour or less, and saving “significant costs” for NHG and patients alike, he said. Tan Tock Seng Hospital alone saved $16,000 on films and chemicals between January and March 2006, following implementation of the project.

Amarasingham and colleagues reviewed data from 167,233 over-50s who were admitted to urban Texas hospitals between December 1 2005 and May 30 2006. They graded hospitals using the Clinical Information Technology Assessment Tool (CITAT), which measures the level of computerization in four clinical areas.

Average patient costs were reduced by US$538 ($816), US$132 ($200) and US$110 ($167) in hospitals with high scores on decision support, CPOE and test results, respectively. Costs were not significantly different within the notes and records domain.

Amarasingham acknowledged a “generational gap” with technology use, but said that all opinions must be considered when implementing new systems.

“If there are physicians who are reluctant or scared of using it then we need to reach out to them and involve them in the process. They are sometimes our best physicians with enormous experience that they can bring to the table,” he said.

Patient access to online health records helps doctors shake inertia

Medical Tribune November 2008 SFXIV
David Brill

Online personal health records can not only empower patients but also galvanize their physicians into action, a new study suggests.


Type 2 diabetics who used an online system were significantly more likely to have their medications adjusted during clinic visits, the randomized trial in US primary care practices found.

The system, which was directly linked into the electronic medical records used by the physicians, provided users with clinical information and enabled them to create their own diabetes care plan for discussion during consultations.

Patients were also encouraged to ask more questions and take an active role in their disease management.

Dr Richard Grant, who led the study, said that clinical inertia on the part of physicians can often contribute to patients failing to reach their targets.

“The study is very encouraging and underscores the point that the more patients know about what ought to be done, the more likely it is that medical management changes are made. If you empower patients, good things happen,” he said.

Associate Professor Thai Ah Chuan, a senior consultant and endocrinologist at National University Hospital (NUH) said that the system was interesting in principle but would be very difficult to implement in Singapore at present.

“First you’d have to improve the whole electronic medical records system, then you’d have to look into the medico-legal issues, and then there are the questions of motivation, training and money,” she said.

Phone consultations have proved popular for diabetes patients in Singapore, she said, but noted that online healthcare systems would only benefit a small proportion of people.

“My impression of local patients is that they use the internet for pleasure but never for health. To them health is the responsibility of their physician, so having a system like that … it’s providing information and some kind of empowerment but beyond that, whether it will then improve and benefit control is yet to be seen.”

Many hospitals in Singapore do not have fully electronic records and could not therefore adopt such a system yet, Thai added. NUH, for example, is still in the process of upgrading but hopes to be completely paper-free by next year.

Diabetes medication was changed in 53 percent of consultations among the study intervention group compared to 15 percent among controls (P<0.001).>Arch Intern Med 2008 Sep 8;168(16):1776-82]

There were no significant differences, however, in the control of diabetes-specific risk factors after 1 year – an effect that the authors attribute to low enrollment rates. Just 244 patients – 4 percent of the overall diabetes population – took part in the study.

Grant, who is based at Harvard Medical School, said that many diabetics are elderly and may not feel comfortable with using the internet.

He also noted, however, that there is a large population of younger people with computers who are simply reluctant to engage with health information systems. More research is needed to understand the reasons for these barriers, he added.

Remote disease detection in the palm of your hand

Medical Tribune November 2008 SFXII
David Brill

Scientists in Singapore have developed a simple battery-operated device that could be used to detect pathogens in remote medical clinics and war zones.

The palm-sized system, measuring around 10 cm in diameter, can detect a wide range of proteins and other molecules and does not need to be connected to a computer to function.

The researchers hope to make the device commercially available in the near future, estimating that it would cost around S$500 per unit once mass production was underway.

Dr. Pavel Neuzil, who led the project, said that the sensor took around 2 years to develop. He suggested that it could be used to detect diseases such as cancer or Alzheimer’s disease, or to identify toxins used in bioterrorism.

“This whole effort, lab-on-a-chip, is meant for simple tools which can be very economical and can go to places where people who don’t have electricity can do very simple things,” he said.

Neuzil and his colleague Dr. Julien Reboud, who are based at Singapore’s Institute of Microelectronics, reported their work last month in the journal Analytical Chemistry. [2008 Aug 1;80(15):6100-3]

The system employs a technique called localized surface plasmon resonance to measure the intensity of light reflected from the surface of the test molecule. Although the guiding principles are not new, the device is greatly simplified compared to its predecessors, Neuzil said.

He added that the ability to operate without a computer was a major advantage of the system, which was initially developed for performing polymerase chain reactions and for use in tackling avian influenza.

“At the beginning somebody told me you should power it from USB because everybody has a computer around. And I told him ‘you are very funny because if you want to talk about avian flu it would be for Indonesia, places where they don’t even have electricity,’” he said.

Quick, accurate HPV test for developing countries

Medical Tribune November 2008 SFXIX
Seah Yee Mey and David Brill

A new rapid screening test for the human papilloma virus (HPV), created specifically for use in developing countries, is 90 percent accurate in detecting precancerous cervical disease, a study has shown.

careHPV is a signal-amplification assay adapted from the hybrid capture test, which is widely regarded as the gold standard in HPV DNA screening. Fourteen high-risk types of carcinogenic HPV can be detected using careHPV in about 2.5 hours.

The test takes up only a small area of clean bench-top space, with no need for mains electricity or running water supply. The short assay time allows for testing and clinical follow-up the same day.

careHPV can be operated by non-technical support staff with just 1 or 2 days of training.

The prototype was tested on 2,530 women aged 30 to 54 years in Shanxi province, eastern China, with complete data available for 2,388 women. careHPV correctly indentified precancerous cells in 90 percent of cervical specimens, while 84.2 percent of those without precancerous disease were identified as negative.

The recent publication of the findings online in The Lancet Oncology represents the culmination of a 5-year collaboration between the Program for Appropriate Technology in Health (PATH), a US-based nonprofit organization, and QIAGEN, who manufacture the test.

PATH, who receive funding for the project from the Bill and Melinda Gates Foundation, will now oversee a further 5 years of operational research in public health clinics in India, Uganda and Nicaragua.

The test still needs to be commercialized and undergo registration studies before it will be widely available, said Professor John Sellors, corresponding author of the study.

It is hoped that the 3 test countries will serve as examples for their respective regions, he added, noting that the generation of operational data will enable PATH to work alongside policy makers in other countries and help them to implement their own projects in future.

“From these results in China, careHPV looks very promising as a test that will allow the rapid and highly accurate screening of women in developing regions for cervical cancer,” said Sellors, a professor of family medicine at McMaster University in Canada.

“If women 30 years and older could be screened at least once in their lifetimes with such a test, and appropriate treatment administered at the same visit, public health programmes would be affordable and deaths from cervical cancer would be reduced by a third.”

The cost of careHPV is yet to be confirmed and will be negotiated on an individual basis with each government or organization.

careHPV was designed by Attila Lorincz, professor of molecular epidemiology at Barts and the London School of Medicine and Dentistry, UK. The prototype study in China was led by Professor You-Lin Qiao of the Cancer Institute, Chinese Academy of Medical Sciences, Beijing.

Cervical cancer is the second most common cancer in women, with some 500,000 new cases and 300,000 deaths worldwide every year. Carcinogenic HPV causes almost 100 percent of the cancers.

Nanotubes can be used to ‘cook’ tumor cells

Medical Tribune August 2008 P3

Cancer cells can be killed using nanotechnology to deliver a highly specific heat source, a study has shown.

Researchers at the University of Texas Southwestern Medical Center, US, coupled single-walled carbon nanotubes to monoclonal antibodies and targeted these to lymphoma cells in vitro. Exposure to near-infrared light caused the nanotubes to emit heat, thereby ablating the tumor cells while leaving other cells unaffected.

Describing the specificity of the technique as “excellent”, the researchers conclude that the next step is to evaluate the use of these nanotube-antibody constructs in vitro.

[Proc Natl Acad Sci U S A 2008 Jun 24;105(25):8697-702]