A Nursing Home Gets Wired

The next few weeks are going to be filled with WIRED fun. I started off the month of March with Sigma Care, the new electronic medical record, (EMR), for one of my nursing homes. Digitizing the nursing home has been a long-term project. I have used spreadsheets and relational data base programs to organize my nursing home lists and to print forms to use for charting. Finally, I have a non-hospital EMR to play with.

For the first time at this nursing home, I can print a list of my patients sorted by nursing unit. I can also see my patient's medication list without looking through the medication administration record, (MAR). Writing orders and labs on the computer is a bit hard to do this first week, because I'm not used to it, but being able to see all my orders on a screen without having to read bad handwriting in the MAR has been worth it.

This evening I had to verify orders for one of my partner's patients who was readmitted. I brought up the list on my Mac and was able to find two medications that were missing from the hospital discharge medication list. The nurse was having trouble pronouncing the names of some of the drugs, (a common occurrence). This was not a problem as I could figure out what she was saying because I had the list in front of me.

I also was able to see the list on my iPhone by using the Opera browser. I heard that you can see the lists on Android devices as well. I will be trying out this EMR on several devices including the iPad and the Xoom during the next few weeks and will have more to say on hand-held devices soon.

This week I will be trained on Dragon speech recognition software by my hospital so I should have some interesting news to report next time.

Ingenious Medical Imaging 2-Patient generated images

Sometimes patients will send you pictures of themselves for diagnosis.

A patient called me early this Sunday complaining of redness and swelling at the site of a tetanus shot from several days earlier. I thought it might be a common immunologic reaction to the vaccine. I told him to come to the office on Monday so I could take a look at the arm. He told me he was skiing near Lake Tahoe. He was worried and so he offered to email me a picture in hopes I might make a diagnosis.

The initial results were quite disappointing.

The later that day I called him back and asked him to send another image. The second image was much clearer and it was obvious this was a bruise related to bleeding under the skin at the injection site. The bruise was starting to spread out under the skin which made it appear larger which alarmed the patient. Actually the bruise was fading and flattening out and once reassured my patient returned to the slopes.

What did I tell my patient to get the image to clear up?

First you need to know what kind of camera your patient is using. In this case it was an iPhone3GS. I have an iPhone 3G and so I know that it has a low resolution camera without flash. Also the first image is out of focus and underexposed. It could be out of focus because the camera was too close and couldn't focus or the shutter speed was too slow because the image was taken indoors with out a flash.

I asked the patient to hold the camera further away from his body to allow the camera to focus properly and also to give the image some scale. I also asked him to stand next to a window to allow natural light to be used which rendered the colors more accurately and allowed the camera to use a higher shutter speed to avoid blur.

A camera phone can be used as a diagnostic tool. Remember it is just like any other camera and distance to the subject and lighting are very important. Newer phones are outfitted with more sophisticated imaging so likely image quality will improve. Doctors need to expect more patient generated images in the future.